People with limited English skills face hurdles to care

Non-English speakers seeking cancer care can face barriers even before they make it to their first appointment, a new study shows.

University of Michigan researchers found that English speakers who called a general hospital line were able to get information on next steps to cancer care 94% of the time. But among people who spoke Spanish or Mandarin — the nation’s 2nd and 3rd most-popular languages — only 38% and 28% of callers, respectively, received information they needed to access care, such as a phone number or transfer to a cancer department.

The non-English callers reported being hung up on by hospital staff or being disconnected because automated messages were not available in their language, according to the Journal of the National Comprehensive Cancer Network study. The simulated calls were made to about 150 hospitals in 12 U.S. states, including California, Texas and New Jersey, which have the nation’s highest proportions of non-English speakers.

More than 25 million people with limited English proficiency live in the U.S., the researchers noted. Under the Affordable Care Act, health programs or facilities that receive federal funding must provide services from a qualified interpreter to patients with limited English proficiency.

Disadvantaged people more likely to live near at-risk levees

At least 17 million people across the U.S. rely on levees to protect them from flooding. But the people living behind the weakest ones tend to lack the resources to maintain them, putting their lives and property at risk, a new study says. 

Published Sept. 5 in Earth’s Future, the research found that communities located behind levees tended to have higher proportions of people of color than areas without levees. Hispanic people were most overrepresented, with a 40% nationwide disparity. In the Midwest, about 61% more Black people lived behind levees than whites. People with low incomes and education levels were also overrepresented in levee-protected areas.

 The researchers also examined data on the quality of the nation’s levees, which are classified from high- to low-risk for failure. Black and Asian residents were disproportionately represented behind the highest at-risk levees, while American Indian people were overrepresented near levees that had not yet been screened or classified by the U.S. Army Corps of Engineers.

Levees, which are built to protect land from flooding, usually consist of low earthen embankments. They differ from dams, which are generally made to hold back water for storage and release. The Army Corps has catalogued almost 25,000 miles of levee systems in its national database, but many levees are estimated to be uncounted.

Most of the nation’s levees were built centuries ago and were not made to withstand today’s environmental conditions, particularly as flooding is worsened by climate change, the researchers noted. Most U.S. levees are at or approaching the end of their useful lives, a 2021 assessment found.

Medicaid users with HIV may miss vital care

More than a quarter of Medicaid users with HIV may not be receiving health services that are critical to their care, a new federal report finds. 

Released Aug. 31 by the Office of Inspector General at the U.S. Department of Health and Human Services, the report showed that 27% of Medicaid users with HIV — about 73,000 people — may have missed one of three services that are crucial for viral suppression in 2021, as reflected in their medical claims. 

About 4% of Medicaid users with HIV — about 11,000 people — may not have received any of the services, which comprise a medical visit, viral load test and antiretroviral therapy prescription. Those people would be at especially high risk of poor health and of transmitting HIV, the report said.

When broken down by service, 23% of Medicaid users with HIV did not have a viral load test listed in their medical claims, 11% were missing an ART prescription and 10% lacked evidence of a medical visit.

People who were covered only by Medicaid were more likely to have missed the three services compared to dual enrollees, who are covered by both Medicaid and Medicare.

Every U.S. state had patients who missed one or more services, but some ranked especially high: 87% of Medicaid-only users with HIV in Utah missed one service, as did 60% of patients in Arkansas and 59% in Arizona. Sixty-one percent of Medicaid-only users in in Washington, D.C., also missed one service.

The researchers said differences in the way claim information is collected may play a role in the findings, as could barriers to patient outreach in some states.

Impact of parental incarceration follows kids into adulthood

Kids who grow up with a parent in jail are more likely to have cardiovascular disease risks when they reach adulthood, new research shows. 

Published Aug. 30 in JAMA Cardiology, the study found that adults who experienced incarceration of a parent during their childhood had higher levels of hypertension and coronary disease biomarkers than adults whose parents were not incarcerated.

University of Chicago researchers looked at data on more 9,600 people ages 33-44 who were part of Add Health, a research project that has followed participants from adolescence into young adulthood. 

Those who’d experienced parental incarceration had 33% higher odds of developing adult-onset hypertension and 60% higher odds of increased inflammation in a marker for coronary disease risks.

While the researchers did not find a correlation for diabetes or high cholesterol risks, they noted that markers for those usually show up in middle age and could still develop.

More than 21% of Black participants reported that they’d had an incarcerated parent or caregiver during childhood, compared to 14% of all participants.

About 1.8 million people are incarcerated in U.S. prisons and jails, with as many as 63% of them parents of children under 18, the study noted. Previous research has linked childhood parental incarceration with anxiety disorder, low education attainment and social isolation in adulthood.

Air pollution poses greater harm to people of color

Air pollution has decreased across the U.S., but people of color are still suffering from its effects more than white Americans.

Despite declines in fine-particle pollution, people from racial and ethnic minority groups have disproportionately higher rates of deaths from associated cardiovascular disease, new research in Nature Human Behavior finds. 

U.S. environmental regulations have helped drive down exposure to fine-particle pollution, also known as PM2.5, in recent decades. The decrease has translated to lower overall rates of cardiovascular deaths related to PM2.5, including heart attacks and strokes.

But those effects have not been felt equally: From 2001-2016, about 202 deaths per 1 million people occurred among white Americans and 279 deaths per 1 million people occurred among Hispanic Americans. But for Black Americans, the rate was significantly higher, with almost 906 PM2.5-related cardiovascular deaths per 1 million people.

The Yale University researchers suggested poorer air quality based on where people live could account for some of the disparities in death rates. PM2.5 sources include wildfire smoke and emissions from vehicles, power plants and industrial operations.