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
1 to 17 of 17 Research Studies DisplayedKleinman 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
Coley RY, Johnson E, Simon GE
Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits.
This study looked at racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visit. The main outcome measured was the suicide rate within 90 days after a mental health visit. The study used a 50% sample of visits from a random set of outpatients at 7 large integrated health care systems by patients 13 years and older (6,984,184 visits). Suicide rates were highest for visits by patients with no race/ethnicity recorded, followed by Asian, White, American Indian/Alaskan Native, Hispanic, and Black. Sensitivity of both models used were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients with no race/ethnicity recorded.
AHRQ-funded; HS026369.
Citation: Coley RY, Johnson E, Simon GE .
Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits.
JAMA Psychiatry 2021 Jul;78(7):726-34. doi: 10.1001/jamapsychiatry.2021.0493..
Keywords: Disparities, Racial and Ethnic Minorities, Behavioral Health, Mortality, Risk
Javalkar K, Robson VK, Gaffney L
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Researchers characterized the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). They found that lower socioeconomic status or higher social vulnerability index, Hispanic ethnicity, and Black race independently increased risk for MIS-C. They recommended additional studies to target interventions to improve health equity for children.
AHRQ-funded; HS000063.
Citation: Javalkar K, Robson VK, Gaffney L .
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-039933..
Keywords: Children/Adolescents, Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Risk
Selden TM, Berdahl TA
AHRQ Author: Selden TM, Berdahl TA
COVID-19 and racial/ethnic disparities in health risk, employment, and household composition.
In this study, the investigators used data from the Medical Expenditure Panel Survey to explore potential explanations for racial-ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. The authors found that black adults in every age group were more likely than whites to have health risks associated with severe COVID-19 illness. However, whites were older on average than blacks.
AHRQ-authored.
Citation: Selden TM, Berdahl TA .
COVID-19 and racial/ethnic disparities in health risk, employment, and household composition.
Health Aff 2020 Sep;39(9):1624-32. doi: 10.1377/hlthaff.2020.00897..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Disparities, Racial and Ethnic Minorities, Risk
Chen DW, Reyes-Gastelum D, Wallner LP
Disparities in risk perception of thyroid cancer recurrence and death.
The authors studied risk perception among survivors of thyroid cancer. Patients diagnosed with differentiated thyroid cancer from the Surveillance, Epidemiology, and End Results registries were surveyed and an analytic cohort defined by a 5% or greater risk of disease recurrence and mortality. The authors found that less educated patients and Hispanic patients were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life.
AHRQ-funded; HS024512.
Citation: Chen DW, Reyes-Gastelum D, Wallner LP .
Disparities in risk perception of thyroid cancer recurrence and death.
Cancer 2020 Apr 1;126(7):1512-21. doi: 10.1002/cncr.32670..
Keywords: Disparities, Cancer, Risk, Quality of Life, Social Determinants of Health, Racial and Ethnic Minorities
Glazer KB, Danilack VA, Werner EF
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
This study’s goal was to quantify the extent to which overweight and obesity explain cesarean delivery rates among women of different racial and ethnic backgrounds. Administrative records were used from New York City for 216,481 singleton, nulliparous births from 2008 to 2013. Risk ratios, risk differences, and population attributable fractions for associations between body mass index and cesarean, stratified by race and ethnicity was calculated. Black and Hispanic women had the highest cesarean rates attributable to obesity and overweight (17.4% and 14.6%) respectively.
AHRQ-funded; HS025013.
Citation: Glazer KB, Danilack VA, Werner EF .
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
Ann Epidemiol 2020 Feb;42:4-11.e4. doi: 10.1016/j.annepidem.2019.12.012.
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Keywords: Disparities, Racial and Ethnic Minorities, Pregnancy, Labor and Delivery, Risk, Obesity, Women
Marcolini EG, Albrecht JS, Sethuraman KN
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
This study used US and European trauma database statistics, including the National Trauma Databank, to examine sex disparities in trauma care. Their findings indicate that sex differences in risk-taking behaviors that lead to traumatic injury have been associated with males, with female menstrual cycle timing, and with cortisol levels. Differences in access to services at trauma centers, including triage or transfer and level of medical attention are associated with sex as well race, rural or urban location, and insurance status. Outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient; outcomes after general trauma and specifically traumatic brain injury show mixed results.
AHRQ-funded; HS024560.
Citation: Marcolini EG, Albrecht JS, Sethuraman KN .
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
Anesthesiol Clin 2019 Mar;37(1):107-17. doi: 10.1016/j.anclin.2018.09.007..
Keywords: Access to Care, Disparities, Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Risk, Sex Factors, Trauma
Desir FA, Lesko CR, Moore RD
One sIZE fITS (n)one: the influence of sex, age, and sexual human immunodeficiency virus (HIV) acquisition risk on racial/ethnic disparities in the HIV care continuum in the United States.
In this study the investigators examined the impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities. They found that racial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. They suggest that clinical and public health interventions that jointly target these demographic factors are needed.
AHRQ-funded; 90047713.
Citation: Desir FA, Lesko CR, Moore RD .
One sIZE fITS (n)one: the influence of sex, age, and sexual human immunodeficiency virus (HIV) acquisition risk on racial/ethnic disparities in the HIV care continuum in the United States.
Clin Infect Dis 2019 Feb 15;68(5):795-802. doi: 10.1093/cid/ciy556..
Keywords: Disparities, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities, Risk
Kang M, Kempker JA
Definitions, epidemiology, clinical risk factors, and health disparities in acute respiratory distress syndrome.
This case definition introduces challenges to the reliable and accurate epidemiologic study of acute respiratory distress syndrome (ARDS). Within these limitations, ARDS appears to be a condition that is relatively rare within the general population but common within the context of the intensive care unit. Furthermore, the frequency and outcomes of ARDS seem to vary between populations, with no clearly discernible temporal trends in incidence or case fatality that are uniform across studies.
AHRQ-funded; HS025240.
Citation: Kang M, Kempker JA .
Definitions, epidemiology, clinical risk factors, and health disparities in acute respiratory distress syndrome.
Semin Respir Crit Care Med 2019 Feb;40(1):3-11. doi: 10.1055/s-0039-1683884..
Keywords: Disparities, Respiratory Conditions, Chronic Conditions, Risk
Tung EL, Wroblewski KE, Boyd K
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. It concluded that in a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
AHRQ-funded; HS023007.
Citation: Tung EL, Wroblewski KE, Boyd K .
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
J Am Heart Assoc 2018 Mar 24;7(7). doi: 10.1161/jaha.117.008030.
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Keywords: Blood Pressure, Disparities, Risk, Social Determinants of Health, Urban Health
Valero-Elizondo J, Hong JC, Spatz ES
Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002-2013.
This study aimed to describe the trends in prevalence of cardiovascular risk factors (CRFs) among US adults by SES from 2002 to 2013. It found that the proportion of individuals with obesity, diabetes and hypertension increased overall, with low-income groups representing a higher prevalence for each CRF. Of note, physical inactivity had the highest prevalence increase, with the "lowest-income" group observing a relative percent increase of 71.1 percent.
AHRQ-funded; HS023000.
Citation: Valero-Elizondo J, Hong JC, Spatz ES .
Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002-2013.
Atherosclerosis 2018 Feb;269:301-05. doi: 10.1016/j.atherosclerosis.2017.12.014.
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Keywords: Disparities, Cardiovascular Conditions, Medical Expenditure Panel Survey (MEPS), Risk, Social Determinants of Health
Beckman AL, Herrin J, Nasir K
Trends in cardiovascular health of US adults by income, 2005-2014.
This research letter discusses the trends in cardiovascular health of US adults by income from 2005-2014. The investigators assessed national trends in cardiovascular risk factors by income level among adults aged 25 years and older using data from the National Health and Nutrition Examination Surveys, a nationally representative, multistage probability sample of the US population, across 5 periods: 2005 to 2006, 2007 to 2008, 2009 to 2010, 2011 to 2012, and 2013 to 2014.
AHRQ-funded; HS023000.
Citation: Beckman AL, Herrin J, Nasir K .
Trends in cardiovascular health of US adults by income, 2005-2014.
JAMA Cardiol 2017 Jul;2(7):814-16. doi: 10.1001/jamacardio.2017.1654..
Keywords: Cardiovascular Conditions, Risk, Disparities, Health Status, Blood Pressure, Obesity, Diabetes, Low-Income, Tobacco Use
Naidech AM, Toledo P, Prabhakaran S
Disparities in the use of seizure medications after intracerebral hemorrhage.
The researchers investigated potential disparities in the use of prophylactic seizure medications in patients with intracerebral hemorrhage. They concluded that although multicenter electronic health record data showed apparent racial/ethnic disparities in the use of prophylactic seizure medications, a more complete single-center cohort found the apparent disparity to be confounded by the clinical factors of hypertension and hematoma location.
AHRQ-funded; HS023437; HS000078.
Citation: Naidech AM, Toledo P, Prabhakaran S .
Disparities in the use of seizure medications after intracerebral hemorrhage.
Stroke 2017 Mar;48(3):802-04. doi: 10.1161/strokeaha.116.015779.
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Keywords: Disparities, Medication, Prevention, Adverse Drug Events (ADE), Risk
Hsu D, Brieva J, Silverberg JI
Costs of care for hospitalization for pemphigus in the United States.
The purpose of this study was to determine the incidence of and risk factors for hospitalization with pemphigus and cost of care. It concluded that there is a significant inpatient burden for pemphigus in the United States. Moreover, there appear to be racial/ethnic and health care disparities with respect to pemphigus, such that poor, nonwhite, and/or uninsured or underinsured patients have higher odds of hospitalization.
AHRQ-funded; HS023011.
Citation: Hsu D, Brieva J, Silverberg JI .
Costs of care for hospitalization for pemphigus in the United States.
JAMA Dermatol 2016 Jun;152(6):645-54. doi: 10.1001/jamadermatol.2015.5240..
Keywords: Healthcare Costs, Hospitalization, Disparities, Healthcare Cost and Utilization Project (HCUP), Risk
Wernli KJ, Brenner AT, Rutter CM
Risks associated with anesthesia services during colonoscopy.
The researchers aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. They concluded that the overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.
AHRQ-funded; HS013853; HS019482.
Citation: Wernli KJ, Brenner AT, Rutter CM .
Risks associated with anesthesia services during colonoscopy.
Gastroenterology 2016 Apr;150(4):888-94. doi: 10.1053/j.gastro.2015.12.018.
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Keywords: Adverse Events, Care Management, Colonoscopy, Disparities, Patient Safety, Risk
Jack B, Bickmore T, Hempstead M
Reducing preconception risks among African American women with conversational agent technology.
The researchers developed and tested “Gabby,” an online preconception conversational agent system, in a 6-month randomized controlled trial of non-pregnant African American women, most in college, to determine how well Gabby works and to identify additional areas for improvement. They found that Gabby was significantly associated with preconception risk reduction.
AHRQ-funded; 290200600012I.
Citation: Jack B, Bickmore T, Hempstead M .
Reducing preconception risks among African American women with conversational agent technology.
J Am Board Fam Med 2015 Jul-Aug;28(4):441-51. doi: 10.3122/jabfm.2015.04.140327..
Keywords: Disparities, Health Promotion, Risk, Pregnancy
Walsh T, Bertozzi-Villa C, Schneider JA
Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men.
The researchers systematically reviewed the literature on anal human papillomavirus (HPV)infection, dysplasia, and cancer among Black and White men who have sex with men (MSM) to determine if a racial disparity exists. They determined that studies involving Black MSM are nearly absent from the literature. Of 25 eligible studies, 2 stratified by race and sexual behavior. Both reported an elevated rate of abnormal anal outcomes among Black MSM.
AHRQ-funded; HS023050.
Citation: Walsh T, Bertozzi-Villa C, Schneider JA .
Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men.
Am J Public Health 2015 Apr;105(4):e34-45. doi: 10.2105/ajph.2014.302469..
Keywords: Disparities, Sexual Health, Risk