National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Access to Care (1)
- Adverse Events (2)
- Arthritis (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (3)
- Critical Care (1)
- Disparities (5)
- Ear Infections (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Health Insurance (1)
- Hospital Readmissions (1)
- Hospitals (1)
- Injuries and Wounds (1)
- Low-Income (2)
- Mortality (1)
- Orthopedics (1)
- Outcomes (3)
- Patient-Centered Outcomes Research (2)
- Patient Experience (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (8)
- Risk (1)
- Sleep Problems (1)
- (-) Social Determinants of Health (14)
- (-) Surgery (14)
- Vulnerable Populations (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedTaylor 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
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
Diaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health
Langston DM, Oslock WM, Paredes AZ
Hospital location and socioeconomic disadvantage of emergency general surgery patients.
This study’s purpose was to test the hypothesis that a hospital’s neighborhood disadvantage is associated with vulnerability of its emergency general surgery (EGS) patients. An area deprivation index (ADI), which is a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospitals in more disadvantaged areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons.
AHRQ-funded; HS022694.
Citation: Langston DM, Oslock WM, Paredes AZ .
Hospital location and socioeconomic disadvantage of emergency general surgery patients.
J Surg Res 2021 May;261:376-84. doi: 10.1016/j.jss.2020.12.028..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Social Determinants of Health, Vulnerable Populations, Critical Care
Garcia RM, Prabhakaran S, Richards CT
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
This study sought to determine if socioeconomic status among minorities indicates higher or lower use of a gastrostomy tube for patients with intracerebral hemorrhage. Patients at a single center were enrolled in an observational cohort study from 2010 to 2017. Zip codes were used to impute socioeconomic status. Of the 512 patients, 18.2% underwent gastrostomy tube placement. Blacks had the highest percentage of placement and Whites the lowest. Only with Hispanics was socioeconomic index independently associated with gastrostomy placement and the lower the income, the less likelihood of gastrostomy use.
AHRQ-funded; HS023437.
Citation: Garcia RM, Prabhakaran S, Richards CT .
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104567. doi: 10.1016/j.jstrokecerebrovasdis.2019.104567.
.
.
Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Surgery, Disparities
Bass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Qi AC, Peacock K, Luke AA
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
The purpose of this study was to determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, were associated with higher rates of surgical site infections (SSI) after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. The investigators report that inconsistent associations between social risk factors and SSIs were found.
AHRQ-funded; HS019455.
Citation: Qi AC, Peacock K, Luke AA .
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
JAMA Netw Open 2019 Oct 2;2(10):e1912339. doi: 10.1001/jamanetworkopen.2019.12339..
Keywords: Healthcare Cost and Utilization Project (HCUP), Risk, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Social Determinants of Health
Mehta B, Szymonifka J, Dey S
Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.
The objective of this study was to assess the relationship of neighborhood immigrant proportion (IP) to preoperative and 2-year postoperative pain and function after elective total knee arthroplasty (TKA) using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients in a high-volume institutional TKA registry were analyzed retrospectively, and demographics, pre-op and 2-year post-op WOMAC pain and function scores, and addresses obtained. Patient-level variables were linked to Census Bureau tract data. Researchers conclude that patients living in high IP neighborhoods do not have worse pre-op or 2-year post-op pain and function outcomes after TKA compared to those living in lower IP neighborhoods.
AHRQ-funded; HS016075.
Citation: Mehta B, Szymonifka J, Dey S .
Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.
BMC Musculoskelet Disord 2019 Feb 9;20(1):67. doi: 10.1186/s12891-019-2446-y..
Keywords: Arthritis, Outcomes, Patient-Centered Outcomes Research, Racial and Ethnic Minorities, Social Determinants of Health, Surgery
Leeds IL, Alimi Y, Hobson DR
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
This study aims to demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup. It concluded that differences in outcomes by race and socioeconomic status did not arise following implementation of an enhanced recovery pathway. Differences in process measures by population subgroups highlight differences in care that require further investigation.
AHRQ-funded; HS024736; HS024547.
Citation: Leeds IL, Alimi Y, Hobson DR .
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
Dis Colon Rectum 2017 Oct;60(10):1092-101. doi: 10.1097/dcr.0000000000000879.
.
.
Keywords: Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Outcomes, Adverse Events
Goodman SM, Mandl LA, Parks ML
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Race is an important predictor of total knee arthroplasty (TKA) outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. This study found that blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandl LA, Parks ML .
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Clin Orthop Relat Res 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8.
.
.
Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Patient-Centered Outcomes Research, Surgery
Nieman CL, Tunkel DE, Boss EF
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
The study’s objective was to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for tympanostomy tube (TT). It found that among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of chronic otitis media with effusion (OME) as opposed to recurrent acute otitis media (RAOM).
AHRQ-funded; HS022932.
Citation: Nieman CL, Tunkel DE, Boss EF .
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
Int J Pediatr Otorhinolaryngol 2016 Sep;88:98-103. doi: 10.1016/j.ijporl.2016.06.029.
.
.
Keywords: Children/Adolescents, Ear Infections, Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Low-Income
Martsolf GR, Barrett ML, Weiss AJ
AHRQ Author: Steiner CA, Coffey R
Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty.
This study examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA). It found that inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at less than 3 percent of the hospitals.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Barrett ML, Weiss AJ .
Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty.
J Bone Joint Surg Am 2016 Aug 17;98(16):1385-91. doi: 10.2106/jbjs.15.00884.
.
.
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Social Determinants of Health, Hospital Readmissions, Surgery
Nieman CL, Benke JR, Boss EF
Does race/ethnicity or socioeconomic status influence patient satisfaction in pediatric surgical care?
The researchers evaluated patient satisfaction in outpatient pediatric surgical care and assess differences in scores by race/ ethnicity and socioeconomic status. Their analysis found no disparities in the patient experience by individual- or community-level factors.
AHRQ-funded; HS022932.
Citation: Nieman CL, Benke JR, Boss EF .
Does race/ethnicity or socioeconomic status influence patient satisfaction in pediatric surgical care?
Otolaryngol Head Neck Surg 2015 Oct;153(4):620-8. doi: 10.1177/0194599815590592..
Keywords: Patient Experience, Social Determinants of Health, Surgery, Racial and Ethnic Minorities, Children/Adolescents
Boss EF, Benke JR, Tunkel DE
Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing.
The purpose of this study was (1) to evaluate receipt and timing of polysomnography (PSG) in relation to ultimate surgical therapy with adenotonsillectomy for children undergoing evaluation for sleep-disordered breathing and (2) to evaluate differences based on socioeconomic status. It found that referral for PSG resulted in significant loss to follow-up for all children and delayed definitive surgical treatment for children with public insurance.
AHRQ-funded; HS022932.
Citation: Boss EF, Benke JR, Tunkel DE .
Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing.
JAMA Otolaryngol Head Neck Surg 2015 Feb;141(2):106-11. doi: 10.1001/jamaoto.2014.3085..
Keywords: Children/Adolescents, Sleep Problems, Social Determinants of Health, Access to Care, Health Insurance, Surgery