Common Health Disparities in Women’s Health

Derek van Amerongen, MD, MS: I am Dr Derek van Amerongen, former National Healthline medical director and practicing ob-gyn [obstetrician-gynecologist]. I’m joined by a very distinguished panel today of experts in this field to engage in this discussion. I would ask them to introduce themselves, beginning with Dr Sharon Deans.

Sharon Deans, MD, MPH, MBA: Good morning. My name is Sharon Deans. I am the regional vice president for Clinical Services for the Medicaid line of business for Elevance Health [in the Charlotte metropolitan area, North Carolina].

Roxie Cannon Wells, MD: Hello, I’m Dr Roxie Wells, president of Cape Fear Valley Hoke Hospital in Raeford, North Carolina, and a family physician by profession.

Soyini Hawkins, MD, MPH, FACOG: Hello, I am Dr Soyini Hawkins. I am a minimally invasive gynecological surgeon, founder, and owner of the Fibroid and Pelvic Wellness Center of Georgia, in the suburbs of Atlanta, Georgia.

Derek van Amerongen, MD, MS: Thank you, doctors. Let’s begin with a discussion of the current state of women’s health equity. Dr Wells, what are some of the most-identified disparities we see in women’s health today, and what groups do they impact?

Roxie Cannon Wells, MD: When we think about health disparities, I think it’s important that we define it. And the way that I define it is, preventable circumstances related to an individual’s health, based on who they are; age, sex, race, ethnicity, or what have you. Then when I think about disparities, I tend to view them through 2 lenses. First, how disparities affect mortality, life expectancy, burden of disease, and mental health. I also look at how social determinants of health affect or cause disparities. Things like insurance status, whether an individual is uninsured or underinsured, and then whether there’s a lack of access to care. But when I think about mortality, if I look at it through the lens of mortality and I think about the leading causes of death for women, and this is all ages, races, etc, the top 5 are: No. 1, heart disease; No. 2, cancer; No. 3, stroke; No. 4, chronic lower respiratory disease; and then [No. 5, Alzheimer disease]. And when you think about heart attacks, for women, [more] women typically die than men when they suffer a heart attack. There are several reasons for that, and we all know what they are, or some of them include [an individual’s] inability to recognize the symptoms. The symptoms may be atypical. But when we think about health care disparities for women, those 5 things come to mind. And then we also have to think about things like osteoporosis. We have to think about mental health, just a smorgasbord of things, when you think about disparities with women.

Derek van Amerongen, MD, MS: Excellent points. And understanding that, Dr Deans, how are these disparities different among various racial and ethnic groups in women?

Sharon Deans, MD, MPH, MBA: That’s the thing that we have to consider, that they are different, based on race and socioeconomic status. There’s no one-size-fits-all solution, and we need to look at the data that we have to understand how the populations are behaving, and then make sure that we’re able to answer that call, to provide individualized care across a population. So whether their challenge is social determinants of health, we’ve been talking about it for at least 10 years, and we’re finally now acting on it and being able to do assessments, both from the payer side as well as from the provider side. [It’s] understanding the need to have physicians that look like their patients in the community. The reason for that is that there’s an unspoken story that you don’t need to tell when you come into a doctor that looks like you because they understand what your walk is like, during the course of that. But the idea is that everybody is entitled to live as healthily as they possibly can, and there’s no one-size-fits-all solution for that.

Derek van Amerongen, MD, MS: Certainly, an important first step in addressing these health equity gaps is to understand the current environment, but what are some of the challenges with collecting race, ethnicity, and social determinants of health data? Especially from the payer perspective, Dr Deans?

Sharon Deans, MD, MPH, MBA: Absolutely, it’s extremely inconsistent from state to state. I worked in 3 different states in Medicaid, and [race and ethnicity data] is not collected regularly. We talk about it; how important it is. When they fill out the applications for Medicaid coverage, it’s not a hard stop, so to speak, where they have to fill that part out before they can go to the next. So, we get about 50% of our data as “Other,” or unanswered. And it’s hard to plan around that, because you’re not sure who those individuals are, and you can’t skip them. You have to figure out who they are. I think just starting from the beginning with the process of applying for Medicaid, there should be hard stops in the application, so you can identify folks. Also making leeway, to not box folks into Black, White, or Hispanic. There are other identifications. The same with gender preference and sexual orientation. All of that needs to be included because that’s all a very important part of a person’s identity and a part of what we need to do to respond to their identity.

Derek van Amerongen, MD, MS: Dr Wells, you’re part of a major health care provider organization. How are you addressing this issue?

Roxie Cannon Wells, MD: A couple of things. One, I think you’re absolutely right. It should be a hard stop. Not just for Medicaid or private insurers or what have you, but it should be a hard stop for hospitals and health systems when we’re collecting information. But we handle it somewhat similarly. Our EHR [electric health record] is set up to collect that data. We collect race, ethnicity, and language. And then we use those to really try to delve into why there are disparities, or to even find if there are disparities. For instance, things as simple as CAUTI [catheter-associated urinary tract infections]and CLABSI [central line–associated bloodstream infections], when we look at individuals who have catheter-induced UTIs [urinary tract infections]. Or if we look at individuals who have central line infections, central line placement infections. It gives us an opportunity to determine if there is a gender or racial difference in those infections, and then we delve deeper into why. Also, when we’re looking at grievances or complaints that patients may have, we really want to look and do our homework as to whether we see racial or gender disparities there. Not only that, but we also want to look at things like system improvement reports. [Are] the reports that we get from our staff… based on race or gender, or language or what have you? So we take all of those things into consideration. Even in dealing with codes, when we look at codes and rapid responses, we want to make sure that we’re handling them the same. We want to look if there are deaths that occur, how many? Are they gender-related, are they race-related? We also want to look at rapid responses to make sure that we’re doing everything we can in those instances as well. But we really use our EHR to extract information or data regarding individuals’ race, ethnicity, and language, and then use that information to improve in every aspect.

Transcript edited for clarity.