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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
76 to 100 of 753 Research Studies DisplayedMoriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
de Guerre L, Rice J, Cheng J
Racial differences in isolated aortic, concomitant aortoiliac, and isolated iliac aneurysms: this is a retrospective observational study.
The purpose of this research was to investigate racial and ethnic disparities in the clinical presentation, foundational and operative features, and outcomes following aortoiliac aneurysm repair. Prior research has revealed variations in the incidence of abdominal aortic aneurysms across racial and ethnic groups, along with more intricate iliac anatomical structures in Asian individuals. The researchers analyzed White, Black, Asian, and Hispanic patients who underwent aortoiliac aneurysm repair in the VQI between 2003 and 2019, and examined baseline comorbidities, operative attributes, and perioperative outcomes according to race and ethnicity. They study found that within the 60,435-patient sample, Black and Asian patients were most likely to receive repair for aortoiliac and isolated iliac aneurysms, while White and Hispanic patients predominantly underwent isolated aortic aneurysm repair. Black patients were more prone to symptomatic repair and experienced rupture repair at a reduced aortic diameter. The iliac aneurysm diameter was largest in Black and Asian patients. Asian individuals were most likely to exhibit aortic neck angulation greater than 60 degrees, over 20% graft oversizing, and postoperative endoleaks. Additionally, Asian patients had a higher likelihood of hypogastric artery aneurysm and hypogastric coiling procedures. The study concluded that Asian and Black patients demonstrated a higher likelihood of undergoing repair for aortoiliac and isolated iliac aneurysms, while White and Hispanic patients predominantly received repair for isolated aortic aneurysms.
AHRQ-funded; HS027285
Citation: de Guerre L, Rice J, Cheng J .
Racial differences in isolated aortic, concomitant aortoiliac, and isolated iliac aneurysms: this is a retrospective observational study.
Ann Surg 2023 Jan 1;277(1):165-72. doi: 10.1097/sla.0000000000004731.
Keywords: Racial and Ethnic Minorities, Cardiovascular Conditions
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Fan CA, Hara-Hubbard KK, Barrington WE
The experience of hate incidents across racial and ethnic groups during the COVID-19 pandemic.
This article investigated the prevalence of hate incidents across racial and ethnic groups and the relationship between race/ethnicity and hate incidents during the first year of the COVID-19 pandemic. National data was taken from the Understanding America Study COVID-19 Longitudinal Survey. The majority of members of all six marginalized racial and ethnic groups reported at least one hate incident; Asian, AI/AN, Black, and Multiracial groups were shown to have significantly higher odds of experiencing each category of hate incident. All marginalized groups had higher odds of receiving poorer service. The authors concluded that the health community must research and treat hate incidents as a public health issue while recognizing the contexts of structural and interpersonal racism in the U.S.
AHRQ-funded; HS013853.
Citation: Fan CA, Hara-Hubbard KK, Barrington WE .
The experience of hate incidents across racial and ethnic groups during the COVID-19 pandemic.
Front Public Health 2022 Dec 12; 10:982029. doi: 10.3389/fpubh.2022.982029..
Keywords: COVID-19, Racial and Ethnic Minorities
McQuillan J, Andersen JA, Berdahl TA
AHRQ Author: Berdahl TA
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
The objective of this study was to examine associations between changes in Rheumatoid Arthritis symptoms and depressive symptoms and to test if these associations differed by education, or gender, or race/ethnicity. Data was taken from the National Rheumatoid Arthritis Study, 1988-98. The results indicated that people with Rheumatoid Arthritis experienced increases in depressive symptoms as well as pain, functional disability, and household work disability over the study period. There was no difference noted in the rate of change in depressive symptoms by education, gender, nor race/ethnicity, but the association of functional disability with depressive symptoms was stronger for men than women. The researchers concluded that it is important to monitor and treat both mental and physical health symptoms, and that future research should focus on the collection of data that reflects the educational, gender, and racial/ethnic diversity of people with Rheumatoid Arthritis.
AHRQ-authored.
Citation: McQuillan J, Andersen JA, Berdahl TA .
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
Arthritis Care Res 2022 Dec;74(12):2050-58. doi: 10.1002/acr.24730..
Keywords: Arthritis, Depression, Behavioral Health, Racial and Ethnic Minorities, Sex Factors, Chronic Conditions
Canedo JR, Villalta-Gil V, Grijalva CG CG
How do Hispanics/Latinos perceive and value the return of research results?
This study’s objective was to examine differences among Hispanics/Latinos by education and income in the experience and expectations about the return of research results, perceived value of specific types of information, and the least and most valuable specific information. This retrospective observational design study used a cross-sectional national survey sample of Hispanics/Latinos (n = 327). Higher educational attainment and income were both positively associated with the perceived value of getting results. Higher education respondents specifically perceived greater value in information about how lifestyle and genetics affect their risk of disease, how genetics affect how they respond to medications, their ancestry, available clinical trials near them, and how to connect with other study participants.
AHRQ-funded; HS026122.
Citation: Canedo JR, Villalta-Gil V, Grijalva CG CG .
How do Hispanics/Latinos perceive and value the return of research results?
Hisp Health Care Int 2022 Dec;20(4):238-47. doi: 10.1177/15404153211070821..
Keywords: Racial and Ethnic Minorities, Cultural Competence, Education: Patient and Caregiver
Cheung PC, Kramer MR, Kempker JA
Intermediate or intensive care unit admission across race and ethnicity.
This study’s aim was to assess the association between race and ethnicity and admission to intermediate (IMCUs) or intensive care units (ICUs) among hospitalized patients. Florida hospital discharge data from the State Inpatient Database was used to assess the relationship between race (White, Black, Other) and Hispanic ethnicity and IMCU or ICU admission. After controlling for demographics and comorbidities, the prevalence of IMCU or ICU admission was higher among non-Hispanic Blacks and non-Hispanic patients of other races compared with non-Hispanic Whites. The prevalence of IMCU or ICU use was lower among Hispanic Whites and Hispanics of other races compared with non-Hispanic Whites after controlling for other demographic characteristics and comorbidities.
AHRQ-funded; HS025240.
Citation: Cheung PC, Kramer MR, Kempker JA .
Intermediate or intensive care unit admission across race and ethnicity.
South Med J 2022 Dec;115(12):913-18. doi: 10.14423/smj.0000000000001487..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Intensive Care Unit (ICU)
Strauss AT, Sidoti CN, Purnell TS
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
This multicenter study examined racial and ethnic inequities in liver transplantation. The authors recruited participants from the liver transplantation (LT) teams including coordinators, advanced practice providers, physicians, social workers, dieticians, pharmacists, leadership at 2 major LT centers. They conducted 54 interviews and had 49 observation hours. They created a conceptual framework describing how transplant work system characteristics and other external factors may improve equity in the LT evaluation process. They proposed transplant center-level solutions (i.e., including but not limited to training of staff on health equity) to modifiable barriers in the clinical work system that could help patient navigation, reduce disparities, and improve access to care. Their findings call for an urgent need for transplant centers, national societies, and policy makers to focus efforts on improving equity (tailored, patient-centered resources) using the science of human factors and systems engineering.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Purnell TS .
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
Liver Transpl 2022 Dec;28(12):1841-56. doi: 10.1002/lt.26532..
Keywords: Racial and Ethnic Minorities, Transplantation, Disparities, Access to Care
Richmond J, Adams LB, Annis IE
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
The purpose of this cross-sectional survey study was to assess factors related with African American parents seeking care for their child within 30 days after identifying the child’s behavioral or emotional need and with postponing care for 1 year or more. The researchers surveyed 289 African American parents who were raising a child with emotional or developmental challenges to explore relationships between parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care (within 30 days after identifying a child’s need) and deferring care seeking. The study found that approximately 22% of parents rapidly sought care, and 49% deferred care for 1 year or more. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. The researchers concluded that when developing programs that support African American families, professionals should be advised about facilitators and barriers to mental health care seeking.
AHRQ-funded; HS026122.
Citation: Richmond J, Adams LB, Annis IE .
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
Psychiatr Serv 2022 Dec;73(12):1359-66. doi: 10.1176/appi.ps.202100553..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Behavioral Health, Healthcare Utilization
Levinson Z, Cantor J, Williams MV
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Investigators sought to identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. They found that hospitals with large Black patient shares experienced greater strain during the pandemic. These hospitals received more federal relief; however, funding was not targeted overall toward hospitals with high ICU occupancy rates.
AHRQ-funded; HS024067.
Citation: Levinson Z, Cantor J, Williams MV .
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Health Serv Res 2022 Dec;57(Suppl 2):279-90. doi: 10.1111/1475-6773.14028..
Keywords: COVID-19, Intensive Care Unit (ICU), Critical Care, Racial and Ethnic Minorities, Hospitals
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C .
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial and Ethnic Minorities, Practice Patterns, Medication
Purnell TS, Bignall ONR, Norris KC
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
This article discusses actions necessary to effectively prepare a new generation of nephrology thought leaders who understand the roles of structural racism and social determinants of health (SDOH) in continuing racial disparities as critical issues in efforts that promote kidney health equity. The authors provide their recommendations for centering antiracism and social justice in nephrology education to advance kidney health equity, including: 1 Acknowledging and adopting evidence-based strategies to address implicit biases and explicit acts of interpersonal racism in healthcare encounters that may perpetuate kidney health disparities; 2) Strive to remove structural racism at the societal and health system levels that systematically introduce inequities in kidney care; 3) incorporate research training inclusive of methodologic and content areas that are vital to health equity; 4) foster role modeling within nephrology education through faculty mentorship and professional networking opportunities. The authors conclude that to effectively advance kidney research and practice, sustainable solutions to eradicate disparities must be developed and a prepared nephrology workforce must be trained, one that centers antiracism and social justice in sustained efforts to advance kidney health equity.
AHRQ-funded; HS024600.
Citation: Purnell TS, Bignall ONR, Norris KC .
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
J Am Soc Nephrol 2022 Nov;33(11):1981-84. doi: 10.1681/asn.2022040432..
Keywords: Racial and Ethnic Minorities, Kidney Disease and Health, Disparities, Education: Continuing Medical Education, Education: Curriculum
Marcaccio CL, Patel PB, de Guerre L
Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity.
The purpose of this study was to identify variations in 5-year outcomes and imaging surveillance after elective endovascular aortic aneurysm repair (EVAR) by sex, race, and ethnicity and to examine possible mechanisms contributing to these variations. The primary outcome was 5-year aneurysm rupture. Secondary outcomes were 5-year reintervention and mortality, and having no aortic imaging follow-up from 6 to 24 months after EVAR. The study found that among 16,040 patients, 73% were White males, 18% were White females, 2.6% were Black males, 1.1% were Black females, 0.9% were Asian males, 0.2% were Asian females, 1.7% were Hispanic males, and 0.4% were Hispanic females. At 5 years, Black females had the highest rupture rates at 6.4% and white males had the lowest at 2.3%. Compared with White males, rupture rates were higher in White females, Black females, and Asian females. Among other groups, Black males had higher reintervention and both Black and Hispanic males had higher rates of no imaging follow-up. In adjusted analyses, White, Black, and Asian females remained at significantly higher risk for 5-year rupture. The researchers concluded that Black females had higher 5-year aneurysm rupture, reintervention, and mortality rates after elective EVAR as compared with White male patients, whereas White females had higher rupture, mortality and loss-to-imaging-follow-up compared to White male patients. Black males had higher reintervention and no imaging follow-up, and Asian females had higher rupture rates.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, de Guerre L .
Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity.
J Vasc Surg 2022 Nov;76(5):1205-15.e4. doi: 10.1016/j.jvs.2022.03.886..
Keywords: Disparities, Racial and Ethnic Minorities, Sex Factors, Outcomes, Imaging, Heart Disease and Health, Cardiovascular Conditions
Marcaccio CL, O'Donnell TFX, Dansey KD
Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.
The purpose of this study was to examine the demographics of patients enrolled in critical U.S. endovascular aortic device trials to explore the representation of vulnerable populations, including women and racial and ethnic minorities. The primary outcomes included the percentage of trials reporting participant sex, race, and ethnicity and the percentage of participants across sex, racial, and ethnic groups. The study found that the Food and Drug Administration (FDA) provided 29 approvals from 29 trials of 24 devices with a total of 4046 patients: 52% (15) were EVAR devices, 41% (12) were TEVAR devices, and 3.4% (1) was a FEVAR device, with 1 dissection stent (3.4%). Fifty-two percent of the trials reported the three most common racial groups (White, Black, Asian), and 48% reported Hispanic ethnicity. The TEVAR trials were the most likely to report all three racial groups and Hispanic ethnicity (92% and 75%, respectively), while the EVAR trials had the lowest reporting rates (13% and 20%, respectively). The median female enrollment was 21%, with the EVAR trials having the lowest female enrollment compared with 41% in the TEVAR trials, 21% in the FEVAR trial, and 34% in the dissection stent trial. The study concluded that in critical aortic device trials that led to FDA approval, female patients were underrepresented, especially for EVAR, and racial and ethnic minority groups were under-represented and underreported.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, O'Donnell TFX, Dansey KD .
Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.
J Vasc Surg 2022 Nov;76(5):1244-52.e2. doi: 10.1016/j.jvs.2022.05.003..
Keywords: Disparities, Racial and Ethnic Minorities, Heart Disease and Health, Cardiovascular Conditions, Medical Devices, Sex Factors
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Interrante JD, Tuttle MS, Admon LK
Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid.
Using maternal discharge records from childbirth hospitalizations in the HCUP National Inpatient Sample, 2007-15, researchers examined differences in rates of severe maternal morbidity and mortality by rural or urban geography, race and ethnicity, and clinical factors among Medicaid-funded births and privately insured hospital births. The highest rate of severe maternal morbidity and mortality occurred among rural Indigenous Medicaid-funded births; births among Black rural and urban residents and among Hispanic urban residents also experienced elevated rates. The researchers concluded that heightened rates of severe maternal morbidity and mortality among Medicaid-funded births indicate an opportunity for state and federal policy responses to address the maternal health challenges faced by Medicaid beneficiaries, including Black, Indigenous, and rural residents
AHRQ-funded; HS027640.
Citation: Interrante JD, Tuttle MS, Admon LK .
Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid.
Womens Health Issues 2022 Nov-Dec;32(6):540-49. doi: 10.1016/j.whi.2022.05.003..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Women, Pregnancy, Mortality, Risk, Racial and Ethnic Minorities, Medicaid
O'Connell J, Grau L, Goins T
The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs.
This study analyzed the costs of treatment for all-cause dementia among American Indians and Alaska native (AI/AN) adults who access services through the Indian Health Service (IHS) and Tribal health programs. The authors analyzed fiscal year 2013 IHS/Tribal treatment costs for AI/ANs aged 65 and over with dementia and a matched sample without dementia (n= 1842). Mean total treatment costs for adults with dementia were $5400 higher than for adults without dementia ($13,027 versus $7627). The difference in adjusted total treatment costs was $2943, the majority of which was due to the difference in hospital inpatient costs.
AHRQ-funded; 290200600020I.
Citation: O'Connell J, Grau L, Goins T .
The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs.
Alzheimers Dement 2022 Nov;18(11):2055-66. doi: 10.1002/alz.12603..
Keywords: Dementia, Racial and Ethnic Minorities, Healthcare Costs, Disparities
Umeukeje EM, Koonce TY, Kusnoor SV
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
The authors conducted a systematic review to assess how well estimating glomerular filtration rate (eGFR), with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. They identified 12 studies which included patients with and without kidney disease from Africa, the United States, Europe, and Brazil. They found that the majority of these studies determined that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. They concluded that their systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR.
AHRQ-funded; HS026122.
Citation: Umeukeje EM, Koonce TY, Kusnoor SV .
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
PLoS One 2022 Oct 18;17(10):e0276252. doi: 10.1371/journal.pone.0276252..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Diagnostic Safety and Quality
Chovatiya R, Begolka WS, Thibau IJ
Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among Black individuals in the United States.
The purpose of this study was to explain the categories and impact of out-of-pocket (OOP) healthcare expenses associated with atopic dermatitis (AD) management among black individuals. The researchers administered a voluntary online survey to 113, 502 members of the National Eczema Association. 77.3% of respondents met the participation criteria of being U.S. residents, 18 years of age and older, and self-reporting that they had AD or were the primary caregivers of individuals with AD. The study found that Blacks (74.2%) vs. non-Blacks (63.3%) reported more OOP costs for prescription medications covered (65.1%) and not covered (46.5%), by insurance, emergency room visits (22.1% vs. 11.8%), and outpatient laboratory testing (33.3% vs. 21.8%,). There was a relationship between Black race and increased household financial impact from OOP expenses, and predictors of financial impact included minimally controlled AD, systemic therapy, greater than $200 monthly OOP expenses, and Medicaid. Blacks with Medicaid had greater odds of harmful financial impact than those of black race or with Medicaid alone. The researchers concluded that there is a relationship between Black race increased OOP costs for AD, with significant financial impact to the household.
AHRQ-funded; HS026385.
Citation: Chovatiya R, Begolka WS, Thibau IJ .
Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among Black individuals in the United States.
Arch Dermatol Res 2022 Oct;314(8):739-47. doi: 10.1007/s00403-021-02282-3..
Keywords: Skin Conditions, Healthcare Costs, Racial and Ethnic Minorities
Hegland TA, Owens PL, Selden TM
AHRQ Author: Hegland TA, Owens PL, Selden TM
New evidence on geographic disparities in United States hospital capacity.
The purpose of this study was to describe hospital capacity across the United States. The researchers combined American Hospital Association Survey, Hospital Compare, and American Community Survey data with the 2017 near-census of U.S. hospital inpatient discharges from the Healthcare Cost and Utilization Project (HCUP). The study found that 0.11 more beds per 1000 population were supplied to zip codes where Non-Hispanic individuals live than zip codes where non-Hispanic White individuals live. However, the hospitals supplying this capacity have 0.36 fewer staff per bed and perform worse on many care quality measures. Zip codes in the most urban parts of America have the least hospital capacity (2.11 beds per 1000 persons) from across the rural-urban continuum. While more rural areas have higher capacity levels, urban areas have advantages in staff and capital per bed. The researchers did not find systematic differences in care quality between rural and urban areas. The study concluded that lower hospital care quality and resource intensity plays a key role in racial, ethnic, and income disparities in hospital care related outcomes.
AHRQ-authored.
Citation: Hegland TA, Owens PL, Selden TM .
New evidence on geographic disparities in United States hospital capacity.
Health Serv Res 2022 Oct;57(5):1006-19. doi: 10.1111/1475-6773.14010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Hospitals, Quality of Care, Racial and Ethnic Minorities
Butler T, Cummings LS, Purnell TS
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
The authors of this article propose a more diverse transplant workforce to address the problem of kidney transplant inequity. Black patients are disproportionately affected by kidney failure and systemic barriers to kidney transplantation such as delayed referrals, which may be due to clinician bias. Workforce diversity would help to alleviate the harm of implicit biases.
AHRQ-funded; HS024600.
Citation: Butler T, Cummings LS, Purnell TS .
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
J Am Soc Nephrol 2022 Oct; 33(10):1817-19. doi: 10.1681/asn.2022040429..
Keywords: Kidney Disease and Health, Transplantation, Workforce, Disparities, Racial and Ethnic Minorities
White VanGompel E, Lai JS, Davis DA
Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite).
This study sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism(©) in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. The study was conducted using PROMIS© instrument development standards adapted with cultural rigor methodology. The study had 2 phases: Phase 1 included item pool generation, modified Delphi method, and cognitive interviews and Phase 2 evaluated the item pool using factor analysis and item response theory. Items were identified or written to cover 7 previously identified theoretical domains with 806 Black mothers and birthing people completing the pilot test. Good fit indices were indicated with factor analysis. Factor 1 was “Humanity” which had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy; Factor 2 “Racism” which had 12 items measuring experiences of neglect and mistreatment; and Factor 3 “Kinship” which had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system.
AHRQ-funded; HS028028.
Citation: White VanGompel E, Lai JS, Davis DA .
Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite).
Birth 2022 Sep;49(3):514-25. doi: 10.1111/birt.12622..
Keywords: Racial and Ethnic Minorities, Women, Patient Experience
Jackson Levin N, Zhang A, Reyes-Gastelum D
Change in worry over time among Hispanic women with thyroid cancer.
This survey assessed change in worry over time in Hispanic women with thyroid cancer. A total of 273 Hispanic women with thyroid cancer diagnosed in 2014-2015 were recruited from SEER Los Angeles. Participants were surveyed at two points in time: time 1 from 2017 to 2018 and time 2 in 2019 on recurrence, quality of life, family at risk, death, and harm from treatments. Women were surveyed on their amount of worry: high worry (somewhat, quite a bit, very much) or low worry (not at all, a little). The survey showed 20.1-39.6% had high worry at both time 1 and time 2. An additional 7.6-13.4% had low worry at time 1 that evolved into high worry at time 2. Women with younger age (20-39) compared to older (40-79) had higher worry about thyroid cancer recurrence. A history of recurrent or persistent disease was associated with high worry about harms from treatment. Greater number of complications or side effect symptoms was associated with worry across all five items.
AHRQ-funded; HS024512.
Citation: Jackson Levin N, Zhang A, Reyes-Gastelum D .
Change in worry over time among Hispanic women with thyroid cancer.
J Cancer Surviv 2022 Aug;16(4):844-52. doi: 10.1007/s11764-021-01078-8..
Keywords: Cancer, Women, Racial and Ethnic Minorities, Quality of Life, Anxiety
Jindal M, Thornton RLJ, McRae A
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
The authors sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy. They conducted a pre-post survey study in two urban, university-based, midsized pediatric residency programs. They found that, among participants with baseline pro-White bias, there was a statistically significant shift toward no preference, while among participants with a baseline pro-Black bias, there was a statistically significant shift toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy.
AHRQ-authored.
Citation: Jindal M, Thornton RLJ, McRae A .
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
J Grad Med Educ 2022 Aug;14(4):407-13. doi: 10.4300/jgme-d-21-01048.1..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Education: Curriculum
Temkin-Greener H, Mao Y, McGarry B
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
The purpose of this study was to examine the type and quality of care received in residential long-term care setting by racial/ ethnic minorities or residents eligible for dual Medicare and Medicaid. With 2018 Medicare data, the researchers identified 255,564 fee-for-service Medicare beneficiaries over the age of 55 who were living in 24,108 assisted living facilities across the United States and evaluated the relationship between race/ethnicity and dual status with emergency room use, inpatient hospital admission, 30-day readmission, and placement in a nursing home. The study found variations within and across assisted living facilities for racial/ethnic minority and dual residents, suggesting that outcome disparities are the most significant by dual eligibility status instead of only race/ ethnicity. The researchers concluded that these results can be used to inform and guide future research, as well as healthcare providers and policy makers.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Mao Y, McGarry B .
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
Med Care Res Rev 2022 Aug;79(4):500-10. doi: 10.1177/10775587211050189..
Keywords: Elderly, Racial and Ethnic Minorities, Long-Term Care, Medicare