Public awareness of genetic nondiscrimination laws in four states and perceived importance of life insurance protections.

Genetic testing has grown dramatically in the past decade and is becoming an integral part of health care. Genetic nondiscrimination laws have been passed in many states, and the Genetic Information Nondiscrimination Act (GINA) was passed at the federal level in 2008. These laws generally protect individuals from discrimination by health insurers or employers based on genetic information, including test results. In 2010, Connecticut, Michigan, Ohio, and Oregon added four questions to their Behavioral Risk Factor Surveillance System (BRFSS) survey to assess interest in genetic testing, awareness of genetic nondiscrimination laws, concern about genetic discrimination in determining life insurance eligibility and cost, and perceived importance of genetic nondiscrimination laws that address life insurance. Survey results showed that awareness of genetic nondiscrimination laws was low (less than 20 % of the adult population), while perceived importance of these types of laws was high (over 80 % of respondents rated them as very or somewhat important). Over two-thirds of respondents indicated they were very or somewhat concerned about life insurance companies using genetic test results to determine life insurance coverage and costs. Results indicate a need for more public education to raise awareness of protections provided through current genetic nondiscrimination laws. The high rate of concern about life insurance discrimination indicates an additional need for continued dialogue regarding the extent of legal protections in genetic nondiscrimination laws.

Public awareness and use of direct-to-consumer personal genomic tests from four state population-based surveys, and implications for clinical and public health practice.

PURPOSE: Direct-to-consumer personal genomic tests are widely available, but population-based data are limited on awareness and use of these tests among the general public in the United States. METHODS: We assessed awareness and use of direct-to-consumer personal genomic tests in Connecticut, Michigan, Oregon, and Utah using the 2009 Behavioral Risk Factor Surveillance System and compared the state results to the 2008 national HealthStyles survey results. RESULTS: Awareness was the highest in Oregon (29.1%) and the lowest in Michigan (15.8%). Factors associated with awareness across all states and nationally were higher education, higher income, and increasing age, except among those 75 years or older. Less than 1% of respondents had used the tests, with about one-half to three-quarters of those sharing the results with a health-care provider. CONCLUSIONS: Awareness of direct-to-consumer genetic tests is greater in this study as compared with a related study conducted in 2006, whereas use is similarly low in both studies. The few respondents who reported using the tests often reported sharing their results with their health-care provider, indicating an important opportunity for health-care providers to offer patient education regarding these tests. Public health agencies have important roles in surveillance, education, and policy development on direct-to-consumer genomic tests.

Tracking racial and ethnic disparities of knee replacement rates in Connecticut.

OBJECTIVE: Determine knee replacement rates among white, black, and Hispanic men and women in Connecticut. METHODS: Connecticut population estimates and hospital discharge data were obtained. Race and ethnicity were identified by hospital personnel. Connecticut residents with knee replacement (ICD-9-CM 81.54) in any of 10 procedure fields were included. Rates were age-adjusted to the U.S. 2000 population. RESULTS: 1996-1998 age-adjusted knee replacement rates per 100,000 population aged 25 and older were significantly higher among black women (115.8, 95% confidence interval 103.9-127.7) than white women (84.9, 82.4-87.4), significantly higher among white men (66.4, 63.9-68.9) than black men (44.0, 34.9-53.1), and lowest among Hispanic men (16.9, 10.1-23.7) and women (47.5, 37.8-57.2). CONCLUSION: Inferences about disparities cannot be drawn, although Connecticut data are consistent with no disparity between the knee replacement rate in black women relative to white women. Data about symptomatic knee osteoarthritis are needed. Patient and physician treatment preferences must be considered.