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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 389 Research Studies Displayed
Purnell TS, Bignall ONR, Norris KC
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
This article discusses actions necessary to effectively prepare a new generation of nephrology thought leaders who understand the roles of structural racism and social determinants of health (SDOH) in continuing racial disparities as critical issues in efforts that promote kidney health equity. The authors provide their recommendations for centering antiracism and social justice in nephrology education to advance kidney health equity, including: 1 Acknowledging and adopting evidence-based strategies to address implicit biases and explicit acts of interpersonal racism in healthcare encounters that may perpetuate kidney health disparities; 2) Strive to remove structural racism at the societal and health system levels that systematically introduce inequities in kidney care; 3) incorporate research training inclusive of methodologic and content areas that are vital to health equity; 4) foster role modeling within nephrology education through faculty mentorship and professional networking opportunities. The authors conclude that to effectively advance kidney research and practice, sustainable solutions to eradicate disparities must be developed and a prepared nephrology workforce must be trained, one that centers antiracism and social justice in sustained efforts to advance kidney health equity.
Citation: Purnell TS, Bignall ONR, Norris KC . Centering anti-racism and social justice in nephrology education to advance kidney health equity. J Am Soc Nephrol 2022 Nov;33(11):1981-84. doi: 10.1681/asn.2022040432..
Keywords: Racial / Ethnic Minorities, Kidney Disease and Health, Disparities, Education: Continuing Medical Education, Education: Curriculum
Marcaccio CL, Patel PB, de Guerre L
Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity.
The purpose of this study was to identify variations in 5-year outcomes and imaging surveillance after elective endovascular aortic aneurysm repair (EVAR) by sex, race, and ethnicity and to examine possible mechanisms contributing to these variations. The primary outcome was 5-year aneurysm rupture. Secondary outcomes were 5-year reintervention and mortality, and having no aortic imaging follow-up from 6 to 24 months after EVAR. The study found that among 16,040 patients, 73% were White males, 18% were White females, 2.6% were Black males, 1.1% were Black females, 0.9% were Asian males, 0.2% were Asian females, 1.7% were Hispanic males, and 0.4% were Hispanic females. At 5 years, Black females had the highest rupture rates at 6.4% and white males had the lowest at 2.3%. Compared with White males, rupture rates were higher in White females, Black females, and Asian females. Among other groups, Black males had higher reintervention and both Black and Hispanic males had higher rates of no imaging follow-up. In adjusted analyses, White, Black, and Asian females remained at significantly higher risk for 5-year rupture. The researchers concluded that Black females had higher 5-year aneurysm rupture, reintervention, and mortality rates after elective EVAR as compared with White male patients, whereas White females had higher rupture, mortality and loss-to-imaging-follow-up compared to White male patients. Black males had higher reintervention and no imaging follow-up, and Asian females had higher rupture rates.
Citation: Marcaccio CL, Patel PB, de Guerre L . Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity. J Vasc Surg 2022 Nov;76(5):1205-15.e4. doi: 10.1016/j.jvs.2022.03.886..
Keywords: Disparities, Racial / Ethnic Minorities, Sex Factors, Outcomes, Imaging, Heart Disease and Health, Cardiovascular Conditions
Marcaccio CL, O'Donnell TFX, Dansey KD
Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.
The purpose of this study was to examine the demographics of patients enrolled in critical U.S. endovascular aortic device trials to explore the representation of vulnerable populations, including women and racial and ethnic minorities. The primary outcomes included the percentage of trials reporting participant sex, race, and ethnicity and the percentage of participants across sex, racial, and ethnic groups. The study found that the Food and Drug Administration (FDA) provided 29 approvals from 29 trials of 24 devices with a total of 4046 patients: 52% (15) were EVAR devices, 41% (12) were TEVAR devices, and 3.4% (1) was a FEVAR device, with 1 dissection stent (3.4%). Fifty-two percent of the trials reported the three most common racial groups (White, Black, Asian), and 48% reported Hispanic ethnicity. The TEVAR trials were the most likely to report all three racial groups and Hispanic ethnicity (92% and 75%, respectively), while the EVAR trials had the lowest reporting rates (13% and 20%, respectively). The median female enrollment was 21%, with the EVAR trials having the lowest female enrollment compared with 41% in the TEVAR trials, 21% in the FEVAR trial, and 34% in the dissection stent trial. The study concluded that in critical aortic device trials that led to FDA approval, female patients were underrepresented, especially for EVAR, and racial and ethnic minority groups were under-represented and underreported.
Citation: Marcaccio CL, O'Donnell TFX, Dansey KD . Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials. J Vasc Surg 2022 Nov;76(5):1244-52.e2. doi: 10.1016/j.jvs.2022.05.003..
Keywords: Disparities, Racial / Ethnic Minorities, Heart Disease and Health, Cardiovascular Conditions, Medical Devices, Sex Factors
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
Citation: Anjorin AC, Marcaccio CL, Patel PB . Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia. J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial / Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Coley RY, Duan KI, Hoopes AJ
A call to integrate health equity into learning health system research training.
This paper is a call to integrate health equity into the competency domain for learning health systems (LHS) research training. In 2016, AHRQ recommended seven domains for training and mentoring researchers, but health equity was not included. Scholars in the Consortium for Applied Training to Advance the Learning health system with Scholars/Trainees (CATALyST) K12 program recommend that competency domains be extended to reflect growing demands for evidence on health inequities and interventions to alleviate them. The authors present real-life case studies in an LHS research training program that illustrate facilitators, challenges, and potential solutions at the program, funder, and research community-level to receiving training and mentorship in health equity-focused LHS science. They recommend actions in four areas for LHS research training programs: (a) integrate health equity throughout the current LHS domains; (b) develop training and mentoring in health equity; (c) establish program evaluation standards for consideration of health equity; and (d) bring forth relevant, extant expertise from the areas of health disparities research, community-based participatory research, and community-engaged health services research.
Citation: Coley RY, Duan KI, Hoopes AJ . A call to integrate health equity into learning health system research training. Learn Health Syst 2022 Oct;6(4):e10330. doi: 10.1002/lrh2.10330..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Disparities
Severance TS, Njuguna F, Olbara G
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
This study described the international collaboration to investigate disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Estimates of cancer incidence in similar populations around the world would indicate approximately 1500 patients should be diagnosed each year. However, internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75-80% of patients go undiagnosed and do not receive treatment. The authors reviewed 41 malaria slides at a local referring hospital that demonstrated both morphologic and genetic evidence of leukemia. This disparity suggested a lack of education and training that were the lead factors contributing to lower rates of diagnosis.
Citation: Severance TS, Njuguna F, Olbara G . An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Pediatr Blood Cancer 2022 Oct;69(10):e29768. doi: 10.1002/pbc.29768..
Keywords: Children/Adolescents, Cancer, Disparities, Diagnostic Safety and Quality
Hegland TA, Owens PL, Selden TM
AHRQ Author: Hegland TA, Owens PL, Selden TM
New evidence on geographic disparities in United States hospital capacity.
The purpose of this study was to describe hospital capacity across the United States. The researchers combined American Hospital Association Survey, Hospital Compare, and American Community Survey data with the 2017 near-census of U.S. hospital inpatient discharges from the Healthcare Cost and Utilization Project (HCUP). The study found that 0.11 more beds per 1000 population were supplied to zip codes where Non-Hispanic individuals live than zip codes where non-Hispanic White individuals live. However, the hospitals supplying this capacity have 0.36 fewer staff per bed and perform worse on many care quality measures. Zip codes in the most urban parts of America have the least hospital capacity (2.11 beds per 1000 persons) from across the rural-urban continuum. While more rural areas have higher capacity levels, urban areas have advantages in staff and capital per bed. The researchers did not find systematic differences in care quality between rural and urban areas. The study concluded that lower hospital care quality and resource intensity plays a key role in racial, ethnic, and income disparities in hospital care related outcomes.
Citation: Hegland TA, Owens PL, Selden TM . New evidence on geographic disparities in United States hospital capacity. Health Serv Res 2022 Oct;57(5):1006-19. doi: 10.1111/1475-6773.14010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Hospitals, Quality of Care, Racial / Ethnic Minorities
Gutman CK, Lion KC, Aronson P
Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol.
The purpose of this proposed study is to explore the role of implicit racial bias in inequitable implementation of emergency care clinical guidelines for low-risk febrile infants. The researchers will conduct a cross-sectional study of low-risk febrile infants treated in the emergency departments (ED) of 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee. The study will evaluate the relationship between 1) race and ethnicity and 2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. Simultaneously, the researchers will conduct individual semi-structured interviews with 1) minority parents of febrile infants and 2) pediatric ED physicians. The data will be reviewed to assess disparities and bias in communication and medical decision-making.
Citation: Gutman CK, Lion KC, Aronson P . Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol. BMJ Open 2022 Sep 20;12(9):e063611. doi: 10.1136/bmjopen-2022-063611..
Keywords: Newborns/Infants, Disparities
Halvorson EE, Thurtle DP, Easter A
Disparities in adverse event reporting for hospitalized children.
The authors compared the adverse event (AE) rate identified by voluntary event reporting (VER) with that identified using the Global Assessment of Pediatric Patient Safety (GAPPS) between hospitalized children by weight category, race, and English proficiency. In the population studied, they identified 288 total AEs, 270 by the GAPPS and 18 by VER. They found a disparity in AE reporting for children with limited English proficiency, with fewer AEs by VER compared with no difference in AEs by GAPPS. They identified no disparities by weight category or race. They concluded that voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.
Citation: Halvorson EE, Thurtle DP, Easter A . Disparities in adverse event reporting for hospitalized children. J Patient Saf 2022 Sep 1;18(6):e928-e33. doi: 10.1097/pts.0000000000001049..
Keywords: Children/Adolescents, Disparities, Adverse Events, Medical Errors, Patient Safety, Hospitals, Hospitalization, Inpatient Care
Shao CC, McLeod MC, Gleason LT
Inequity in telemedicine use among patients with cancer in the Deep South during the COVID-19 pandemic.
The authors’ goal was to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic. They found that telemedicine use, specifically with video, was significantly lower among historically vulnerable populations. They concluded that understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure that the continued evolution of telemedicine will be equitable.
Citation: Shao CC, McLeod MC, Gleason LT . Inequity in telemedicine use among patients with cancer in the Deep South during the COVID-19 pandemic. https://www.pubmed.ncbi.nlm.nih.gov/35348793
Oncologist 2022 Jul 5;27(7):555-64. doi: 10.1093/oncolo/oyac046..
Oncologist 2022 Jul 5;27(7):555-64. doi: 10.1093/oncolo/oyac046..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Cancer, Disparities
Alvarado F, Cervantes CE, Crews DC
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
The purpose of this systematic qualitative review was to evaluate outcomes in Hispanic donors and examine how Hispanic ethnicity was presented. In October 2021, the researchers reviewed PubMed, EMBASE, and Scopus for studies, with 18 meeting the inclusion criteria. Across the studies, Hispanic donors ranged between 6% and 21% of the donor populations. The study found that Hispanic donors were not at increased risk for end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, overall perioperative surgical complications or post-donation mortality compared to non-Hispanic White donors. Also compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were observed regarding the risk for post-donation chronic kidney disease and hypertension. The researchers concluded that future studies should explain variation in health outcomes by considering and assessing differences within the Hispanic donor population.
Citation: Alvarado F, Cervantes CE, Crews DC . Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review. Am J Transplant 2022 Jul;22(7):1737-53. doi: 10.1111/ajt.17017..
Keywords: Transplantation, Kidney Disease and Health, Chronic Conditions, Racial / Ethnic Minorities, Disparities
Blanco C, Kato EU, Aklin WM
AHRQ Author: Kato EU, Tong ST, Bierman A, Meyers D
Research to move policy - using evidence to advance health equity for substance use disorders.
This paper discusses ways that evidence-based research can advance health equity for substance use disorder (SUD) treatment. Racial and ethnic disparities in treatment access and outcomes have widened, despite substantial efforts to address the epidemic of overdose-related deaths in the US. Overdose rates are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in White populations. Possible opportunities to address these disparities include addressing social determinants of health, implementing prevention measures, and supporting data science. The steps to ensure that research reduces disparities are to: 1) include members of underrepresented groups in the development of preventive interventions and treatments, 2) adequately recruit members of historically represented groups and ensure that studies are large enough to measure differences in outcomes according to race and ethnic group, 3) establish equitable partnerships with people who currently have or have had SUDS and their families and engage these groups in evidence production, 4) diversify the scientific workforce, and 4) have investigators measure the effects of policies and interventions on equity.
Citation: Blanco C, Kato EU, Aklin WM . Research to move policy - using evidence to advance health equity for substance use disorders. N Engl J Med 2022 Jun 16;386(24):2253-55. doi: 10.1056/NEJMp2202740..
Keywords: Substance Abuse, Behavioral Health, Policy, Racial / Ethnic Minorities, Disparities, Social Determinants of Health
Sanchez JI, Shankaran V, Unger JM
Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors.
This population-based study assesses individual- and neighborhood-level factors associated with receipt of carcinoembryonic antigen (CEA) and computer tomography (CT) surveillance testing. Using SEER-Medicare data to identify beneficiaries diagnosed with colorectal cancer (CRC) stages II-III, they found that, overall, 78% and 58% of CRC survivors received CEA and CT testing, respectively. Further, Medicare-Medicaid dual coverage was associated with 39% lower odds of receipt of CEA tests among non-Hispanic Whites, while Blacks with dual coverage had almost two times the odds of receiving CEA tests compared to Blacks without dual coverage. Although this study did not find significant differences in receipt of initial CEA and CT surveillance testing across racial/ethnic groups, the assessment of the factors that measure access to care suggests differences in access to these procedures within racial/ethnic groups.
Citation: Sanchez JI, Shankaran V, Unger JM . Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors. J Cancer Surviv 2022 Jun;16(3):638-49. doi: 10.1007/s11764-021-01057-z..
Keywords: Disparities, Cancer: Colorectal Cancer, Cancer
Mobley EM, Moke DJ, Milam J
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
This scoping review’s aim was to demonstrate evidence-based approaches to alleviate barriers and decrease disparities among childhood cancer survivors. A literature review identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including 9 clinical practice guidelines, 4 policy statements, and 3 recommendations. Twenty-seven published studies evaluated an intervention; however these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Interventions most commonly evaluated survivorship care plans (n = 11), or models of care (n = 11) followed by individual survivorship care services (n= 9). Interventions predominantly targeted patients rather than providers or systems.
Citation: Mobley EM, Moke DJ, Milam J . Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review. J Cancer Surviv 2022 Jun;16(3):667-76. doi: 10.1007/s11764-021-01060-4..
Keywords: Children/Adolescents, Disparities, Cancer
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
Citation: Jin MC, Hsin G, Ratliff J . Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors. Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Jacobs PD, Abdus S
AHRQ Author: Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
Citation: Jacobs PD, Abdus S . Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States. Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial / Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Kemme S, Yoeli D, Sundaram SS
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
The purpose of the study was to explore and understand the impact of the COVID-19 pandemic on nationwide pediatric liver transplants. The researchers compared data for transplant waiting list additions, removals, and liver transplants during pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020). The study results showed a 38% decrease in liver transplantations during early COVID-19, recovering to pre-pandemic rates during late COVID-19. White children had a 30% decrease in overall liver transplantation, while non-White children had a 44% decrease in overall liver transplantation. Additions to the waiting list decreased 25% during COVID-19, with Black transplant candidates the most affected, and children spent longer on the waiting list during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days). The study concluded that the COVID-19 pandemic decreased access to pediatric liver transplants, especially during early COVID-19. The researchers discussed that although the rate of pediatric liver transplants has resumed to pre-COVID-19 levels, racial disparities must be addressed.
Citation: Kemme S, Yoeli D, Sundaram SS . Decreased access to pediatric liver transplantation during the COVID-19 pandemic. Pediatr Transplant 2022 Mar;26(2):e14162. doi: 10.1111/petr.14162..
Keywords: Children/Adolescents, COVID-19, Transplantation, Access to Care, Disparities
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
Citation: Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA . Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities
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 / Ethnic Minorities, Risk
Radhakrishnan A, Reyes-Gastelum D, Abrahamse P
Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities.
The authors sought to characterize providers involved in diagnosing and treating thyroid cancer. Patients with differentiated thyroid cancer from the Georgia and Los Angeles County Surveillance, Epidemiology and End Results registries were surveyed. The authors found that, among thyroid cancer patients, 40.6% reported being informed of their diagnosis by their surgeon, 37.9% by their endocrinologist, and 13.5% by their primary care physician (PCP). The researchers concluded that PCPs were involved in thyroid cancer diagnosis and treatment, and their involvement was greater among older patients and patients of minority race/ethnicity.
Citation: Radhakrishnan A, Reyes-Gastelum D, Abrahamse P . Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities. J Clin Endocrinol Metab 2022 Feb 17;107(3):e1096-e105. doi: 10.1210/clinem/dgab781..
Keywords: Cancer, Disparities, Diagnostic Safety and Quality, Practice Patterns, Quality Improvement, Quality of Care
Reid LD, Weiss AJ, Fingar KR
AHRQ Author: Reid LD
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
The authors assessed how patient, hospital, and community characteristics explain the safety-net hospital (SNH)/non-SNH disparity in postpartum readmission rates. Using HCUP data, they found that higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. They recommended hospital initiatives to reduce the risk of postpartum readmissions among SNH patients. They concluded that improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, will require enduring investments in public health.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Reid LD, Weiss AJ, Fingar KR . Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis. J Hosp Med 2022 Feb;17(2):77-87. doi: 10.1002/jhm.2769..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Safety Net, Hospital Readmissions, Pregnancy, Labor and Delivery, Women, Maternal Care
Song Zhang, Zhang X, Patterson LJ
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
This study assessed assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Medicare claims from the Social Security Administration was used to determine in-hospital mortality and mortality inclusive of discharges to hospice and discharges to postacute care. Over 31 million Medicare recipients in the database were analyzed with over 14 million hospitalizations from January 2019 to February 2021. There was a decline in non-COVID-19 and an emergence of COVID-19 hospitalizations among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital mortality was not significantly different among Black patients relative to White patients but was 3.5 percentage points higher among Hispanic patients and other racial and ethnic minority groups. There were disparities in discharges to hospice and postacute care as well.
Citation: Song Zhang, Zhang X, Patterson LJ . Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic. JAMA Health Forum 2021 Dec 23;2(12):e214223. doi: 10.1001/jamahealthforum.2021.4223..
Keywords: COVID-19, Racial / Ethnic Minorities, Disparities, Medicare, Hospitalization, Outcomes, Mortality
Lin JS, Hoffman L, Bean SI
Addressing racism in preventive services: methods report to support the US Preventive Services Task Force.
The purpose of this report was to articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. An audit was conducted assessing published literature on policy and position statements addressing racism, a subset of cancer and cardiovascular topics in USPSTF reports, recent systematic reviews on interventions to reduce health inequities, and societies, organizations, agencies, and funding bodies to gather information about how they address racism and health equity. Findings showed that racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. The most directly relevant and immediately useful guidance identified is that from the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group.
Citation: Lin JS, Hoffman L, Bean SI . Addressing racism in preventive services: methods report to support the US Preventive Services Task Force. JAMA 2021 Dec 21;326(23):2412-20. doi: 10.1001/jama.2021.17579..
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Racial / Ethnic Minorities, Disparities, Research Methodologies, Prevention, Evidence-Based Practice
Steenland MW, Wilson IB, Matteson KA
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
This study’s objective was to measure the association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. A total of 60,990 childbirths were reviewed from January 1, 2014 on with a total of 72.3% paid for by Medicaid and 27.7% paid for by a commercial payer. The mean age of the birthing person was 27; with 67% White, 22% Black, and 7% Hispanic. Medicaid expansion in Arkansas was associated with a 27.8 percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 percentage points before expansion to -2.0 after. However, disparities in outpatient care after expansion persisted between Black and White individuals.
Citation: Steenland MW, Wilson IB, Matteson KA . Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. JAMA Health Forum 2021 Dec;2(12):e214167. doi: 10.1001/jamahealthforum.2021.4167..
Keywords: Medicaid, Maternal Care, Pregnancy, Racial / Ethnic Minorities, Disparities, Policy, Women, Access to Care
Vervoort D, Canner JK, Haut ER
Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair.
In this study, the authors’ goal was to examine racial disparities associated with reinterventions following elective endovascular abdominal aortic aneurysm repair (EVAR) in a real-world cohort. Using the Vascular Quality Initiative EVAR dataset, they found that Black patients requiring reintervention were more frequently female, more frequently current or former smokers, and less frequently insured by Medicare/Medicaid. After adjusting for baseline differences, the risk of reintervention after elective EVAR was significantly lower for Black versus White patients, and all-cause mortality was comparable between groups. The authors recommended further investigation.
Citation: Vervoort D, Canner JK, Haut ER . Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair. J Surg Res 2021 Dec;268:381-88. doi: 10.1016/j.jss.2021.07.010..
Keywords: Racial / Ethnic Minorities, Disparities, Outcomes