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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 5 of 5 Research Studies Displayed
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
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
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA . Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment. Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
Citation: Mallela DP, Canner JK, Zarkowsky DS . Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP. J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial and Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Patel M, Phillips-Caesar E, Boutin-Foster C
Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.
The researchers conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying cardiovascular disease related behaviors among a Bangladeshi cohort. Bangladeshi individuals in this study cited a combination of internal and external factors as barriers to lifestyle modification. The authors recommended interventions to address these barriers that simultaneously address self-efficacy and work-life balance.
Citation: Patel M, Phillips-Caesar E, Boutin-Foster C . Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US. J Immigr Minor Health 2014 Oct;16(5):994-1000. doi: 10.1007/s10903-013-9868-7.
Keywords: Cardiovascular Conditions, Lifestyle Changes, Racial and Ethnic Minorities, Risk
Petrov ME, Howard VJ, Kleindorfer D
Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study.
The authors investigated the relation between sleep medication use and incident stroke. At the sleep assessment, 9.6% of the participants used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3 ± 1.0 years, 297 stroke events occurred. The authors found that over-the-counter sleep medication use was associated with increased risk of incident stroke; however, there was no significant association with prescription sleep medications. They concluded that over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.
Citation: Petrov ME, Howard VJ, Kleindorfer D . Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study. J Stroke Cerebrovasc Dis 2014 Sep;23(8):2110-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.03.025.
Keywords: Medication: Safety, Medication, Risk, Sleep Problems, Stroke, Cardiovascular Conditions, Racial and Ethnic Minorities