The Health Disparities Fellowship Program was developed to increase the number of biomedical researchers dedicated to reducing and eliminating health disparities in the United States. Reflecting the objective of this fellowship program, Dr. Ramos has worked with her mentor, Dr. Kenneth Olden, to address two of the ten high priority objectives set forth by the U.S. Department of Health and Human Services to reduce and/or eliminate health disparities. These two high priority objectives are obesity and access to heath care.[unreadable] [unreadable] The project addressing obesity involved the analysis of nationally representative data from the Centers for Disease Control and Prevention. The population of interest was the US female population of childbearing age, 19-44 years of age. The hypothesis of the study was whether the prevalence of metabolic syndrome had increased and what was contribution for the risk of metabolic syndrome due to race/ethnicity and maternal disease history. Metabolic syndrome is a clustering of risk factors for cardiovascular disease (i.e. obesity, impaired glucose metabolism, hypertension, dyslipidemia). The data for this study was obtained from the National Health and Nutrition Examination Surveys conducted from 1988-2004. Over a 20-year period, the prevalnce of mtebaolic syndrome among females of childbearing age has increased from 15% to 28%. Furthermore, among Hispanic and African-American females in this age group, the prevalence is signficantly higher. Among the clinical correlates of disease, hypertension was more prevalent among Black females and dyslipidemia was more prevalent amogn Hispanics. This suggests that the etiology of cardiovascular disease among women is different between these 2 ethnicities. These findings from this study were published in the June 2008 issue the American Journal of Public Health. [unreadable] [unreadable] [unreadable] The second section of the health disparities project investigated of the relationship between disparities in mortality and mortality among the 50 states in the US and the health care delivery system. Our outcomes of interest were as follows: infant mortality rate, low infant birth weight, life expectancy at birth, rates of mortality that is ammendable to health care, cardiovascular death rates, cancer death rates, years of potential life lost, and preventable hospitalization rates. With respect to the health care delivery systemn, we examined the contribution of each of the following characteristics of health care delivery infrastructure within each state to the aforementioned outsomes of interest: percent of population without health insurance, percent of counties designated as medicaly underserved, primary care physician: population ratio, number of community health centers, state public health budgets per capita, CDC-funded bitrth surveillance program, percent of population reporting they have a regular doctor, and percent of population reporting not being able to see a doctor due to cost. Regression analysis was performed assessing the realtionship between each of the health outcomes and each of characteristics of of the health care delivery infrastructure. Initial analysis found that percent of population without health insurance, percent of counties designated as medicaly underserved, and percent of population reporting not being able to see a doctor due to cost were consistent predictors of each of the selected health outcomes. Additionally, cardiovascular death rates were significantly influenced by primary care physician: population ratio, number of community health centers, state public health budgets per capita and cancer death rates were significantly influenced by the percent of population reporting that they have a regular doctor. The unique aspect of this project is that the data analysis is between the 50 US states. The data sources for this project are from the US Census Bureau and from various agencies within the US Department of Health and Human Services. The findings from this study are being prepared as a manuscript to be submitted for peer-review by December 2008.
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