BSN4002 - Apr 08 2013 to Jun 14 2013 - Section 04
Part I: Community/State Demographics
With a population of almost six million, Maryland is the 19th most-populated state in the United States. In 2010, the median household income of Maryland residents was $70,647; however, 8.6 percent of Maryland residents live in poverty (Maryland Vital Statistics Administration, Division of Health Statistics, 2010). Maryland’s income statistics are well below the national rate of 15.1 percent – yet the state’s poverty rate has increased by 12.5 percent from 2009 to 2010, the subject period of the annual census report. Maryland was named the wealthiest state by the United States Census Department in December 2010, but pockets of suburban wealth conceal rural and urban poverty across the state. Research showed that in the period covered by that same census report, the numbers of Marylanders in poverty increased by almost 80,000. Poverty rates have fluctuated according to past census data but are now just above the 10.7 percent that the state hit in 1994, the earliest available state figures.
The median age for Maryland residents is 38.0 years young. The largest Maryland racial/ethnic groups are White (54.7 percent) followed by Black (29.0 percent) and Hispanic (8.2 percent). In 2010, 645,744 were counted as foreign-born, mainly representing people from Latin America and Asia (about 6 percent are Asian). In addition to these documented ethnic groupings, about 4.0 percent are undocumented (illegal) immigrants. Maryland also has a sizeable Korean-American population. In fact, 1.7 percent of Marylanders are of Korean origin. African-Americans form a sizeable proportion of the state's population – over a quarter in 2008. Although populous in most of the state, large concentrations of the African-American population can be found in Baltimore City, Prince George's County, Charles County, Randallstown, and the southern Eastern Shore. Most of the Eastern Shore and Southern Maryland are populated by Marylanders of British ancestry, with the Eastern Shore traditionally Methodist and the southern counties Catholic.
Maryland is quickly becoming one of the U.S. states where the combined racial and ethnic minority population will exceed the White population. By 2010, the estimate Maryland population will include 40.3 percent minorities, up by 0.7 percentage points from the previous year. Eight of twenty-four jurisdictions across the state have 30 percent or more minorities. Almost 20 percent of the population in the Eastern Shore is of minority origin.
Part II: Health Status
Data compiled by the Office of Minority Health and Health Disparities show that African-American death rates exceed White death rates in all 22 Maryland jurisdictions where the age-adjusted rates could be calculated. Twelve jurisdictions have a larger Black vs. White mortality ratio than Baltimore City, and five other jurisdictions have ratios that are comparable to the city. Ten of the top 15 causes of death show a mortality disparity between Blacks and Whites. Black age-adjusted heart disease mortality exceeds that for Whites by 52.4 deaths per 100,000 population. Blacks are 12.7 times more likely to die from HIV/AIDS than Whites. (U.S. Census Bureau, 2008).
Results from the 2001 through 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey shows that in Maryland: Diagnosed diabetes is at least twice as prevalent for African-American adults as for White adults. For Hispanic adults, the increase over White adults is at least 50 percent. In the middle and older age groups, African-American adults have 30 percent and 17% respectively more diagnosed hypertension than White adults. Because minority groups in the community have less access to health care, more of the diabetes and hypertension burden among minorities goes undiagnosed. So the disparities in the burden of these diseases are probably even greater than the disparities in diagnosed diseases reported above.
End Stage Renal Disease in Maryland
Based on pooled data from 2001 through 2010, the rates of new cases of End-Stage Renal Disease (kidney disease, referred to as ESRD) in Maryland have been about three times higher for African-Americans and Native Americans than for Whites. Since diabetes and hypertension cause about two-thirds of all ESRD cases, the higher levels of ESRD in American Indians in Maryland suggest that they have higher rates of and/or poorer control of diabetes and hypertension than do Whites (Maryland Department of Planning; Population Projections, 2008).
For minorities in the State of Maryland, the higher prevalence of such co-morbid conditions as hypertension, diabetes and cardiovascular disease suggest that both the incidence and prevalence of chronic kidney disease, including end-stage renal disease (ESRD), are likely to be higher within the minority population. Although an increase in ESRD has been observed for all racial groupings, it is disproportionately high among the ethnic minority populations. The reasons for this are varied and numerous, and in the State of Maryland may involve a complex interplay of environmental, socioeconomic, cultural, and possibly genetic factors. It is clear, therefore, that kidney disease in the ethnic minority populations is a cause for specific concern, and that targeted strategies are needed to improve disease management and treatment outcomes in these high-risk groups. According to the National Kidney Foundation (NKF) of Maryland website (2010), chronic kidney disease affects nearly 20 million people in the United States. Minorities are almost two to four times more likely than non-minorities to reach the stage of ESRD that requires dialysis or a kidney transplant. For example, the incidence of kidney failure in the country per million is 783 for African-Americans and 295 for Whites. As was stated earlier in this paper, the main causes of kidney disease are diabetes and high blood pressure, both of which are more common among minorities. Geographical disparities across the U.S. exist because organ allocation occurs in donor service areas and some of these areas either have higher supply and lower demand or vice versa, as in the case of Maryland. Unfortunately, many people on the waiting list die while still waiting for a kidney.
Currently, there are about 2,000 people waiting for a kidney transplant in Maryland, Segev said. Last year, 120 donors provided 228 kidneys (in the case of some donors, only one kidney is transplantable). Typical waiting times for a transplanted kidney in the state can be three to five years or more. The NKF Maryland reported that nationwide, more than 50,000 patients are waiting for kidney transplants, while only about 14,000 will receive transplants this year because of a shortage of suitable organ donors.
Also, conventional thinking has it (according to the NKF data release from 2010), that African-Americans do better on dialysis than Whites. If a patient or their physician believes they will do fine on dialysis, they may then be more reluctant to accept the initial risk of the surgery involved in a transplant.
Taking into account the Maryland population demographics that show a diverse multicultural population, comprising significant percentages of minority groups, it is interesting to note the higher incidences of certain health problems including diabetes and hypertension among the non-White groups, compared with the Whites. Research suggests that is due to a number of reasons including less access to healthcare facilities, but it does lead to a higher incidence of ESRD among those minority groups, exacerbating the nationwide shortage of kidneys for kidney transplants. Clearly that is a situation that needs to be addressed, perhaps by increasing awareness of the need for kidney donors, but also in the longer term for the scientists to develop artificial kidneys.
Maryland Department of Planning. Population Projections. (2008). Retrieved from: http://www.mdp.state.md.us/msdc/dw_Popproj.htm
Maryland Vital Statistics Administration, Division of Health Statistics, Maryland vital statistics annual report 2010. (2010). Maryland Department of Health and Mental Hygiene, Vital Statistics Administration, Division of Health Statistics: Baltimore, MD.
Maryland Vital Statistics Administration, Maryland Vital Statistics Annual Report. (2005). Maryland Department of Health and Mental Hygiene.
National Center for Health Statistics, Health United States, 2005, with chart book on trends in the health of Americans. (2005). U.S. Department of Health and Human Services.
National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 48:S1-S322 (suppl 1). (2010).
United States Census Bureau. Maryland data from 2008 American Community Survey.
U.S. Census Bureau. 2005 American Community Survey. (2011).
U.S. Census Bureau. American Fact Finder Fact Sheet, United States. (2008).
U.S. Census Bureau. Statistical Abstract of the United States. (2008). Retrieved from: http://www.census.gov/popest/estimates.php
U.S. Census Bureau. U.S. interim projections by age, sex, race, and Hispanic origin. (2010). Retrieved from: http://www.census.gov/ipc/www/usinterimproj/