Health Disparity Studies in South Carolina
Guest: Dr. Leonard Egede – General Internal Medicine / Geriatrics, MUSC
Host: Dr. Linda Austin – College of Medicine / Dean’s Office, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Leonard Egede, who is Associate Professor of Medicine and Director for the Center for Health Disparities Research. Dr. Egede, I understand you just got quite a nice grant for the study of health disparities. I guess we should start with the basics though. When someone says health disparities in the state of South Carolina, what does that really translate to?
Dr. Leonard Egede: Well, I guess, for the state, it translates primarily three core areas. One is race and ethnicity. The second is socioeconomic status. And the third is rural/urban differences. So, when we talk about disparities in the state, of course, there’s a broad definition of disparities. But, really, we’re talking about issues related to differences by race and ethnicity; differences in terms of income and poverty status; and then differences in terms of rural/urban location.
Dr. Linda Austin: So, when you study those differences, obviously, there are certain disadvantages for getting health care when you are rural versus urban, I would imagine; if you are poor versus rich, that’s pretty obvious; potentially, if you are dark-skinned versus light-skinned. But, what are the markers that you study? How do you measure those differences?
Dr. Leonard Egede: I think the rural /urban difference is very straightforward. You have markers of rural residents. You have about three definitions of rural; of living in a rural area. And we use varying definitions depending on the population we’re studying. I think there are three guidelines for that, and they’re straightforward.
In terms of income and poverty, generally, people have used household income. But there’s a lot of criticism about household income, because it doesn’t tell you about poverty in early life. So, there are folks, now, who think you should be looking more at wealth. But, in terms of basic analysis, we tend to look at income, education, and employment.
Dr. Linda Austin: But I’m thinking, when you’re looking at outcomes, specifically, what are the outcomes that you look at? Is it longevity? Is it the kinds of illnesses people get? What are you studying?
Dr. Leonard Egede: Overall, we study general measures. And we also have disease-specific measures. So, for general measures, you look at life expectancy. You look at things like quality of life. You also look at informatology. Those are all general markers that vary by this factor. So, this is a broad marker. People talk about informatology being a marker of the degree of quality of any health care system. When we look at those factors, it gives you a sense of what’s happening and how it impacts the overall population.
Then there are disease-specific areas. For disease-specific areas, for diabetes, for example, we look at glycemic control. We look at blood pressure control. We look at risk of death; these factors. So, that gives you a sense. For cardiovascular disease, we look at very similar measures. For mental health, we also look at very similar measures; the likelihood of having depression and the lost productivity as a result.
Dr. Linda Austin: Can you share some specific examples? For example, if you are rural, you’re life expectancy is likely to be x. Or, if you’re African-American, your risk for stroke is y.
Dr. Leonard Egede: So, if we took diabetes; because diabetes is very prevalent in South Carolina, if you’re African-American, you’re twice as likely to have diabetes compared to Whites. You’re almost one and half times more likely to die from diabetes compared to someone of the same age who is White. And, in terms of having good control of your diabetes, you’re almost one and half times less likely to get good control of your diabetes compared to someone of similar age who is White.
If you look at life expectancy, African-Americans once had the lowest life expectancy across the board. They had about five to seven years less expectancy compared to their White counterparts. African-American women and White women seem to have a very similar life expectancy now, but a few years ago, there were differences based on race. But, overall, if you compare African-Americans to Whites now, African-Americans have about five to seven more years of life expectancy compared to their White counterparts.
Dr. Linda Austin: Wow. That’s dramatic. Tell us, now, about the grant that you received.
Dr. Leonard Egede: Well, this is a VA funded grant; funded by the Veterans Administration. It’s called the Center for Disease Prevention and Health Interventions in Diverse Populations. This is about a 1.4 million dollar grant to develop a core infrastructure to address issues related to health disparities and rural health differences among veterans. It’s a four-year grant. And the goal of the grant is to build the infrastructure and identify investigators who have an interest in this area of research, and then also allow us to get additional funding to eliminate differences by race and gender, and socioeconomic status, as well address urban/rural differences.
So, we’re funded for the first four years on this grant. On a similar grant, our initial focus was on just health disparities. Now; we just got renewed for another four years, we’re expanding our focus to look health disparities and rural health. And, in terms of our funding, we’ve gone from very minimal funding to about 15 million dollars, so we’ve grown dramatically. The grant supports our research and allows us to get additional funding from multiple agencies to address this research area.
Dr. Linda Austin: And, that grant, then, will be conducted over what period of time?
Dr. Leonard Egede: Over a four-year period. As part of our group, we have about 18 core investigators who are part of this process. They come from multiple colleges across campus; different colleges and different research areas. But the focus is primarily on health disparities and rural health.
Dr. Linda Austin: Well, this is a period of time when people have been so concerned about the economy. What is your prediction about what the impact will be, of the poor economic straights we’re in, on disparity?
Dr. Leonard Egede: So then, let me make it worse. I think when people are pushed, when there’s financial difficulty, less money is allocated to health care. And when that happens, it makes it very difficult for the poor, for the underserved, to actually get access to care. So, if you think about any institution, one of the first areas people cut funds is funding for unfunded patients. So, more than likely, those that don’t have access are going to have even less access in this climate.
Dr. Linda Austin: Very disturbing, isn’t it?
Dr. Leonard Egede: Yes. But I think we also have to be realistic. The institution needs to survive. And one of the ways to survive is try to maximize profits and minimize losses. So, an institution like MUSC, where state funding is being cut, it’s very difficult to maintain certain programs without actually losing the ability to provide service.
Dr. Linda Austin: Dr. Egede, I understand you have a second grant. Tell us about that one.
Dr. Leonard Egede: Okay. The second grant is an NIH grant. It’s an R01. It’s called Telephone-Delivered Behavioral Skills Intervention with Type 2 Diabetes. This is a grant from the National Institute of Digestive and Kidney Diseases (NIDDK). It’s a 2.3 million dollar grant, over a four-year period, to develop interventions to improve diabetes control in African-Americans with type 2 diabetes.
Dr. Linda Austin: Very interesting. And, the population for that will be?
Dr. Leonard Egede: All African-Americans with poorly-controlled type 2 diabetes as defined by hemoglobin A1c greater than 9.
Dr. Linda Austin: And, what period of time will that study go?
Dr. Leonard Egede: It’s a four-year study. We just started the study. It’s going to run through 2012.
Dr. Linda Austin: Are you looking for volunteers for that study?
Dr. Leonard Egede: Yes. We’re looking for volunteers for the study. So, if you receive care from MUSC and you have type 2 diabetes, and you’re African-American, just call us. The number to call is: (843) 876-1238.
Dr. Linda Austin: Well, good luck with that study as well and congratulations on this important work.
Dr. Leonard Egede: Thank you
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.