My research seeks to answer the question, why do African Americans live sicker and die younger than all other American ethnic groups. A list of some of my studies are outline below.
EHDIC: Exploring Health Disparities in Integrated Communities
The EHDIC study was funded by grants from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (grant #P60MD000214) and Pfizer, Inc.
Much of the current health disparities literature fails to account for the fact that the nation is largely segregated, with racial groups exposed to different health risks and variable access to health services based on where they live. Here, we sought to determine if racial disparities typically reported in national data are the same among black white Americans living in integrated settings. Focusing on a low-income, racially mixed neighborhood of Southwest Baltimore, we found that nationally-reported disparities in hypertension, diabetes, smoking, obesity among women, and health services utilization either vanished or were greatly reduced. We conclude that policies aimed solely toward health behavior change, biological differences among race groups or increasing access to health care are limited in their ability to close race disparities in health. Such policies must address the differing resources of neighborhoods.
LaVeist TA, Pollack P, Fesahazion RG, Thorpe, RR, Gaskin DJ. "Place Not Race: Disparities Dissipate in Southwest Baltimore When Black and Whites Live Under Similar Conditions" Health Affairs 2011 Oct;30(10):1880-7.
LaVeist, T., Bowen-Reid, T., Jackson, J., Gary, T., Thorpe, R., Gaskin, D., Browne, D. (2008) “Exploring Health Disparities in Integrated Communities: Overview of the EHDIC Study” Journal of Urban Health Jan;85(1):11-21. PMCID2430138
The Economic Burden of Health Inequalities
The Joint Center for Political and Economic Study commissioned Drs. Darrell Gaskin, Patrick Richard and me to conduct analysis to estimate the economic impact of racial disparities on the U.S. economy. We estimated the cost to be $1.24 trillion over 4 years. We have subsequently conducted similar analysis for cancer disparities (commissioned by C-Change) and Alzheimer's disease (commissioned by among African American Network Against Alzheimer's).
Trust is the foundation of the relationships that make civil society possible and the importance of trust within healthcare is no less critical. Patients are inherently vulnerable within medical encounters and must be trustful of the multiple institutional entities and individuals involved in their care. Patients must trust that individual healthcare providers are competent and will have their best interest in mind while making treatment decisions. They must trust that the pharmaceutical companies have developed effective drugs and that the regulatory agencies have adequately monitored them. And, they must trust that the healthcare organization and it’s staff will manage their medical information with discretion and confidentially.
In this study we developed a measure of mistrust of healthcare organizational, "the Medical Mistrust Index." And we published a series of studies examining the association of medical mistrust with various patient outcomes.
To examine race differences in knowledge of the Tuskegee study and the relationship between knowledge of the Tuskegee study and medical system mistrust.
We conducted a telephone survey of 277 African-American and 101 white adults 18-93 years of age in Baltimore, MD. Participants responded to questions regarding mistrust of medical care, including a series of questions regarding the Tuskegee Study of Untreated Syphilis in the Negro Male (Tuskegee study).
Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc2005 Jul;97(7):951-6.
LaVeist TA, Isaac LA, Williams KP Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009 Dec;44(6):2093-105. doi: 10.1111/j.1475-6773.2009.01017.x. Epub 2009 Sep 2.
Cardiac Access Study
The Access Management Research Program (AMR) has been ongoing since 1995. The research program is lead by Dr. Thomas LaVeist, a member of the faculty at the Johns Hopkins School of Pubic Health, who has worked closely with Drs. Plantholt, Morgan and Rubinstein and Ms. Kinder.
The goals of the program are:
The first activity of the AMR was to conduct an ambitious study of racial and gender disparities in use of cardiac catheterization. There are a large number of studies published in the medical literature demonstrating that clinically appropriate African Americans and women are less likely to receive cardiac catheterization compared with white males. The goal of our study was to go beyond demonstrating disparities and attempt to explain them. The features of our study were:
A grant from the National Institutes of Health funded the study. The Agency for Healthcare Research and Quality is currently reviewing a grant proposal requesting additional funding to conduct analysis of the data. However, to date we have several important findings:
• Regardless of which variables are accounted for, African American patients are significantly less likely to be referred for catheterization
• Patients who receive a cardiologist consultation are significantly more likely to be referred for catheterization
• African American patients are less likely to receive a cardiologist consultation compared with white patients
• We did not find significant gender differences in use of cardiac catheterization
• Patients with heart failure are the largest group of patients who were not referred for catheterization
• It is not the case that a small number of physicians are responsible for the race disparity in catheterization referral
• These findings relate to all hospitals in the study
LaVeist TA, Arthur M, Morgan A, Rubinstein M, Kinder J, Kinney LM, Plantholt S. The cardiac access longitudinal study. A study of access to invasive cardiology among African American and white patients. J Am Coll Cardiol. 2003 Apr 2;41(7):1159-66.
LaVeist TA, Arthur M, Morgan A, Plantholt S, Rubinstein M. Explaining racial differences in receipt of coronary angiography: the role of physician referral and physician specialty. Med Care Res Rev. 2003 Dec;60(4):453-67; discussion 496-508.
National African American Mortality Study
Throughout the twentieth century there was been great increase in the longevity of human life. At the dawn of the century, the average life expectancy at birth in the U.S. was 47 years of age. By century’s end average life expectancy in the US had risen to excess of 70 years old. And, it is now commonplace for Americans to surpass 80 years of age. The increases in life expectancy have continued during the first decade of the 21st century. There were 53,364 centenarians reported in the 2010 Census. Increases in life expectancy had been mainly attributed to improvements in sanitary conditions, a reduction in infectious diseases (Riley 2001) and improvements in medical technology (Wright, et al. 1998). However, social and behavioral factors have contributed as well (House 2002).
However, while life expectancy for all Americans increased dramatically, African Americans lag behind Whites for as many years as race specific records have been collected. In spite of well documented findings of excess deaths in African Americans there is a paucity of knowledge regarding the behavioral and social determinants of longevity in African Americans or the existence of race differences in the effects of predictors of longevity that could explain the intractable race disparities in life expectancy. In order to explain disparities we need to identify predictors that differentially relate to longevity or predictors that uniquely predict longevity among African Americans.
we examine the National Survey of Black Americans to assess the relationship between perceived racism, self and system blaming attribution and survival. Perceived exposure to racism and other covariates were measured at baseline (1979) with a mortality follow up 13 years later (1992). We test the hypothesis that an external attributional orientation (which we refer to as system blaming) as opposed to an internal attributional orientation (which we refer to as self blaming) will be protective of health (as measured at 13-year survival) when individuals are exposed to racism. Using Cox proportional hazards regression modeling, we found support for our hypothesis. African Americans with a system-blaming orientation who reported experiencing racism were more likely to survive the 13-year follow-up period, compared to self blamers who did not perceive themselves to have been exposed to racism (OR = .37, CI95: .21, .64). Controlling for other known correlates of survival (age, health status at baseline, sex, marital status, smoking, and income) did not eliminate the significant effect of self-blame orientation among those exposed to racism (OR = .43, CI 95: .23, .82). The findings suggest that the attribution of negative events to external factors, such as systemic societal racism, rather than to individual characteristics, may be adaptive and protective of health status.
Black Canadian Study
Research on health disparities in the United States has consistently reported poorer health outcomes among racial/ethnic minorities relative to whites, particularly among African Americans. In Canada, there are limited studies on racial/ethnic groups, presumably because of concerns about small samples, confidentiality, and an emphasis on socioeconomic inequalities. The body of literature regarding black Canadians, which compose 2.5% of the nation, is beginning to emerge.
The existing literature indicates that the burden of disease may be greater for black Canadians compared with their white counterparts, and that black Canadians face a number of barriers to achieving good health, including poverty, difficulty accessing health care, discrimination, and poor health behaviors.
We obtained nationally representative estimates of health indicators among native-born black Canadians, and compared these estimates with those of native-born white Canadians. We replicated the analyses using a US sample of African Americans and white Americans to compare racial disparities in health in Canada vs. the United States.
Native-born black Canadians generally reported comparable or better health outcomes than their white counterparts in contrast to the findings in the United States, where African Americans fared worse than white Americans on many health indicators.
Are Black Hispanics, Black or Hispanic?
Disparities in health among blacks and Hispanics compared to whites individuals exist for a number of health measures; however, the health profile of individuals who are both black and Hispanic is not well known. We sought to determine whether race and ethnicity have synchronous or independent effects on health-related outcomes.
We combined the National Health Interview Survey for 2000-2007 to identify 896 black Hispanics. We selected health-related outcomes where white Hispanics and non-Hispanic blacks significantly differed. We computed adjusted prevalence estimates for black Hispanics and compared them to determine whether their health-related outcomes more closely resemble white Hispanics or non-Hispanic blacks. All prevalence estimates were adjusted for age, sex, education, marital status, income and survey year.
Black Hispanics' health behaviors resembled white Hispanics or were similar to both white Hispanics and non-Hispanic blacks. For health services outcomes, they resembled non-Hispanic blacks. However, their health status was influenced by both race and ethnicity, with black Hispanics resembling both white Hispanic and non-Hispanic black people.