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 Drug Events (ADE) (2)
- Adverse Events (1)
- Behavioral Health (1)
- Blood Pressure (1)
- Cancer (2)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (3)
- Children/Adolescents (3)
- Chronic Conditions (2)
- COVID-19 (1)
- Depression (1)
- Diabetes (3)
- Digestive Disease and Health (1)
- (-) Disparities (21)
- Elderly (6)
- Emergency Department (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (3)
- Healthcare Utilization (1)
- Health Insurance (2)
- Heart Disease and Health (1)
- Hospitalization (1)
- Hospitals (1)
- Infectious Diseases (1)
- Injuries and Wounds (1)
- Inpatient Care (1)
- Long-Term Care (1)
- Low-Income (1)
- Medicaid (1)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (1)
- (-) Medication (21)
- Medication: Safety (1)
- Mortality (1)
- Nursing Homes (1)
- Opioids (7)
- Outcomes (1)
- Pain (2)
- Palliative Care (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Practice Patterns (3)
- Prevention (3)
- Racial and Ethnic Minorities (10)
- Risk (1)
- Sex Factors (1)
- Social Determinants of Health (4)
- Stroke (1)
- Substance Abuse (2)
- 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 21 of 21 Research Studies DisplayedWolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
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
Encinosa W, Moon K, Figueroa J
AHRQ Author: Encinosa W
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
This cross-sectional study’s goal was to determine outcomes from multisystem inflammatory syndrome in children (MIS-C) after COVID-19. Outcomes examined were 50 complications, adverse medication events, costs, and the Social Vulnerability Index. An analysis was conducted using data from the 2021 HCUP in individuals younger than 21 years from 31 states. There were 4107 individuals hospitalized with MIS-C (median age 9 years, 59.5% male, 38.1% White) and 23,686 hospitalizations for COVID-19 without MIS-C (median age 15 years, 54.5% female, 44.1% White). Hospitalization rate for MIS-C was 1.48 per 100,000 children, ranging from 0.97 hospitalizations per 100 for White and 1.99 hospitalizations per 100 for Black children. Outcomes were worse when organ dysfunction increased from 2 to 8 organs, with deaths increasing from less than 1% to 5.8% for MIS-C, and 1% to 17.2% for COVID-19. Median length of stay increased from 4 to 8 days for MIS-C, and 3 to 16 days for COVID-19. Median costs for MIS-C increased from $16,225 to $53 359 and from $6474 to $98,643 for COVID-19. The percentage of MIS-C cases in Black children doubled from 16.2% to 31.7% as organ dysfunction increased, remaining unchanged with COVID-19.
AHRQ-authored.
Citation: Encinosa W, Moon K, Figueroa J .
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
JAMA Netw Open 2023 Jan;6(1):e2244975. doi: 10.1001/jamanetworkopen.2022.44975..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs, Disparities, Racial and Ethnic Minorities
Morden NE, Chyn D, Wood A
Racial inequality in prescription opioid receipt - role of individual health systems.
The purpose of this study was to explore the contribution of individual health systems in the receipt of prescription opioids among racial groups in the United States. Medicare claims data for 2016-2017 was used to obtain a random 40% national sample of fee-for-service, Black and White beneficiaries 18 to 64 years of age and identify 310 racially diverse systems. Findings showed that, within individual health systems, Black and White patients received markedly different opioid doses. These system-specific findings could facilitate exploration of the causes and consequences of these differences.
AHRQ-funded; HS024075.
Citation: Morden NE, Chyn D, Wood A .
Racial inequality in prescription opioid receipt - role of individual health systems.
N Engl J Med 2021 Jul 22;385(4):342-51. doi: 10.1056/NEJMsa2034159..
Keywords: Opioids, Medication, Racial and Ethnic Minorities, Disparities, Practice Patterns
Moriya AS, Xu L
AHRQ Author: Moriya AS
The complex relationships among race/ethnicity, social determinants, and opioid utilization.
The objective of this study was to examine individual- and community-level factors associated with racial/ethnic differences in individuals' opioid prescription use. The investigators found that the average annual rate of any outpatient opioid prescription use was higher for non-Hispanic whites than for non-Hispanic blacks and Hispanics. The smaller difference between non-Hispanic blacks and whites was not explained by the differences in the risk factors, while almost all the difference between Hispanics and non-Hispanic whites could be explained by the differences in the means of the risk factors.
AHRQ-authored.
Citation: Moriya AS, Xu L .
The complex relationships among race/ethnicity, social determinants, and opioid utilization.
Health Serv Res 2021 Apr;56(2):310-22. doi: 10.1111/1475-6773.13619..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Social Determinants of Health, Opioids, Medication, Disparities
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Kim JH, Fine DR, Li L
Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: a nationwide observational study.
This study examined the differences in patients with and without opioid use disorder (OUD) who were hospitalized for serious infections focusing on infective endocarditis, epidural abscess, septic arthritis or osteomyelitis. The authors used the 2016 National Inpatient Sample to examine differences in length of stay (LOS), discharge disposition, and charges. Patients with OUD had a lower probability of discharge at any given LOS, and lower odds of discharge to home with higher odds of discharge to a post-acute care facility. There were no significant differences in average total hospital charges.
AHRQ-funded; HS026215.
Citation: Kim JH, Fine DR, Li L .
Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: a nationwide observational study.
PLoS Med 2020 Aug;17(8):e1003247. doi: 10.1371/ournal.pmed.1003247.
.
.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Opioids, Substance Abuse, Hospitalization, Medication, Infectious Diseases
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Fashaw S, Chisholm L, Mor V
Inappropriate antipsychotic use: the impact of nursing home socioeconomic and racial composition.
Researchers examined how nursing home characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics, using national data from Long-Term Care: Facts on Care. They found an overall decline in the use of antipsychotics. Although findings indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility-level socioeconomic disparities continued to persist among nursing homes. They recommended that policy interventions focusing on reimbursement be considered to promote reductions in antipsychotic use, specifically among Medicaid-reliant nursing homes.
ARHQ-funded; HS000011.
Citation: Fashaw S, Chisholm L, Mor V .
Inappropriate antipsychotic use: the impact of nursing home socioeconomic and racial composition.
J Am Geriatr Soc 2020 Mar;68(3):630-36. doi: 10.1111/jgs.16316..
Keywords: Nursing Homes, Long-Term Care, Elderly, Medication, Medication: Safety, Social Determinants of Health, Disparities, Racial and Ethnic Minorities
Ngo-Metzger Q, Zuvekas S, Shafer P
AHRQ Author: Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study was to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities.
AHRQ-authored.
Citation: Ngo-Metzger Q, Zuvekas S, Shafer P .
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
J Am Board Fam Med 2019 Nov-Dec;32(6):807-17. doi: 10.3122/jabfm.2019.06.180313..
Keywords: Medical Expenditure Panel Survey (MEPS), Cardiovascular Conditions, Medication, Healthcare Utilization, Prevention, Heart Disease and Health, Disparities
Shahu A, Herrin J, Dhruva SS
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
This study used data from the randomized clinical trial ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to study the effect of socioeconomics and blood pressure control and cardiovascular outcomes. The study sites were stratified by their county-level median household income into income quintiles. The lowest income sites (quintile 1) were most likely to be women, black or Hispanic, have less education, to live in the South and to have fewer cardiovascular risk factors. Despite standardized treatment protocols, quintile 1 participants were less likely to have blood pressure control, and all greater all-cause mortality, heart failure hospitalizations/mortality and end-stage renal disease than the highest income participants (quintile 5).
AHRQ-funded; HS023000.
Citation: Shahu A, Herrin J, Dhruva SS .
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
J Am Heart Assoc 2019 Aug 6;8(15):e012277. doi: 10.1161/jaha.119.012277..
Keywords: Blood Pressure, Cardiovascular Conditions, Disparities, Patient-Centered Outcomes Research, Medication, Prevention, Outcomes
McClellan CB
Disparities in opioid related mortality between United States counties from 2000 to 2014.
This study examines disparities in opioid related mortality between United States counties from 2000 to 2014. Unfortunately, counties that had lower rates in 2000 had caught up by 2014. The authors suggest that prevention measures need to be broader in scope and be implemented in areas where the opioid crisis doesn’t seem as prevalent.
AHRQ-authored.
Citation: McClellan CB .
Disparities in opioid related mortality between United States counties from 2000 to 2014.
Drug Alcohol Depend 2019 Apr 25;199:151-58. doi: 10.1016/j.drugalcdep.2019.03.005..
Keywords: Disparities, Medication, Mortality, Opioids, Substance Abuse
Xie Z, St Clair P, Goldman DP
Racial and ethnic disparities in medication adherence among privately insured patients in the United States.
The purpose of this study was to examine the association between socioeconomic status (SES) and racial and ethnic disparities in medication adherence for three widely prescribed therapeutic classes. The investigators concluded that racial/ethnic disparities in adherence were mitigated, but persisted after controlling for detailed socioeconomic measures. They suggest that interventions should focus more on improving medication adherence of existing users, particularly in treating asymptomatic conditions.
AHRQ-funded; HS013447.
Citation: Xie Z, St Clair P, Goldman DP .
Racial and ethnic disparities in medication adherence among privately insured patients in the United States.
PLoS One 2019 Feb 14;14(2):e0212117. doi: 10.1371/journal.pone.0212117..
Keywords: Racial and Ethnic Minorities, Disparities, Patient Adherence/Compliance, Medication, Social Determinants of Health, Health Insurance
Albright KC, Howard VJ, Howard G
Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the reasons for geographic and racial differences in stroke study.
This study analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. It found that statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.
AHRQ-funded; HS023009; HS013852.
Citation: Albright KC, Howard VJ, Howard G .
Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the reasons for geographic and racial differences in stroke study.
J Am Heart Assoc 2017 Aug 2;6(8). doi: 10.1161/jaha.117.005523.
.
.
Keywords: Disparities, Medication, Stroke, Elderly, Sex Factors
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.
.
.
Keywords: Disparities, Medication, Prevention, Adverse Drug Events (ADE), Risk
Adedinsewo D, Taka N, Agasthi P
Prevalence and factors associated with statin use among a nationally representative sample of US Adults: National Health and Nutrition Examination Survey, 2011-2012.
The researchers estimated the prevalence and likelihood of statin use among a statin benefit group with diabetes and a second group with arteriosclerosis. In adjusted models, uninsured and Hispanic adults were less likely to be on a statin compared with white adults; 59.5 percent of all adults in the diabetes statin benefit group, and 63.5 percent of all adults in the srteriosclerosis group were on a statin.
AHRQ-funded; HS022444.
Citation: Adedinsewo D, Taka N, Agasthi P .
Prevalence and factors associated with statin use among a nationally representative sample of US Adults: National Health and Nutrition Examination Survey, 2011-2012.
Clin Cardiol 2016 Sep;39(9):491-6. doi: 10.1002/clc.22577.
.
.
Keywords: Cardiovascular Conditions, Diabetes, Medication, Disparities, Racial and Ethnic Minorities
Govani SM, Wiitala WL, Stidham RW
Age disparities in the use of steroid-sparing therapy for inflammatory bowel disease.
The investigators compared the use of steroids and steroid-sparing therapies and rates of complications among elderly and younger patients in a national cohort of veterans with inflammatory bowel disease (IBD). They found that, after starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Additonally, elderly veterans were less likely to receive steroids and steroid-sparing medications than younger veterans.
AHRQ-funded; HS024122.
Citation: Govani SM, Wiitala WL, Stidham RW .
Age disparities in the use of steroid-sparing therapy for inflammatory bowel disease.
Inflamm Bowel Dis 2016 Aug;22(8):1923-8. doi: 10.1097/mib.0000000000000817.
.
.
Keywords: Digestive Disease and Health, Disparities, Elderly, Medication, Practice Patterns
Qato DM, Trivedi AN, Mor V
Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert.
The researchers compared time to discontinuation of rosiglitazone after the safety alert between black and white elderly persons, and across sociodemographic and economic subgroups. They found that white race and a history of low personal income modestly predicted later discontinuation of rosiglitazone after the FDA's safety advisory in 2007.
AHRQ-funded; HS019657.
Citation: Qato DM, Trivedi AN, Mor V .
Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert.
Med Care 2016 Apr;54(4):406-13. doi: 10.1097/mlr.0000000000000502..
Keywords: Medication, Disparities, Elderly, Social Determinants of Health, Vulnerable Populations
Du XL, Parikh RC, Lairson DR
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
The authors examined racial/ethnic and geographical disparities in cancer care and costs during the last 6 months of life for lung cancer decedents after the FDA's approval of bevacizumab. They found that there were substantial racial/ethnic and geographic disparities in the types of cancer care and costs in the last 6 months of life among lung cancer decedents, regardless of the length of survival times and hospice care status.
AHRQ-funded; HS018956.
Citation: Du XL, Parikh RC, Lairson DR .
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
Lung Cancer 2015 Dec;90(3):442-50. doi: 10.1016/j.lungcan.2015.09.017.
.
.
Keywords: Cancer, Cancer: Lung Cancer, Disparities, Healthcare Costs, Medication, Palliative Care, Patient-Centered Outcomes Research, Practice Patterns, Racial and Ethnic Minorities
Ringwalt C, Roberts AW, Gugelmann H
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
The purpose of this study was to examine differences across providers’ specialties in prescriptions filled by white and black Medicaid beneficiaries with chronic noncancer pain (CNCP). It found that race-based differences in beneficiaries’ dispensed opioid prescriptions were more prominent among patients of specialists in obstetrics and gynecology and internal medicine, as well as general practitioners/family medicine physicians.
AHRQ-funded; HS000032.
Citation: Ringwalt C, Roberts AW, Gugelmann H .
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
Pain Med 2015 Apr;16(4):633-40. doi: 10.1111/pme.12555..
Keywords: Chronic Conditions, Disparities, Medicaid, Medication, Opioids, Pain, Racial and Ethnic Minorities
Adams AS, Soumerai SB, Zhang F
Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression.
This study aimed to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on existing black-white disparities in antidepressant treatment rates among patients with diabetes and comorbid depression. It found that policies that remove financial barriers to medications may increase depression treatment rates among patients with diabetes overall while exacerbating treatment disparities.
AHRQ-funded; HS018577; HS018072.
Citation: Adams AS, Soumerai SB, Zhang F .
Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression.
Clin Ther 2015 Mar;37(3):597-609. doi: 10.1016/j.clinthera.2014.12.011..
Keywords: Medication, Disparities, Depression, Diabetes, Healthcare Costs