National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 456 Research Studies DisplayedCheng TL, Mistry KB
AHRQ Author: Mistry KB
Clarity on disparity: who, what, when, where, why, and how.
This purpose of this article was to explain a comprehensive framework of health disparities descriptors that can offer a systematic approach to advance the understanding of causes of health disparities and facilitate action steps to ensure health equity.
AHRQ-authored.
Citation: Cheng TL, Mistry KB .
Clarity on disparity: who, what, when, where, why, and how.
Pediatr Clin North Am 2023 Aug; 70(4):639-50. doi: 10.1016/j.pcl.2023.03.003..
Keywords: Disparities, Social Determinants of Health, Newborns/Infants, Mortality, Health Status, Racial and Ethnic Minorities, Access to Care
McGee-Avila JK, Richmond J, Henry KA
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
This study examined geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. The authors used data from the New Jersey State Cancer Registry. They examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. They observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. They found that Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county and were 2.7% less likely to seek out-of-state care.
AHRQ-funded; HS026122.
Citation: McGee-Avila JK, Richmond J, Henry KA .
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
Health Serv Res 2023 Aug; 58(Suppl 2):152-64. doi: 10.1111/1475-6773.14182..
Keywords: Disparities, Urban Health, Rural/Inner-City Residents, Cancer, Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Cervical Cancer
Bonner SN, Powell CA, Stewart JW
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
The purpose of this review was to explore effective interventions to reduce inequities and identify gaps in intervention-based research with a goal of increasing awareness of surgeons, surgical trainees, researchers, and policy makers of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. The researchers reviewed the PubMed database for English-language studies published from January 2012 through June 2022 to evaluate interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of literature was conducted identifying interventions that have been related with reduction in racial and ethnic disparities in surgical care. The study found that attaining surgical equity will necessitate implementing evidence-based interventions to improve quality for racial and ethnic minorities, prioritizing funding for intervention-based research, utilizing implementation science and community based-participatory research methods, and principles of learning health systems.
AHRQ-funded; HS026030.
Citation: Bonner SN, Powell CA, Stewart JW .
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
Ann Surg 2023 Aug 1; 278(2):184-92. doi: 10.1097/sla.0000000000005858..
Keywords: Racial and Ethnic Minorities, Disparities, Surgery
Taylor KK, Neiman PU, Bonner S
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
The objective of this study was to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. Researchers used the National Health Interview Survey for 2008-2018 to identify adults aged 18 and older who reported surgery in the past year. The results indicated that unmet social health needs varied significantly by race, ethnicity, and insurance, and were independently associated with poor health among surgical populations.
AHRQ-funded; HS028672; HS027788.
Citation: Taylor KK, Neiman PU, Bonner S .
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
Ann Surg 2023 Aug 1; 278(2):193-200. doi: 10.1097/sla.0000000000005689.
Keywords: Social Determinants of Health, Surgery, Disparities, Outcomes
Jones PD, Lai JC, Bajaj JS
Actionable solutions to achieve health equity in chronic liver disease.
To achieve health equity in access to treatment for liver diseases, including liver transplantation, the root causes that drive the inequities must be addressed. It is critical to understand the role that social determinants of health play in the disparate health outcomes that are currently observed in the populations most at risk for various forms of liver disease burden as well as access to treatments. The purpose of this paper was to provide a review of current disparities in chronic liver disease and describe actionable strategies that have potential to improve quality, address gaps, and encourage equity in liver care.
AHRQ-funded; HS025412.
Citation: Jones PD, Lai JC, Bajaj JS .
Actionable solutions to achieve health equity in chronic liver disease.
Clin Gastroenterol Hepatol 2023 Jul; 21(8):1992-2000. doi: 10.1016/j.cgh.2023.03.043..
Keywords: Chronic Conditions, Disparities
Olfson M, Zuvekas SH, McClellan C
AHRQ Author: Zuvekas SH, McClellan C
Racial-ethnic disparities in outpatient mental health care in the United States.
Using data from the 2018-19 Medical Expenditure Panel Survey, researchers compared national rates and patterns of use for outpatient mental health care among Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Analyses focused on individuals using psychotropic medications, psychotherapy, or both, and receipt of minimally adequate mental health care. The results showed that the rate of outpatient mental health service use was more than twice as high for White individuals, and that Black and Hispanic patients were significantly less likely to receive psychotropic medications; Black and Hispanic patients were more likely to receive psychotherapy. No significant differences were found in patients who received minimally adequate treatment for depression, anxiety, attention-deficit hyperactivity disorder, or disruptive behavior disorders. The authors concluded that achieving racial-ethnic equity will require dedicated efforts to promote greater mental health service access for Black and Hispanic persons in need.
AHRQ-authored.
Citation: Olfson M, Zuvekas SH, McClellan C .
Racial-ethnic disparities in outpatient mental health care in the United States.
Psychiatr Serv 2023 Jul; 74(7):674-83. doi: 10.1176/appi.ps.20220365..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Disparities, Behavioral Health, Ambulatory Care and Surgery
Weiner SG, Lo YC, Carroll AD
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
The objective of this study was to evaluate the presence of stigmatizing language in clinical notes related to patients with substance use disorders and to detect patient- and provider-level differences. Results showed that the majority of patients with substance-related diagnoses had at least one note containing stigmatizing language. There were also several patient characteristic disparities associated with patients who had stigmatizing language in their notes. The author concluded that more clinician interventions about use of stigmatizing language are needed.
AHRQ-funded; HS026753.
Citation: Weiner SG, Lo YC, Carroll AD .
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
J Addict Med 2023 Jul-Aug; 17(4):424-30. doi: 10.1097/adm.0000000000001145..
Keywords: Disparities, Cultural Competence, Substance Abuse, Behavioral Health, Racial and Ethnic Minorities
Blebu BE, Liu PY, Harrington M
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
The purpose of this mixed methods design study was to integrate the perspectives of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership developed for the purpose of addressing social and structural determinants in pregnancy. The researchers utilized in-depth interviews and social network analysis to incorporate the perspectives of healthcare clinicians and staff with the views of community-based partner organizations to identify implementation factors related to cross-sector partnerships. The study identified 7 implementation variables related to 3 themes: strengths of a network approach to cross-sector collaboration, relationship-centered care, and barriers and facilitators of cross-sector partnerships. The study results highlighted establishing relationships between healthcare staff, patients, and community-based partner organizations.
AHRQ-funded; HS026407.
Citation: Blebu BE, Liu PY, Harrington M .
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
Front Public Health 2023 Jun 16; 11:1106740. doi: 10.3389/fpubh.2023.1106740..
Keywords: Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Maternal Care, Women, Implementation
Jain A, Brooks JR, Alford CC
AHRQ Author: Jain A, Alford CC, Chang CS, Mueller NM, Umscheid CA, Bierman AS
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
This AHRQ-authored study examined the increased use of health care algorithms in health decision tools, and whether including a patient's race or ethnicity among their inputs can lead clinicians and decision-makers to make choices that vary by race and potentially affect inequities. This qualitative survey included 42 organization representatives (e.g., clinical professional societies, universities, government agencies, payers, and health technology organizations) and individuals. The respondents identified 18 algorithms currently in use with the potential for bias. Seven qualitative themes with 31 subthemes were identified including: (1) algorithms are in widespread use and have significant repercussions, (2) bias can result from algorithms whether or not they explicitly include race, (3) clinicians and patients are often unaware of the use of algorithms and potential for bias, (4) race is a social construct used as a proxy for clinical variables, (5) there is a lack of standardization in how race and social determinants of health are collected and defined, (6) bias can be introduced at all stages of algorithm development, and (7) algorithms should be discussed as part of shared decision-making between the patient and clinician.
AHRQ-authored.
Citation: Jain A, Brooks JR, Alford CC .
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
JAMA Health Forum 2023 Jun 2; 4(6):e231197. doi: 10.1001/jamahealthforum.2023.1197..
Keywords: Racial and Ethnic Minorities, Disparities, Healthcare Delivery, Evidence-Based Practice
Johnson CL, Colley A, Pierce L
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
A sudden shift in health condition and the intensification of chronic conditions often necessitate the consideration of emergency general surgery (EGS). While goal-oriented care discussions can enhance goal-concordant care and mitigate feelings of depression and anxiety in patients and caregivers, such conversations, along with standardized documentation, are seldom conducted for EGS patients. The researchers conducted a retrospective cohort study employing data from electronic health records of patients admitted to the EGS service in a high-level academic center to ascertain the frequency of significant advance care planning (ACP) documentation (discussions and legal ACP forms) during EGS hospitalization. Multivariable regression was used to identify patient, clinician, and procedural elements contributing to the absence of ACP. The study found that out of the 681 patients admitted to the EGS service in 2019, only 20.1% had ACP documentation in the electronic health record at any stage during their hospital stay. Two-thirds (65.8%) of the entire cohort underwent surgery during their admission, but none of them had an ACP conversation documented with the surgical team before the operation. Patients with ACP documentation were likely to be insured by Medicare and had a higher incidence of comorbid conditions.
AHRQ-funded; HS024532.
Citation: Johnson CL, Colley A, Pierce L .
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
J Trauma Acute Care Surg 2023 Jun; 94(6):863-69. doi: 10.1097/ta.0000000000003909..
Keywords: Disparities, Surgery, Emergency Department, Chronic Conditions
Griesemer I, Birken SA, Rini C
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
The purpose of this study was to explore the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) program, which altered systems of care at two United States cancer centers and eliminated the Black-White racial disparity in treatment completion in patients with early-stage breast and lung cancer. The study objective was to identify and document critical characteristics of ACCURE to enable translation of the intervention to other care settings. The researchers conducted semi-structured interviews with 18 participants who were involved in the design and implementation of ACCURE. The study found that participants described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key features. Intervention features were designed to improve either institutional transparency or accountability of the care system to community values and patient needs for minimally biased, tailored communication, and support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Birken SA, Rini C .
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
SSM Qual Res Health 2023 Jun; 3:100204. doi: 10.1016/j.ssmqr.2022.100204..
Keywords: Racial and Ethnic Minorities, Disparities, Quality Improvement, Quality of Care
Feyman Y, Avila CJ, Auty S
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
This study examined whether minority veterans experienced higher rates of all-cause mortality than White veterans during the COVID-19 pandemic. The authors used administrative data from the Veterans Health Administration’s Corporate Data Warehouse. Veterans were excluded in the analysis if they were missing county of residence or race-ethnicity data. Overall, veteran mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. Non-Hispanic White veterans experienced the smallest relative increase in mortality (17%), while Native American veterans had the highest increase (40%). Black Veterans (32%) and Hispanic Veterans (26%) had somewhat lower excess mortality, although these changes were significantly higher compared to White veterans. Disparities were smaller compared to the general population.
AHRQ-funded; HS026395.
Citation: Feyman Y, Avila CJ, Auty S .
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
Health Serv Res 2023 Jun; 58(3):642-53. doi: 10.1111/1475-6773.14112..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities, Disparities
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Khor S, Heagerty PJ, Basu A
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
This study examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, the authors identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. The recurrence proxy was found to have excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower among Hispanic patients and 4.3% lower among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6%. Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91). The authors theorize that higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns.
AHRQ-funded; HS013853.
Citation: Khor S, Heagerty PJ, Basu A .
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
JCO Clin Cancer Inform 2023 Jun; 7:e2300004. doi: 10.1200/cci.23.00004..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Disparities
McDaniel CE, Leyenaar JK, Bryan MA
Urban-rural disparities in interfacility transfers for children during COVID-19.
This study’s goal was to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic. The authors conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. They calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling. The O-E ratio of IFT in year 1 for urban children was 14.0% and 14.8% for rural children compared to pre-pandemic. In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7%) compared to 90.7%. For mental-health indications in year 2, rural transfer ratios were higher than urban, 126% compared to 113.7%.
AHRQ-funded; HS028683.
Citation: McDaniel CE, Leyenaar JK, Bryan MA .
Urban-rural disparities in interfacility transfers for children during COVID-19.
J Rural Health 2023 Jun; 39(3):611-16. doi: 10.1111/jrh.12746..
Keywords: COVID-19, Children/Adolescents, Disparities, Rural Health, Urban Health, Rural/Inner-City Residents
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
Griesemer I, Lightfoot AF, Eng E
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
This paper discussed an intervention that was conducted to eliminate racial disparity in cancer treatment through a program called Accountability for Cancer Care through Undoing Racism and Equity (ACCURE). The program successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. It used specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Thematic analysis on all clinical notes that were written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162) was conducted by community and academic research partners. The authors identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Those themes include: (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Lightfoot AF, Eng E .
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
Health Promot Pract 2023 May; 24(3):415-25. doi: 10.1177/15248399221136534..
Keywords: Cancer, Racial and Ethnic Minorities, Disparities, Health Promotion
Mota L, Marcaccio CL, Zhu M
Impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease.
This study’s goal was to examine the impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease (PAD). An area deprivation index (ADI) score was assigned to each patient in the Vascular Quality Initiative registry who underwent infrainguinal revascularization (open or endovascular) or amputation for symptomatic PAD between 2003 and 2020. ADI scores range from 1 to 100 based on residential zip code, and patients were categorized by ADI quintiles (Q1 to Q5). Outcomes of interest included indication for procedure (claudication, rest pain, or tissue loss) and rates of revascularization (vs primary amputation). The 79,974 identified patients were categorized as: Q1: 9604 (12%), Q2:14,961 (18.7%), Q3: 19,800 (24.8%), Q4: 21,735 (27.2%), and Q5: 13,873 (17.4%). There were significant trends toward lower rates of claudication (Q1: 39% vs Q5: 34%), higher rates of rest pain (Q1: 12.4% vs Q5: 17.8%) as the indication for intervention, and lower rates of revascularization (Q1: 80% vs Q5: 69%) with increasing ADI quintiles. There was a progressively higher likelihood of presenting with rest pain vs claudication, with patients in Q5 having the highest probability when compared with those in Q1 in adjusted analyses. Patients in Q5, when compared with those in Q1, also had a higher likelihood of presenting with tissue loss vs claudication. Patients in Q2-Q5 also had a lower likelihood of undergoing any revascularization procedure compared with patients in Q1.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Zhu M .
Impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease.
J Vasc Surg 2023 May; 77(5):1477-85. doi: 10.1016/j.jvs.2022.12.062..
Keywords: Cardiovascular Conditions, Disparities, Social Determinants of Health
Richmond J, Murray MH, Milder CM
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
The purpose of this study was to identify factors contributing to racial disparities in stage of lung cancer stage diagnosis in low-income adults. The researchers identified cases of incident lung cancer from the prospective observational Southern Community Cohort Study by linking them with state cancer registries in 12 southeastern states. A subset of participants who answered psychosocial questions such as those related to racial discrimination experiences were assessed to determine if model predictive power improved. The study identified 1,572 patients with incident lung cancer with available lung cancer stage. Compared with White participants Black participants with lung cancer reflected higher unadjusted odds of distant stage diagnosis. Higher neighborhood area deprivation was related with distant stage diagnosis. No significant differences were found in distant stage disease for Black vs White participants after controlling for individual- and area-level factors, but participants with COPD showed decreased odds of distant stage diagnosis in the primary model.
AHRQ-funded; HS026122.
Citation: Richmond J, Murray MH, Milder CM .
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
Chest 2023 May; 163(5):1314-27. doi: 10.1016/j.chest.2022.11.025..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
AHRQ-funded; HS026957.
Citation: Sanghavi P, Chen Z .
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Agochukwu-Mmonu N, Qin Y, Kaufman S
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
This study examined the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. The authors used a 20% sample of national Medicare data to identify beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. They then linked urologists to their practices with tax identification numbers and patients to their practices based on their primary urologist. They identified 54,443 patients with incident prostate cancer, with most (87%) White and 9% Black. They found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years). Black patients had lower odds of definitive therapy and underwent less treatment than White patients in every practice context. Black patients had lower predicted probability of treatment (66%) than White patients (69%).
AHRQ-funded; HS025707.
Citation: Agochukwu-Mmonu N, Qin Y, Kaufman S .
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
JCO Oncol Pract 2023 May; 19(5):e763-e72. doi: 10.1200/op.22.00147..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Disparities, Racial and Ethnic Minorities
Giardina TD, Woodard LD, Singh H
Advancing diagnostic equity through clinician engagement, community partnerships, and connected care.
This article explores the persistent disparities in healthcare, particularly in the diagnostic process, which have been further exposed by the COVID-19 pandemic. The authors highlight the higher rates of infection, hospitalization, and death from COVID-19 among Black, Hispanic, and Asian patients, who are also less likely to be tested for the virus. Similar disparities are noted in cardiac testing, mental health diagnoses, appendicitis diagnosis, and receipt of diagnostic imaging in the Emergency Department. The authors propose a three-pronged approach to address these disparities: clinician engagement, community partnerships, and connected care. Clinician engagement involves fostering critical consciousness among healthcare providers to recognize and address systemic inequities. Community partnerships with Community Health Workers (CHWs) can help fill gaps in the diagnostic process. Lastly, connected care through telehealth can potentially eliminate traditional barriers to care, although disparities in access to technology and digital literacy remain a challenge. The authors call for further research and initiatives to address these disparities and promote diagnostic equity.
AHRQ-funded; HSP233201500022I; HS025474
Citation: Giardina TD, Woodard LD, Singh H .
Advancing diagnostic equity through clinician engagement, community partnerships, and connected care.
J Gen Intern Med 2023 Apr; 38(5):1293-95. doi: 10.1007/s11606-022-07966-8..
Keywords: Community Partnerships, Disparities, Telehealth, Health Information Technology (HIT)
Taylor Gangnon, R R, Powell WR
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
This national retrospective cohort study examined Medicare beneficiaries hospitalized with diabetic foot ulcers. Investigators sought to determine what proportion of rural patients, particularly those identifying as black, received specialty care in comparison with the national proportion. Their findings indicated that a smaller proportion of rural patients, particularly those identified as black, received specialty care compared with the overall cohort. They concluded that this might contribute to disparities in major amputations, but future studies are required to determine causality.
AHRQ-funded; HS026279.
Citation: Taylor Gangnon, R R, Powell WR .
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
BMJ Open Diabetes Res Care 2023 Apr; 11(2). doi: 10.1136/bmjdrc-2022-003185..
Keywords: Rural Health, Racial and Ethnic Minorities, Diabetes, Chronic Conditions, Disparities
Eneanya ND, Adingwupu OM, Kostelanetz S
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
The rationale behind the disparity in blood creatinine levels between Black and non-Black individuals factored into previous GFR prediction formulas remains unclear. The purpose of this study was to investigate if social health determinants could explain this gap. The researchers conducted a secondary examination of the initial data from the Modification of Diet in Renal Disease and Chronic Renal Insufficiency Cohort investigations. Data from these cohorts were divided based on racial characteristics (Black versus non-Black). The study initially assessed the degree to which the Black race coefficient in the GFR estimation from creatinine is influenced by the interrelation of race with social health determinants and non-GFR creatinine determinants. Researchers then assessed whether the discrepancy in adjusted mean creatinine between racial groups could be attributed to social health determinants and non-GFR creatinine determinants. The study found that in models that associated measured GFR with creatinine, age, sex, and race, the Black race coefficient was 21% in the Modification of Diet in Renal Disease study and 13% in the Chronic Renal Insufficiency Cohort, and was not weakened by the inclusion of social health determinants, either singularly or in combination. In both studies, the Black race coefficient was more pronounced at lower income levels as compared to higher ones. In models associating creatinine with measured GFR, age, and sex, average creatinine was elevated in Black participants in comparison with non-Black participants in both studies, with social health determinants having no impact.
AHRQ-funded; HS026122.
Citation: Eneanya ND, Adingwupu OM, Kostelanetz S .
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
Clin J Am Soc Nephrol 2023 Apr; 18(4):446-54. doi: 10.2215/cjn.0000000000000109..
Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Kidney Disease and Health, Disparities
Mota L, Marcaccio CL, Patel PB
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
This study measured the impact of neighborhood social disadvantage on abdominal aortic aneurysm (AAA) severity and management. The authors identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An area deprivation index (ADI) score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation, which was then divided into quintiles. Outcomes looked at were rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Among the 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%). Increasing ADI quintiles trended towards increasing rAAA and decreasing EVAR rates. In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair and lower odds of undergoing EVAR.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Patel PB .
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
J Vasc Surg 2023 Apr;77(4):1077-86.e2. doi: 10.1016/j.jvs.2022.10.048.
Keywords: Social Determinants of Health, Cardiovascular Conditions, Surgery, Disparities