Tell me about income and wealth disparity in America

I went to a panel tonight on Reimagining Public Health in NYC - A Discussion on the Racial and Wealth Gap and Health Equity

Me:

Can you write an essay about the connection between redlining, income and wealth gap, and health outcomes in the Black community? Highlight the disparity in maternal mortality race based upon race

ChatGPT:

The connection between redlining, income and wealth gap, and health outcomes in the Black community is multifaceted and complex. Redlining, a discriminatory practice that involves denying financial services or access to housing based on race, has had a significant impact on the economic wellbeing of Black families. This, in turn, has contributed to the widening income and wealth gap between Black and white households, which has led to disparities in health outcomes.

Redlining began in the 1930s and was a federal government policy that allowed banks and other financial institutions to deny loans and insurance to people living in certain neighborhoods. These neighborhoods were typically populated by Black families and other minorities, and the practice was based on the assumption that these communities were risky investments. As a result, these neighborhoods were deprived of essential resources such as quality education, healthcare, and healthy food options.

The legacy of redlining has contributed to the income and wealth gap between Black and white households. According to a study by the Brookings Institution, the median wealth of white households is ten times that of Black households. This disparity is largely due to historical and ongoing discrimination that has limited Black families' access to education, employment, and housing opportunities.

The income and wealth gap has had a profound impact on the health outcomes of the Black community. Black Americans have higher rates of chronic diseases such as diabetes, hypertension, and heart disease, which are often linked to poverty and limited access to healthcare. They are also more likely to die from these diseases than white Americans.

One area where the impact of these disparities is particularly stark is maternal mortality. According to the Centers for Disease Control and Prevention, Black women are three to four times more likely to die from pregnancy-related complications than white women. This disparity cannot be explained by differences in income or education level, as it persists across all socioeconomic levels.

There are several reasons for this disparity, including the fact that Black women are more likely to experience complications during pregnancy, such as hypertension and pre-eclampsia. They are also more likely to receive substandard care during pregnancy and childbirth, including being ignored or dismissed when they report symptoms of distress. Studies have shown that implicit bias and stereotypes about Black women's pain and abilities to cope with childbirth are also factors.

To address these disparities, it is essential to address the root causes of redlining, income and wealth gap, and implicit bias in healthcare. Policies and initiatives that promote equitable access to education, employment, and affordable housing are essential. Additionally, healthcare providers must receive training to recognize and address implicit biases that may affect their care of Black patients. Finally, Black women must be empowered to advocate for their health and hold healthcare providers accountable for providing high-quality care.

In conclusion, the connection between redlining, income and wealth gap, and health outcomes in the Black community is a complex and multi-layered issue. The legacy of redlining has contributed to the income and wealth gap between Black and white households, which, in turn, has led to disparities in health outcomes, including maternal mortality. Addressing these disparities will require a comprehensive approach that involves addressing the root causes of redlining, income and wealth gap, and implicit bias in healthcare.

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New Kidney Function Equation Works Independent of Sex and Race

MedicalResearch.com Interview with:

Prof. dr. Pottel Prof. dr. Hans Pottel KU Leuven Kulak Department of Public Health and Primary Care Belgium MedicalResearch.com: What is the background for this study? Response:  The glomerular filtration rate (GFR) is used to diagnose patients with chronic kidney disease and is also used to adjust the dose of drugs that are eliminated by the kidneys. An accurate estimation of GFR is considered of importance in the management of kidney health in patients. In 2021 we published a new serum creatinine based equation, called the European Kidney Function Consortium (EKFC) equation (Pottel H. et al, Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data. Ann Intern Med (2021) 174: 183-191): EKFC-eGFR = 107.3 / a x With a = 0.322 if Biomarker/Q is less than 1, and a = 1.132 if Biomarker/Q is 1 or more. The equation can easily be interpreted: the leading coefficient equals the glomerular filtration rate (GFR) of 107.3 mL/min/1.73m², which is the average GFR in healthy children (aged > 2 years), adolescents and young adults. The average healthy GFR remains constant until the age of 40 years, and starts decreasing beyond that age. The GFR is inversely related to the ‘rescaled’ biomarker. The rescaling factor (Q) is the average biomarker value for healthy people of a specific population (e.g. children, adult men, adult women, white people, black people, …). Biomarker/Q equals ‘1’ for the average healthy person, corresponding with eGFR = 107.3 mL/min/1.73m² (up to 40 years of age). It should be noted that for serum creatinine, the Q-value depends on sex and race. Our hypothesis was that the above equation is valid for any renal biomarker, on the condition that the biomarker is appropriately scaled. We showed that the same equation was able to estimate GFR from 2 years to oldest ages. In the current study we tested and validated our hypothesis by applying the above formula for appropriately ‘rescaled’ cystatin C. MedicalResearch.com: What are the main findings? Is there a practical advantage to the Cystatin-C based equation over eGFR, especially since the sex and race of patients are known?  Response: The main finding is that the above equation indeed works very well for appropriately rescaled cystatin C, with a scaling factor Q independent of sex and race. Our cystatin C based EKFC-equation can thus be used in Black and White patients, men and women, and potentially in patients of mixed ethnicity, in transgender patients, etc. Moreover, the equation can easily be extended to children by defining the scaling factor Q (which will be done soon in future research). This will make the equation applicable for all ages, avoiding implausible jumps at the transition between pediatric nephrology care and adult nephrology care. MedicalResearch.com: Does this equation have a cost advantage/disadvantage? Response: Currently the cost for cystatin C is about 10 times the cost for serum creatinine. In many countries the cost for cystatin C is not reimbursed by the social security agency. We are convinced that the current study might be a game changer. MedicalResearch.com: Is there anything else you would like to add? Any disclosures? Response: There is a variety in the quality of assays used to measure creatinine and cystatin C. One important requirement of our study was that serum creatinine was obtained with assays that were calibrated directly to the gold standard Isotope Dilution Mass Spectrometry method. For cystatin C all assays were calibrated against the international certified IFCC standard. Therefore, the current equation is only valid for high quality measurements of the biomarkers. One other important remark is that we included data from Black people in Europe and Africa, but we did not have high quality measurements of the biomarkers for African Americans. Therefore, the performance of our new cystatin C based equation should still be demonstrated in African Americans. Citation: Cystatin C–Based Equation to Estimate GFR without the Inclusion of Race and Sex Hans Pottel, Ph.D., Jonas Björk, Ph.D., Andrew D. Rule, M.D., Natalie Ebert, M.D., M.P.H., Björn O. Eriksen, M.D., Ph.D., Laurence Dubourg, M.D., Ph.D., Emmanuelle Vidal-Petiot, M.D., Ph.D., Anders Grubb, M.D., Ph.D., Magnus Hansson, M.D., Ph.D., Edmund J. Lamb, Ph.D., Karin Littmann, M.D., Ph.D., Christophe Mariat, M.D., Ph.D., et al. N Engl J Med 2023; 388:333-343 DOI: 10.1056/NEJMoa2203769 January 26 2023 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Read the full article

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Disparities Persist Between Kidney Transplantation and Dialysis Facility Ownership

MedicalResearch.com Interview with: Dr. Patzer Rachel Patzer, PhD, MPH Associate Professor Director, Health Services Research Center Department of Medicine Department of Surgery Emory University School of Medicine   MedicalResearch.com: What is the background for this study? Response: We know that historically, for-profit dialysis facilities have been shown to have lower rates of kidney transplantation than patients who receive treatment in non-profit dialysis facilities. However, these studies are outdated, and did not examine access to living donor transplantation or include the entirety of the end-stage kidney disease population  MedicalResearch.com: What are the main findings? Response: .  The main findings of our study are that over the 17-year study period, there was a consistent disparity by dialysis facility ownership with respect to access to the national waiting list, as well as deceased and living donor transplantation. MedicalResearch.com: What should readers take away from your report? Response: Despite studies that called attention to this issue several decades ago, it does not appear as though there has been any improvements in access to kidney transplantation among patients who receive dialysis in for-profit dialysis facilities.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: We cannot say for certain whether the disparities we see are due to leadership or provider practices within the for-profit dialysis facilities and whether these facilities are educating or referring fewer patients for transplant, because these data are not available in national surveillance data.  Our research team is working to collect better day on these endpoints to study earlier steps in the transplant process.  MedicalResearch.com: Is there anything else you would like to add?  Response: It is important for patients with late-stage chronic kidney disease or those who are starting on dialysis to have conversations about kidney transplant as a treatment option with their clinical providers, such as their nephrologist or social worker. The providers in dialysis facilities – regardless of profit status – are required by law to educate patients about transplant as a treatment option. Ideally this should include a thorough discussion with a chance for patients to ask questions about the risks and benefits of treatment options, and the steps necessary to get a kidney transplant. If this does not occur, patients should advocate for themselves and ask questions about their potential candidacy for transplant.    Citation: Gander JC, Zhang X, Ross K, et al. Association Between Dialysis Facility Ownership and Access to Kidney Transplantation. JAMA. 2019;322(10):957–973. doi:10.1001/jama.2019.12803 Last Modified:   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

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Latinos, But Not African Americans, Report Less Discrimination in California Health Care

MedicalResearch.com Interview with: Dr. Schulson Lucy Schulson, MD MPH Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in healthcare. Since those studies were published, California has made concerted efforts at the state and local level to address health equity; these efforts may have impacted perceptions of discrimination in health care. However, it is not known how perceptions of discrimination in healthcare have changed over the last ten years overall and for specific groups. This study sought to compare perceptions of discrimination in health care in 2003-2005 compared to 2015-2017 overall, for racial and ethnic minorities, among immigrants, and among those with Limited English Proficiency (LEP).  MedicalResearch.com: What should readers take away from your report? Response: Perceptions of discrimination in healthcare have decreased by about 50% overall when comparing more contemporary rates to 2003-2005 rates. However, this decrease was only significant among self-identified Latinos, immigrants, and those with LEP. Notably, African-Americans continue to perceive high rates of discrimination in healthcare-- about 1 in 10 (10%) reported recent discrimination in healthcare. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future studies need to examine why Latinos and immigrants have experienced a decrease in perceived discrimination in health care in California while African Americans have not. Additionally, it important to see if these trends continue into the future, particularly if the broader political context changes.   Finally, as health care discrimination is associated with poor health outcomes it is critical to continue to create interventions to address discrimination in health care.  Our findings differ from those of another study with a national patient sample that found that African American were reporting less discrimination, while Latinos were not.1   Our findings may be specific to California, which has undertaken specific steps to improve care for immigrants and for patients with limited English proficiency. We need more research to understand what has worked in California -- -and what still needs to be done. No disclosures. Nguyen TT, Vable AM, Glymour MM, Nuru-Jeter A. Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions. J Gen Intern Med. 2018;33(3):291-297. doi:10.1007/s11606-017-4209-5 Citation: Schulson LB, Paasche-Orlow MK, Xuan Z, Fernandez A. Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017. JAMA Netw Open. Published online July 03, 20192(7):e196665. doi:10.1001/jamanetworkopen.2019.6665 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2737102    The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Chronic Pain in Cancer Patients Varies by Income and Insurance Status

MedicalResearch.com Interview with: Dr. Jiang Changchuan (Charles) Jiang MD, MPH MSSLW Internal Medicine Residency Program Class of 2020 Ichan School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Chronic pain is one of the common side effects of cancer treatments and it has been linked to low life quality, lower adherence to treatment, higher medical cost. As the population of cancer survivors grows rapidly, chronic pain will be a major public health issue in this population. We know from previous studies that chronic pain is common in certain cancers such as breast cancer. However, little was known about the epidemiology of chronic pain in the cancer survivors until our study. MedicalResearch.com: What are the main findings? Response: My colleagues and I used the national representative survey "National Health Interview Survey" to identified 4526 adult cancer survivors from 59770 participants in 2016 and 2017. 1 in 3 cancer survivors (34.6%) were found to have chronic pain, representing 5.39 million patients in the United States. The prevalence of chronic pains varied significantly based on patients insurance status and income level. Nearly 1 in 2 cancer survivors had chronic pain when their household income is under the federal poverty level.   MedicalResearch.com: What should readers take away from your report? 1) 1 in 3 cancer survivors suffered from chronic pain, representing 5.39 million patients in the United States. 2) 1 in 6 cancer survivors were limited by chronic pain in life and work activities, representing 2.51 million patients. 3) the prevalence of chronic pain varied remarkably by income level and insurance status. there are significant unmet needs in the cancer survivors' pain management. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Further research is needed to reveal the reason for insurance disparity in chronic pain management. It would also be interesting to explore why chronic pain was more prevalence in certain cancers. These would all contribute to the large unmet needs of pain management in cancer survivors.   Citation: Jiang C, Wang H, Wang Q, Luo Y, Sidlow R, Han X. Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States. JAMA Oncol. Published online June 20, 2019. doi:10.1001/jamaoncol.2019.1439   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article