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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 233 Research Studies Displayed
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.
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, Socioeconomic Factors, Disparities, Racial / Ethnic Minorities, Risk
Lee CI, Zhu W, Onega T
Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.
This study looked at access to digital breast tomography (DBT) versus regular mammography and whether women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early adoption period and persistently lower DBT use over time. This cross-sectional study included 92 geographically diverse imaging facilities across 5 US states, with over 2.3 million screening examinations performed among women aged 40 to 89 years from January 1, 2011, to December 31, 2017. Data were analyzed from June 2019, to August 2020. Women who used DBT increased for all women from 3.3% in 2011 to 82.6% in 2017. In 2012, Black, Hispanic, Asian American, and women with less than a high school education had lower DBT access compared to White women attending the same facility and also college graduates. Lower DBT access continued over time regardless of the number of years after facility-level DBT adoption.
Citation: Lee CI, Zhu W, Onega T . Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status. JAMA Netw Open 2021 Feb;4(2):e2037546. doi: 10.1001/jamanetworkopen.2020.37546..
Keywords: Cancer: Breast Cancer, Cancer, Mammogram, Imaging, Access to Care, Women, Socioeconomic Factors, Racial / Ethnic Minorities, Screening
Hammad Mrig E
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with fundamental cause theory to address limitations in the latter theory, making it more useful in health disparities research. This work deepens appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.
Citation: Hammad Mrig E . Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing. Sociol Health Illn 2021 Jan;43(1):133-48. doi: 10.1111/1467-9566.13195..
Keywords: Socioeconomic Factors, Disparities, Health Insurance, Access to Care, Genetics, Policy
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
Citation: Brewster AL, Fraze TK, Gottlieb LM . The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians. Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords: Payment, Social Determinants of Health, Practice Patterns, Innovations and Emerging Issues, Screening, Risk, Value, Socioeconomic Factors, Nutrition, Vulnerable Populations
Joyce NR, Pfeiffer MR, Zullo AR
Individual and geographic variation in driver's license suspensions: evidence of disparities by race, ethnicity and income.
Using data from the New Jersey Safety Health Outcomes data warehouse 2004-2018, the authors compared characteristics of suspended drivers, their residential census tract, as well as access to public transportation and jobs, by reason for the suspension. They found that 91% of license suspensions were for non-driving-related events, with the most common reason for a suspension being failure to pay a fine. Non-driving-related suspended drivers lived in census tracts with a lower household median income, higher proportion of black and Hispanic residents and higher unemployment rates, but also better walkability scores and better access to public transportation and jobs. They recommended additional work to determine what effect this has for the social and economic well-being of suspended drivers.
Citation: Joyce NR, Pfeiffer MR, Zullo AR . Individual and geographic variation in driver's license suspensions: evidence of disparities by race, ethnicity and income. J Transp Health 2020 Dec;19. doi: 10.1016/j.jth.2020.100933..
Keywords: Racial / Ethnic Minorities, Disparities, Low-Income, Vulnerable Populations, Socioeconomic Factors, Social Determinants of Health
Althoff KN, Leifheit KM, Park JN
Opioid-related overdose mortality in the era of fentanyl: monitoring a shifting epidemic by person, place, and time.
Investigators described US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl. Using the CDC’s WONDER database, they found a disproportionate increase in opioid-related overdose deaths among urban non-Hispanic Black Americans and recommended interventions for this population in order to halt the increase in overdose deaths.
Citation: Althoff KN, Leifheit KM, Park JN . Opioid-related overdose mortality in the era of fentanyl: monitoring a shifting epidemic by person, place, and time. Drug Alcohol Depend 2020 Nov 1;216:108321. doi: 10.1016/j.drugalcdep.2020.108321..
Keywords: Opioids, Medication, Substance Abuse, Mortality, Racial / Ethnic Minorities, Socioeconomic Factors
Whooten RC, Horan C, Cordes J
Evaluating the implementation of a before-school physical activity program: a mixed-methods approach in Massachusetts, 2018.
The aim of this study was to evaluate the implementation of a widely available, before-school, physical activity program in a low-resource, racially/ethnically and socioeconomically diverse, urban school setting to identify adaptations needed for successful implementation. The investigators used a collaborative effort with stakeholders to implement the Build Our Kids' Success (BOKS) program in 3 schools in Revere, Massachusetts.
Citation: Whooten RC, Horan C, Cordes J . Evaluating the implementation of a before-school physical activity program: a mixed-methods approach in Massachusetts, 2018. Prev Chronic Dis 2020 Oct 1;17:E116. doi: 10.5888/pcd17.190445..
Keywords: Children/Adolescents, Education, Implementation, Health Promotion, Prevention, Lifestyle Changes, Socioeconomic Factors
Roberts ET, Mehrotra A
Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine.
In this study, the investigators examined disparities in digital access (ie, access at home to technology that enables video telemedicine visits) among Medicare beneficiaries by socioeconomic and demographic characteristics. The investigators concluded that the proportion of beneficiaries who lacked digital access was higher among those with low socioeconomic status, those 85 years or older, and in communities of color.
Citation: Roberts ET, Mehrotra A . Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine. JAMA Intern Med 2020 Oct;180(10):1386-89. doi: 10.1001/jamainternmed.2020.2666..
Keywords: Elderly, Medicare, Telehealth, Health Information Technology (HIT), Disparities, Access to Care, Socioeconomic Factors, Low-Income, Racial / Ethnic Minorities
Oates GR, Baker E, Rowe SM
Tobacco smoke exposure and socioeconomic factors are independent predictors of pulmonary decline in pediatric cystic fibrosis.
This longitudinal study evaluates the effects of tobacco smoke exposure and socioeconomic factors on pulmonary decline in pediatric cystic fibrosis (CF). Data from the CF Foundation Patient Registration was obtained for patients who were 6-18 years old at the end of 2016. Lung function measures (ppFEV(1)) for 10,895 individuals was calculated at each attained age. At age 6, lung function was 4.7% lower among smoke-exposed children than among unexposed with this deficit continuing through age 18. Smoke exposure and socioeconomic factors had independent, additive associations with lung function. Factors that declined ppFEV(1) include smoke exposure (2.4%), lower paternal education (4.9%), public insurance (0.3%), and increased 0.2% with each $10,000 annual household income.
Citation: Oates GR, Baker E, Rowe SM . Tobacco smoke exposure and socioeconomic factors are independent predictors of pulmonary decline in pediatric cystic fibrosis. J Cyst Fibros 2020 Sep;19(5):783-90. doi: 10.1016/j.jcf.2020.02.004..
Keywords: Children/Adolescents, Respiratory Conditions, Tobacco Use, Socioeconomic Factors, Risk
Bolstad CJ, Moak R, Brown CJ
Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults.
This study tested how neighborhood disadvantage (ND) relates to depressive symptomology and diagnosis to assess for neighborhood disparities in mental health care cross-sectionally. Using data from the University of Alabama at Birmingham Study of Aging, the investigators found living in the high and mid-ND tertiles to be associated with depressive symptomology, yet ND had no significant relation to depression diagnosis. They concluded that older adults living in high and mid-disadvantaged neighborhoods may be more likely to experience depressive symptomology but not receive a diagnosis, indicating a possible disparity in mental health care.
Citation: Bolstad CJ, Moak R, Brown CJ . Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults. Int J Environ Res Public Health 2020 Aug 8;17(16). doi: 10.3390/ijerph17165745..
Keywords: Elderly, Depression, Behavioral Health, Diagnosis, Disparities, Socioeconomic Factors
Fiori KP, Heller CG, Rehm CD
Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019.
This study used results from a 10-item social needs screener conducted across 19 primary care practices in Bronx County, New York to determine reasons for no-show appointments between April 2018 and July 2019. They examined the association between unmet needs and a 2-year history of missed appointments from 41,637 patients. Overall, the no-show appointment rate was 26.6%. Patients with 1 or more unmet social needs had a significantly higher no-show proportion (31.5%) than those without (26.3%). The strongest association with no-shows was with transportation problems.
Citation: Fiori KP, Heller CG, Rehm CD . Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019. Am J Public Health 2020 Jul;110(S2):S242-s50. doi: 10.2105/ajph.2020.305717..
Keywords: Urban Health, Primary Care, Access to Care, Socioeconomic Factors
Atkins M, Castro I, Sharifi M
Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017-2019.
This study examined the effects of housing insecurity and unmet social needs on adherence to pediatric weight management intervention (PWMI) programs. The authors used data from children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensive PWMIs in Massachusetts. Families with housing security had higher contact hours with the program than families without. Children with 3 to 4 unmet social needs (parental stress, parental depression, food insecurity, and housing insecurity) also attended less hours of the program than those without.
Citation: Atkins M, Castro I, Sharifi M . Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017-2019. Am J Public Health 2020 Jul;110(S2):S251-s57. doi: 10.2105/ajph.2020.305772..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Patient Adherence/Compliance, Socioeconomic Factors, Family Health and History
AHRQ Author: Basu J
Multilevel risk factors for hospital readmission among patients with opioid use disorder in selected US States: role of socioeconomic characteristics of patients and their community.
This study examined the association of socioeconomic characteristics of individuals hospitalized with a principal diagnosis of opioid use disorder and their all-cause 30-day readmission risks. Discharge data from the 2014 HCUP Survey was used and was linked to community and hospital characteristics using data from HRSA and the American Hospital Association. Medicare is associated with the highest readmission risk followed by Medicaid covered patients. Self-pay or covered by other payers had a similar risk to private insurance coverage. Urban patients also had a higher readmission rate than rural patients.
Citation: Basu J . Multilevel risk factors for hospital readmission among patients with opioid use disorder in selected US States: role of socioeconomic characteristics of patients and their community. Health Serv Res Manag Epidemiol 2020 Jan-Dec;7:2333392820904240. doi: 10.1177/2333392820904240..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Medication, Substance Abuse, Hospital Readmissions, Hospitals, Socioeconomic Factors
Jannat-Khah DP, Khodneva Y, Bryant K
Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.
This study examined whether time-varying depressive symptoms (TVDS) predict mortality and if racial and income differences moderate the association in a large cohort. The cohort from the REGARDS study was used to look at that determination. The REGARDS study used community-dwelling U.S. adults aged 45 years or older. They found that there was similar and statistically significant differences with white, black, and low-income ($35,000 or less) participants for the association between TVDS and mortality. High-income participants were found to have a lower hazard.
Citation: Jannat-Khah DP, Khodneva Y, Bryant K . Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants. Ann Epidemiol 2020 Jun;46:31-40.e2. doi: 10.1016/j.annepidem.2020.04.004..
Keywords: Depression, Behavioral Health, Racial / Ethnic Minorities, Cardiovascular Conditions, Cancer, Low-Income, Socioeconomic Factors, Mortality
Lee JT, Polsky D, Fitzsimmons R
Proportion of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining accountable care organizations.
The purpose of this study was to test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining an accountable care organization (ACO). This cohort study’s subjects consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician groups. ACO file were used to determine Medicare Shared Savings Program (MSSP) participation. No changes were found in the proportions of vulnerable patients cared for by ACO-participating physician groups after joining an ACO compared with changes among nonparticipating groups.
Citation: Lee JT, Polsky D, Fitzsimmons R . Proportion of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining accountable care organizations. JAMA Netw Open 2020 May;3():e204439. doi: 10.1001/jamanetworkopen.2020.4439.
Keywords: Socioeconomic Factors, Racial / Ethnic Minorities, Medicare
Goto T, Yoshida K, Faridi MK
Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation.
This study examined whether adding social factors improved the predictive ability for 30-day hospital readmissions for COPD. Social factors include educational level and marital status. Out of 905 hospitalizations identified in the Medicare Current Beneficiary Survey from 2006 through 2012, 18.5% were readmitted within 30 days. The optimized model including social factors for prediction improved for early readmissions but not for late readmissions.
Citation: Goto T, Yoshida K, Faridi MK . Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation. BMC Pulm Med 2020 Apr 29;20(1):107. doi: 10.1186/s12890-020-1136-8..
Keywords: Respiratory Conditions, Hospital Readmissions, Hospitalization, Socioeconomic Factors, Chronic Conditions
Fahrenbach J, Chin MH, Huang ES
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
This study examined the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. Results showed that lower hospital summary scores were associated with caring for neighborhoods with higher social risk. Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups and smallest in the safety, efficiency, and effectiveness of care groups. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
Citation: Fahrenbach J, Chin MH, Huang ES . Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program. Med Care 2020 Apr;58(4):376-83. doi: 10.1097/mlr.0000000000001283..
Keywords: Quality of Care, Hospitals, Medicare, Quality Indicators (QIs), Patient Experience, Socioeconomic Factors
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.
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, Socioeconomic Factors, Racial / Ethnic Minorities
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.
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, Socioeconomic Factors, Disparities, Racial / Ethnic Minorities
Grafova IB, Monheit AC, Kumar R
How do changes in income, employment and health insurance affect family mental health spending?
This study used eight two-year panels from the MEPS data for 2004 to 2012 to examine the effect of economic shocks on mental health spending by families with children. Researchers wanted to determine whether the greatest impact on mental health spending comes from income, employment, or health insurance shocks. They used two-part expenditure models to estimate that employment losses are positively related to an increase in total family mental health expenditures. But no link was found between economic shocks and mental health spending on fathers.
Citation: Grafova IB, Monheit AC, Kumar R . How do changes in income, employment and health insurance affect family mental health spending? Rev Econ Househ 2020 Mar;18(1:239-63. doi: 10.1007/s11150-018-9436-y.
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Behavioral Health, Socioeconomic Factors, Health Insurance
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.
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: Socioeconomic Factors, Racial / Ethnic Minorities, Surgery, Disparities
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J . Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot? BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Chemotherapy, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Socioeconomic Factors, Vulnerable Populations, Uninsured, Hospitals, Quality of Care, Treatments
Klawetter S, McNitt C, Hoffman JA
Perinatal depression in low-income women: a literature review and innovative screening approach.
This paper is a literature review of perinatal depression prevalence, consequences, and screening among low-income women and women of color. The Warm Connections program has an innovative perinatal depression screening protocol and was used with WIC participants. The literature showed mixed findings of perinatal prevalence among low-income women and women of color. There were lower perinatal depression rates in the Warm Connections program in studies using less specific perinatal depression screening instruments with similar samples.
Citation: Klawetter S, McNitt C, Hoffman JA . Perinatal depression in low-income women: a literature review and innovative screening approach. Curr Psychiatry Rep 2020 Jan 7;22(1):1. doi: 10.1007/s11920-019-1126-9.
Keywords: Depression, Pregnancy, Women, Low-Income, Socioeconomic Factors, Screening, Behavioral Health, Maternal Care, Disparities, Diagnosis
Wong MS, Arnold CM, Roberts ET
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
The primary aim of this study was to examine the relationship between participation in federal housing assistance programs and self-reported cancer screening among low-income adults. The investigators concluded that their results reinforced the need to improve rates of screening and suggested that providing housing assistance, in and of itself, may be insufficient to overcome the multiple access barriers that low-income populations face.
Citation: Wong MS, Arnold CM, Roberts ET . The relationship between federal housing assistance and uptake of cancer screening among low-income adults. J Gen Intern Med 2019 Dec;34(12):2714-16. doi: 10.1007/s11606-019-05037-z..
Keywords: Cancer, Screening, Low-Income, Vulnerable Populations, Access to Care, Healthcare Utilization, Socioeconomic Factors
Roberts ET, Mellor JM, McInerney M
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
The purpose of this study was to examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. The investigators concluded that characteristics of dual enrollees differed substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerney M . State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment. Health Serv Res 2019 Dec;54(6):1233-45. doi: 10.1111/1475-6773.13205..
Keywords: Medicare, Medicaid, Socioeconomic Factors