City health commission details health disparities

Caitlin Yoshiko Buysse | 8/17/2010, 8:05 p.m.

In a new report released last week, the Boston Public Health Commission (BPHC) detailed the persistent and vast health disparities among racial and ethnic groups.

“Boston’s Black and Latino residents experience higher levels of chronic disease, mortality, and poorer health outcomes compared to White residents,” declares “The Health of Boston 2010.” “For Boston’s black residents, these health inequities begin early in life and persist throughout an individual’s lifespan.”

 Health disparities start at birth, according to the report. The black infant mortality rate consistently exceeds white rates — reaching 14.6 infant deaths per 1,000 live births, compared to four infant deaths for whites. Rates for low birth weight in black infants also rise far above the rates for white infants.

But low birth weights soon balloon to higher overweight rates. Among black high school students, 35 percent are overweight or obese, while 29 percent of white high schoolers fall in these two categories. In adults, 32 percent of blacks are obese, and 30 percent of Latinos, compared to 17 percent of whites.

These black obesity rates are consistent regardless of income — so blacks with an annual income exceeding $75,000 are obese at similar rates as blacks with an annual income below $25,000. For other ethnic groups in Boston — including Latinos and whites — obesity rates are inversely related to income, so as income increases, obesity rates decrease.

Blacks also lead in obesity-related illnesses, such as diabetes, heart disease and high blood pressure. Nine percent of blacks suffer from diabetes, compared to 4 percent of whites. Heart disease causes 427 black deaths per 100,000 people, compared to 297 white deaths, and 136 black hospitalizations per 1,000 people compared to 85 white hospitalizations.

 Blacks and Latinos also suffer from cancer disproportionately more than whites. Black women have the highest rate of breast cancer mortality, even though in every income group, they also have the highest rate of regular mammogram screenings.

More black and Latino women also reported having a Pap test (used to screen for cervical cancer) within the past year than white women, and more black and Latino men reported having the prostate-specific antigen blood test (to screen for prostate cancer) within the past year than white men.

But despite these precautionary measures, blacks still experienced a significantly higher cancer mortality rate than whites.

 Asthma and H1N1 influenza also afflict blacks and Latinos in greater numbers. Thirteen percent of black adults, and 12 percent of Latino adults suffer from asthma, compared to only 9 percent of white adults. And between April and December 2009, there were 492 new cases of H1N1 per 100,000 people amongst Latinos, and 336 amongst blacks, compared to 133 amongst whites.

“Black residents have a lower life expectancy than Boston residents overall,” the report also claims. Black life expectancy is placed at 73.5 years, compared to 79 years for whites — a five and a half-year difference.

 But blacks demonstrate better health in a few areas — suicide and substance abuse. Although blacks report higher rates of anxiety, worry, and sadness, black suicide attempts and deaths fall significantly below those of whites. Ten percent of blacks seriously considered suicide in the past year, compared to 16 percent of whites, and there are about four black suicides per 100,000 people compared to about seven white suicides.

White teens and adults also report higher rates of binge drinking. For teens under 16, whites binge drink at triple the rate of blacks, and for whites ages 16-17, about double the rate of blacks. In adults, 27 percent of white women and 36 percent of white men binge drink, compared to 12 percent of black women and 26 percent of black men.

 Whites are also hospitalized, admitted into treatment, and die from substance abuse more frequently than blacks.

Although Massachusetts has been the only state to adopt a system of near-universal health coverage, the health disparities reported by the Boston Public Health Commission parallel the racial inequities found in other U.S. cities. Ninety-seven percent of Boston adult residents have health insurance coverage — a percentage that varies little with income — but coverage alone has not ameliorated the city’s stark inequalities.

 Though the BPHC concedes that “these health inequities are driven by the interaction of several factors including racism, poverty, and residential segregation,” their report offers few solutions to this persistent problem.

 The full report can be downloaded at www.bphc.org.