Dear Community:

A recent study of 13 million clinical notes revealed a disturbing reality: Black patients are more likely than white patients to have their sincerity or competence questioned in their medical records. Language implying doubt – such as “claims,” “insists,” or “noncompliant” – appeared more often in notes for Black patients, signaling a deep credibility bias. While these terms occurred in less than 1% of notes, experts warn this is likely the tip of an iceberg, reflecting systemic inequities in care.

This bias is not only unacceptable, it’s dangerous. It erodes trust, compromises health outcomes and perpetuates disparities that harm Black communities. At a time when diversity, equity and inclusion efforts, research and funding are under attack nationwide, these findings underscore why our mission at Closing the Health Gap matters more than ever. We must confront bias in all forms and demand equitable care for every patient, everywhere.

Together, we can close the gap. Together, We Must Save Us. Blessings to all of you for a safe and healthy week ahead!

Renee Mahaffey Harris

President & CEO

Closing the Black maternal-health gap: Healthier lives, stronger economies

Conventional wisdom holds that women live longer and healthier lives than men—but that’s only partly true. Globally, women may outlive men, but they spend 25 percent more of their lives in poor health. For Black women in the United States, the picture is even more troubling. Maternal-mortality rates are two to four times higher for Black women than for White, Hispanic, or Asian women, reaching 50 deaths per 100,000 live births in 2023. If current trends continue, that rate could nearly double to 94 deaths per 100,000 live births by 2040, placing the United States on par with many low-income countries.

Mortality is only part of the story. Black American women are disproportionately affected by a range of potentially debilitating maternal-health conditions, including preeclampsia, gestational diabetes, and postpartum depression. An analysis by the McKinsey Institute for Economic Mobility (IEM) and McKinsey Health Institute (MHI) finds that these conditions not only pose immediate health risks but also have long-term consequences. In 2025 alone, these conditions could result in the loss of 350,000 healthy life years for Black women giving birth—meaning that disability and chronic illness connected to maternal health may shape a substantial portion of their lives.

4th Annual Women’s Cardiovascular Symposium – Registration is N​ow Open!

With cardiovascular disease remaining the leading cause of death for women in the United States, morbidity and mortality rates continue to rise despite medical advances and public health awareness campaigns. Persistent knowledge gaps in sex-specific risk factors and differences in clinical presentation often lead to delayed care. Even when women seek medical attention, they are frequently misdiagnosed or undertreated.

To address these alarming disparities, The Women’s Heart Center at The Christ Hospital established the Women’s Cardiovascular Symposium, offering continuing medical education for physicians and healthcare professionals managing cardiovascular disease (CVD) in women. This symposium on October 3 focuses on advancing sex-specific risk assessments and evidence-based strategies to improve clinical outcomes and bridge the care gap for women with or at risk of CVD. As the only educational program in the Midwest focused on sex- and gender-specific cardiovascular differences, it remains an essential resource for healthcare providers.

REGISTRATION DEADLINE: September 13, 2025

• Physicians: $175
• Physician Assistants, Nurse Practitioners, & Pharmacists: $135
• Nurses, First Responders, Technicians, Retired or other Healthcare Professionals: $100

Community Pharmacies Help to Improve Access to Health Care

A better understanding of socioeconomic and infrastructure factors can help pharmacists reduce health inequalities, according to a study published in Public Library of Science.1

"Access to medications and health services is an important public health priority related to the ongoing national discussion on healthcare disparities across the US," the study authors said. "The increasing number of pharmacy closing nationwide represent a growing obstacle for patients to access medications."

In a review published in Preventive Medicine, community pharmacies play a large role in public health services beyond traditional filling of medication. Pharmacists can now offer primary or secondary disease prevention, including smoking cessation, weight management, alcohol misuse, syringe and needle exchange, inoculation, screening, and chlamydia testing. In the review, the majority of studies reported on health inequalities with targeted interventions, which can help close the gap between the least and most disadvantaged patients.

Race and Ethnicity and Comorbidities Among Medicare Beneficiaries With Young-Onset Dementia

Question: What is the prevalence of young-onset dementia (YOD) and its associations with comorbidities among Medicare beneficiaries aged 45 to 64 years across racial and ethnic groups?

Findings: In this cross-sectional study of 2 189 231 Medicare beneficiaries aged 45 to 64 years, 3.25% had YOD, with the highest prevalence among Black adults. YOD made up a significantly larger proportion of Alzheimer disease and related dementias among Black, Hispanic, and American Indian and Alaska Native adults aged 45 years and older compared with White and Asian populations and was associated with many comorbidities.

Meaning: These findings suggest that improved early detection may help address the needs of Medicare beneficiaries with YOD, especially those from minoritized racial and ethnic groups with multiple comorbidities.

Medical insurance integration and rural-urban benefit disparities, 2006-2021: evidence from quasi-natural experiments in China

Objectives: To assess the impact of China's medical insurance integration policy on urban-rural disparities in medical insurance benefit levels, explore its heterogeneous effects in regions with different economic development levels and provide empirical evidence for promoting health equity.

Design: Retrospective panel data analysis using a quasi-natural experiment. Causal inference was conducted using propensity score matching-staggered difference in differences (PSM-staggered DID) method with time-varying policy variables.

Intervention: Gradual implementation of the policy of integration of medical insurance (2006-2021), with start-up dates varying from province to province.

Results: Overall, the policy had a weak positive impact on the per capita benefits of rural residents. Subgroup analyses showed no immediate effect in provinces with a gross domestic product (GDP) per capita of more than 100 000 yuan, but an increase in benefits for rural residents 1 year after implementation; an immediate increase in rural benefits in provinces with a GDP per capita of 60 000-100 000 yuan; and a reduction in overall and rural benefits at the beginning in provinces with a GDP per capita of <60 000 yuan, followed by a restoration of rural benefits after 2 years. Mechanistically, the policy increased medical insurance coverage rates, but higher coverage was associated with short-term reductions in per capita benefits.

NIH director lays out agency’s research and funding priorities in new strategy statement

The director of the US National Institutes of Health outlined last Friday a “unified strategy” to align the agency’s priorities and funding, a move he said was meant to offer clarification following sweeping changes at the agency, including massive budget cuts, grant cancellations and plans for reorganization.

In last Friday’s statement, Dr. Jay Bhattacharya emphasized the need for transparency with the taxpaying American public and an intent to “honor their trust.” He identified key priorities for the NIH, including chronic disease and nutrition – as per an executive order “on Gold-Standard Science and the Make America Healthy Again Commission Report” – as well as artificial intelligence, alternative testing models and real-world data platforms. He also noted that the agency is dedicated to supporting research that pursues “innovative, and sometimes controversial, questions.”

Bias in the Chart? Black Patients More Likely to Be Doubted by Doctors

Black patients were more likely than white patients to have notes from their clinicians questioning their sincerity or competence, a study found. In a cross-sectional analysis of more than 13 million notes in electronic health records, Black patients had higher odds of having credibility-undermining terms in their documentation compared with white patients (adjusted OR 1.29, 95% CI 1.27-1.32), as well as lower odds of credibility-supporting language (aOR 0.82, 95% CI 0.79-0.85), reported Mary Catherine Beach, MD, MPH, of the Johns Hopkins School of Medicine in Baltimore, and colleagues in PLoS One.

"There are markers that suggest that clinicians really do doubt what Black patients say more so than they do of white patients," Beach told MedPage Today. "And I think that there is a credibility bias that exists that really hasn't been well-described or talked about."

Undermining terms included those implying doubt about symptoms ("claims," "insists"), ability to follow instructions ("poor historian," "noncompliant"), or suspected drug-seeking behavior. Such language appeared in fewer than 1% of all notes (n=106,523; 0.82%), but Beach's team warned that it may represent the "tip of an iceberg," pointing to broader racial disparities in how clinicians assess credibility.

Trends and disparities in health status and health care in the United States during COVID-19 pandemic

Background: Concerns exist over a possible worsening of disparities in health status and health care access across racial/ethnic and income groups during the COVID-19 pandemic. We aimed to characterize trends in racial/ethnic and income differences in self-reported measures of health status and health care access among US adults.

Methods: This serial cross-sectional nationally representative study included adults (age ≥ 18 years) participating in the National Health Interview Survey (NHIS) from 2019 to 2022. Self-reported health status (poor or fair health status, functional limitation, clinician-diagnosed depression or anxiety disorders) and health care access and affordability were collected.

Results: Our analysis included 107,230 adults (mean [SE] age, 48.1 [0.1] years, 51.6% women), of whom 6.1% were Asian, 12.1% were Black, 17.3% were Latino/Hispanic, and 64.5% were White. Black individuals with low income had the highest prevalence of poor or fair health status (30.9% [95% CI, 27.8%–34.3%] in 2019 and 28.4% [95% CI, 25.1% to 32.0%] in 2022), and these racial/ethnic gaps did not change significantly, irrespective of income levels. The prevalence of clinician-diagnosed depression or anxiety disorders increased from 2019 to 2022 for all racial/ethnic groups, especially for Whites (from 32.6% [95% CI, 30.8%–34.4%] to 38.2% [95% CI, 36.4% to 40.1%], P < 0.001). There was no significant change in functional limitations during the pandemic. Latino/Hispanic individuals with low income had the highest estimated prevalence of limited health care access from 2019 to 2022. Health insurance access and affordability significantly improved for White individuals with low income from 2019 to 2022 (P < 0.001), but not for other racial/ethnic groups. Racial/ethnic gaps in health care access and affordability did not change significantly, irrespective of income levels.

Strong Men, Strong Futures: A Night of Film, Food and Fellowship

Join the University of Cincinnati Cancer Center for a film viewing followed by a dinner and panel discussion of the latest prostate cancer prevention and care. There will be two screenings of the event:

• Thursday, September 18, 2025 from 5:30 - 8:30 p.m. at Probasco Auditorium (2839 Clifton Ave., Cincinnati, OH 45220)
• Saturday, September 20, 2025 from 3:30 - 6:30 p.m. at United Community Christian Church (1710 Maryland Ave., Covington, KY 41014)

The Black Walnut is an award-winning, compelling and innovative docudrama designed to increase awareness of the alarming prostate cancer disparity impacting Black men. Featuring nine actual prostate cancer survivors, a urologist and a medical oncologist in dramatic roles, the film explores the myriad of barriers Black men encounter in securing healthcare. Black men are more likely to develop prostate cancer than white men and the film aims to encourage men to prioritize their health.

At this event, participants will have the opportunity to:

• View The Black Walnut film and meet the writer and producer Terrance Afer-Anderson.
• Connect and have a discussion with a panel of local prostate-focused physicians and survivors who will provide suggestions on how to address some of the significant barriers and disparities the Black community faces regarding prostate cancer.
• Receive and have access to educational resources and free PSA screenings via blood draw.

Please Register by clicking HERE.