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Study reveals health disparities among older South Carolinians

The following is a summary and recommendations of a recent study that is part of the supporting information being used by AARP SC to advocate for an amendment to SC House Bill 3707, which is in the senate, and would direct that DHEC focus on vulnerable populations in its distribution of the vaccine to the counties under the phase system.

Summary

South Carolina non-Hispanic Blacks aged 50 years and older suffer several socioeconomic and health disparities compared to their non-Hispanic White counterparts.

Non-Hispanic Blacks are more likely than non-Hispanic Whites to have an income of $25,000 or below (49.6% vs 23.7%) and to have less than a high school education (23.3% vs 10.8%). They have higher rates of hypertension (70.7% vs 54.6%) and diabetes (29.2% vs 20.1%%) and are twice as likely to die from diabetes.

Heart disease deaths per 100,000 were 200 for non-Hispanic Blacks compared to 157.9 for non-Hispanic Whites. They are also 61% more likely to die from stroke than non-Hispanic Whites.

Cancer deaths per 100,000 were 170.2 for non-Hispanic Blacks compared with 155.1 for non-Hispanic Whites. Non-Hispanic Blacks have a 21% higher chance of getting colorectal cancer and a 50% higher chance of dying from it compared to non-Hispanic Whites. Non-Hispanic Black men are 1.9 times more likely to get prostate cancer and 2.7 times more likely to die from it compared to non-Hispanic White men.

Non-Hispanic Blacks are 64% more likely to have Alzheimer’s Disease and Related Dementias (ADRD) than non-Hispanic Whites. Obesity rates are also higher among non-Hispanic Blacks at 42% compared to 32% of non-Hispanic Whites. Non-Hispanic Black females over age 50 years have an especially high rate of obesity at 53.4%.

Non-Hispanic Blacks were less likely to report they had healthcare coverage than non-Hispanic Whites (90% vs 94%) and less likely to report they had a personal doctor or healthcare provider (89% vs 92%). Non-Hispanic Blacks were more likely to report they had received a checkup from a doctor in the past 12 months (93.8%) compared to 89.2% of non-Hispanic Whites; however, 8.8% of non-Hispanic Whites and 14.0% of non-Hispanic Blacks responded there was a time in the past 12 months they needed to see a doctor but could not because of cost.

Lack of dental care is a special concern as only 48.8% of non-Hispanic Blacks reported visiting a dentist in the past 12 months compared to 66.0% of non-Hispanic Whites. Non-Hispanic Blacks aged 56-74 years are more likely to have lost all their natural teeth (24.5%) compared with 19% of non-Hispanic Whites.

COVID-19 has been a tremendous burden for non-Hispanic Blacks as they suffer a greater case rate of almost 400 per 100,000 more than non-Hispanic Whites. The state’s mortality rate due to COVID-19 is 11.2 per 100,000 for non-Hispanic Whites, but 26 per 100,000 for non-Hispanic Blacks.

Recommendations

Greater public health and healthcare efforts are needed to reduce the high rate of hypertension among non-Hispanic Blacks as it increases risk of heart disease, stroke, ADRD, and COVID-19.

Diabetes is also of great concern, especially when it is a co-morbidity with hypertension and obesity; non-Hispanic Blacks suffering from this combination of chronic conditions should be prioritized to receive targeted, coordinated and culturally appropriate healthcare and education.

More efforts are also needed to increase use of dental care by non-Hispanic Blacks as poor oral health and tooth loss are important risk factors for various conditions including heart disease and ADRD.

Non-Hispanic Blacks need concentrated outreach efforts to increase rates of colorectal cancer screening and men need targeted efforts to increase prostate-specific antigen (PSA) screening.

Since non-Hispanic Blacks have higher rates of COVID-19 than non-Hispanic Whites, coordinated public health and healthcare efforts should focus on assuring they receive vaccination as soon as possible.

Socioecological conditions such as poor housing/homelessness, unsafe neighborhoods, and lack of transportation contribute to health disparities of older non-Hispanic Blacks, thus require creative, coordinated solutions through multi-agency collaboration.

Cheryl J. Dye, PhD is a professor of Public Health Sciences and the Director of the CU Institute for Engaged Aging at Clemson University. Kelsey Vinson is a graduate research assistant at Clemson University.

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