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Historical redlining, persistent mortgage discrimination, and race in breast cancer outcomes
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: In a study of 1,764 women with breast cancer, living in a historically redlined area was associated with increased odds of a diagnosis of estrogen receptor–negative breast cancer in non-Hispanic Black women and increased odds of late-stage diagnosis in non-Hispanic white women. Persistent mortgage discrimination was associated with an increase in breast cancer mortality in non-Hispanic white women, and non-Hispanic Black women were more likely to die of breast cancer no matter where they lived.
Authors: Jasmine M. Miller-Kleinhenz, Ph.D., of Emory University in Atlanta, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.56879)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
Geographic disparities in access to addiction treatment medication may be linked to race, ethnicity
PITTSBURGH, Feb. 20, 2024 — Buprenorphine, a life-saving medication for opioid use disorder, is far less accessible in geographic areas of the United States with racially and ethnically diverse populations than in predominantly white areas, according to a new study of pre-pandemic data led by health policy scientists at the University of Pittsburgh School of Public Health published today in Journal of Addiction Medicine.
The study is among the first to examine buprenorphine access at the local, sub-county level, and the findings point to lack of access to medications for opioid use disorder as a potential contributing reason why overdose deaths are rising most rapidly among Black Americans and Native Americans.
“The degree is rather striking,” said lead author Coleman Drake, Ph.D., assistant professor in the Department of Health Policy and Management at Pitt Public Health. “Access is substantially better in areas that are very white. When you move to areas with even some racial or ethnic diversity, there is a large decline in the geographic availability of buprenorphine prescribers and prescription fills. In areas that are less than 95 % white, for example, there’s a 45 to 50 % drop.”
The team examined the numbers of buprenorphine prescribers and dispensed buprenorphine prescriptions within geographic regions—ZIP codes and surrounding areas within a 30-minute drive—in 2018.
The more ethnically and racially diverse ZIP codes had 45% to 55% fewer buprenorphine prescribers in urban areas and 62% to 79% fewer prescribers in rural areas. Dispensed prescriptions reflected these inequities, as well, with 51% to 76% fewer dispensed in diverse urban areas and 68% to 87% fewer in diverse rural areas.
Unfortunately, said Drake, efforts leading up to 2018 to increase the number of buprenorphine prescribers have not resulted in equitable access to this treatment. Addressing these disparities will require a two-fold strategy: increasing the number of buprenorphine prescribers in diverse communities and, particularly in urban areas, promoting increased prescribing among those already prescribing the treatment, he said. Additional studies are also needed to determine how more recent changes in provider requirements for prescribing buprenorphine, as well as an increase in telehealth flexibilities, have impacted these health disparities.
Other authors on the study were Dylan Nagy, M.S., of Pitt; Mark K. Meiselbach, Ph.D., Brendan Saloner, Ph.D., and Daniel Polsky, Ph.D., of Johns Hopkins University; Jane M. Zhu, M.D., M.P.P., of Oregon Health & Science University, and Bradley D. Stein, M.D., Ph.D., of RAND Corporation.
This research was supported by the National Institute on Drug Abuse of the National Institutes of Health under the award numbers K01DA051761 and R01DA045800. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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About the University of Pittsburgh School of Public Health
Founded in 1948, the University of Pittsburgh School of Public Health is a top-ranked institution of seven academic departments partnering with stakeholders locally and globally to create, implement and disseminate innovative public health research and practice. With hands-on and high-tech instruction, Pitt Public Health trains a diverse community of students to become public health leaders who counter persistent population health problems and inequities.
JOURNAL
Journal of Addiction Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Geographic Disparities in Access to Addiction Treatment Medication May Be Linked to Race, Ethnicity
ARTICLE PUBLICATION DATE
20-Feb-2024
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