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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.
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1 to 25 of 406 Research Studies DisplayedMota L, Marcaccio CL, Patel PB
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
This study measured the impact of neighborhood social disadvantage on abdominal aortic aneurysm (AAA) severity and management. The authors identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An area deprivation index (ADI) score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation, which was then divided into quintiles. Outcomes looked at were rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Among the 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%). Increasing ADI quintiles trended towards increasing rAAA and decreasing EVAR rates. In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair and lower odds of undergoing EVAR.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Patel PB .
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
J Vasc Surg 2023 Apr;77(4):1077-86.e2. doi: 10.1016/j.jvs.2022.10.048.
Keywords: Social Determinants of Health, Cardiovascular Conditions, Surgery, Disparities
Jones SA, Van Driest S, Sommer EC
Direct-to-patient telehealth equity: Reaching diverse pediatric populations in primary care.
This study’s goal was to assess disparities in direct-to-patient (DTP) telehealth experience for pediatric patients. The authors examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers. Providers completed an electronic survey with patient feedback about the telehealth experience and their own providers for visits from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). The majority of telehealth visits were in English and English speakers had a positive experience overall. Non-English speakers had more barriers, although most telehealth visits were rated as satisfactory.
AHRQ-funded; HS026122.
Citation: Jones SA, Van Driest S, Sommer EC .
Direct-to-patient telehealth equity: Reaching diverse pediatric populations in primary care.
Fam Syst Health 2023 Mar;41(1):61-67. doi: 10.1037/fsh0000685.
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Disparities
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Kumar V, Encinosa W
Racial disparities in the perceived risk of COVID-19 and in getting needed medical care.
This AHRQ-authored study examined racial and ethnic disparities in eight measures on the perceived risks of COVID-19. The authors used the nationally representative Stanford University School of Medicine Coronavirus Attitudes and Behaviors Survey fielded in May of 2020. Black respondents were 15 percentage points more likely than White respondents to believe the pandemic would not end by Summer 2020 (92% vs 77%), and were 19 percentage points more likely than any other race to feel a need to protect their family from COVID-19 (81% vs 62%). Latinx respondents were 10 percentage points more fearful than White respondents of catching COVID-19 in public places (55% vs 45%). Black respondents were 20 percentage points more likely than White respondents to think they would need medical care if infected (71% vs 51%), and 18 percentage points more likely to think they would need to be hospitalized (59% vs 41%). The proportion of Black respondents believing that the hospital would not have enough capacity to treat them if infected with COVID-19 was 12 percentage points higher than White respondents (41% vs 29%).
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Racial disparities in the perceived risk of COVID-19 and in getting needed medical care.
J Racial Ethn Health Disparities 2023 Feb; 10(1):4-13. doi: 10.1007/s40615-021-01191-5..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities
O'Donnell TFX,, Dansey KD, Marcaccio CL
Racial disparities in treatment of ruptured abdominal aortic aneurysms.
This study evaluated regional center transfer rates, turndown rates, and outcomes for Black vs White patients presenting with ruptured abdominal aortic aneurysms (rAAAs) in two large databases. All rAAA repairs in the Vascular Quality Initiative from 2003 to 2020 was used. The authors used the National Inpatient Sample from 2004 to 2015 to examine turndown rates for repair. They identified 4935 patients with rAAAs in the Vascular Quality Initiative (6.2% Black) and 48,489 in the National Inpatient Sample (6.0% Black). Transfer rates were high; however, Black patients were significantly less likely to undergo transfer before repair compared with White patients (49% Black vs 62% White). No significant differences were found in perioperative mortality or complications. However, Black patients were significantly more likely to be turned down for repair (37% vs 28%). This difference was mostly found to be due to insurance status. Patients with private insurance had undergone surgery at a similar rate. However, among patients with Medicare or Medicaid/self-pay, Black patients were less likely than were White patients to undergo repair (Medicare, 64% vs 72%; Medicaid/self-pay, 43% vs 61%). Medicaid/self-pay patients were less likely to undergo repair than were patients of the same race with either Medicare or private insurance.
AHRQ-funded; HS027285.
Citation: O'Donnell TFX,, Dansey KD, Marcaccio CL .
Racial disparities in treatment of ruptured abdominal aortic aneurysms.
J Vasc Surg 2023 Feb; 77(2):406-14. doi: 10.1016/j.jvs.2022.08.009..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Cardiovascular Conditions
Encinosa W, Moon K, Figueroa J
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
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Khoong EC, Rivadeneira NA, Pacca L
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
This report’s objective was to describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. The authors conducted a retrospective cohort study using data from five California public hospital systems between July 2015 and June 2017. The authors assessed follow-up rates of colonoscopy after positive fecal immunochemical tests (FIT) and breast tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Negative associations with follow-up colonoscopy were associated with older age, Medicaid insurance, lack of insurance, English language and site; while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 64% received a timely biopsy; only site was associated with timely follow-up biopsy. Site-level factors were found to have a larger, more consistent impact on follow-up rates than patient sociodemographic traits.
AHRQ-funded; HS024412.
Citation: Khoong EC, Rivadeneira NA, Pacca L .
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
J Gen Intern Med 2023 Jan; 38(1):21-29. doi: 10.1007/s11606-022-07657-4..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Screening, Disparities, Women
Moriya AS, Chakravarty S
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Lock LJ, Channa R, Brennan MB
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
The goal of this retrospective cohort study was to determine the role of level of disadvantage in diabetic eye screening to explain the effect of health systems on rural and urban disparities. Researchers used an all-payer, statewide claims database to include adult Wisconsin residents with diabetes who had claims billed throughout the baseline and measurement years. Results indicated that patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics; similar findings emerged for both Medicare and non-Medicare subgroups. The researchers concluded that health systems, especially those that serve urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions and supporting patients in overcoming barriers.
AHRQ-funded; HS026279.
Citation: Lock LJ, Channa R, Brennan MB .
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
BMJ Open Diabetes Res Care 2022 Dec;10(6):e003174. doi: 10.1136/bmjdrc-2022-003174..
Keywords: Rural Health, Access to Care, Screening, Diabetes, Eye Disease and Health, Disparities, Chronic Conditions, Health Systems
Strauss AT, Sidoti CN, Purnell TS
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
This multicenter study examined racial and ethnic inequities in liver transplantation. The authors recruited participants from the liver transplantation (LT) teams including coordinators, advanced practice providers, physicians, social workers, dieticians, pharmacists, leadership at 2 major LT centers. They conducted 54 interviews and had 49 observation hours. They created a conceptual framework describing how transplant work system characteristics and other external factors may improve equity in the LT evaluation process. They proposed transplant center-level solutions (i.e., including but not limited to training of staff on health equity) to modifiable barriers in the clinical work system that could help patient navigation, reduce disparities, and improve access to care. Their findings call for an urgent need for transplant centers, national societies, and policy makers to focus efforts on improving equity (tailored, patient-centered resources) using the science of human factors and systems engineering.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Purnell TS .
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
Liver Transpl 2022 Dec;28(12):1841-56. doi: 10.1002/lt.26532..
Keywords: Racial and Ethnic Minorities, Transplantation, Disparities, Access to Care
Ganeshan S, Pierce L, Mourad M
Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities.
The purpose of this study was to explore the impact of self-scheduling on equitable access to care. The researchers utilized an electronic health record patient portal at the University of California San Francisco which deployed a self-scheduling tool allowing patients to self-schedule diagnostic imaging studies. The study found that among all patient portal users, Latinx, Black/African American, and non-English speaking patients, as well as patients with Medi-Cal, California's Medicaid program, and Medicare insurance were less likely to self-schedule studies. were all less likely to self-schedule when compared with commercially insured patients.
AHRQ-funded; HS026383.
Citation: Ganeshan S, Pierce L, Mourad M .
Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities.
J Am Med Inform Assoc 2022 Nov 14;29(12):2096-100. doi: 10.1093/jamia/ocac152..
Keywords: Disparities, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
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.
AHRQ-funded; HS024600.
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 and 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.
AHRQ-funded; HS027285.
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 and 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.
AHRQ-funded; HS027285.
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 and 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.
AHRQ-funded; HS027285.
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 and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
O'Connell J, Grau L, Goins T
The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs.
This study analyzed the costs of treatment for all-cause dementia among American Indians and Alaska native (AI/AN) adults who access services through the Indian Health Service (IHS) and Tribal health programs. The authors analyzed fiscal year 2013 IHS/Tribal treatment costs for AI/ANs aged 65 and over with dementia and a matched sample without dementia (n= 1842). Mean total treatment costs for adults with dementia were $5400 higher than for adults without dementia ($13,027 versus $7627). The difference in adjusted total treatment costs was $2943, the majority of which was due to the difference in hospital inpatient costs.
AHRQ-funded; 290200600020I.
Citation: O'Connell J, Grau L, Goins T .
The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs.
Alzheimers Dement 2022 Nov;18(11):2055-66. doi: 10.1002/alz.12603..
Keywords: Dementia, Racial and Ethnic Minorities, Healthcare Costs, Disparities
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.
AHRQ-funded; HS026369.
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.
AHRQ-funded; HS026390.
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
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.
AHRQ-authored.
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 and Ethnic Minorities
Butler T, Cummings LS, Purnell TS
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
The authors of this article propose a more diverse transplant workforce to address the problem of kidney transplant inequity. Black patients are disproportionately affected by kidney failure and systemic barriers to kidney transplantation such as delayed referrals, which may be due to clinician bias. Workforce diversity would help to alleviate the harm of implicit biases.
AHRQ-funded; HS024600.
Citation: Butler T, Cummings LS, Purnell TS .
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
J Am Soc Nephrol 2022 Oct; 33(10):1817-19. doi: 10.1681/asn.2022040429..
Keywords: Kidney Disease and Health, Transplantation, Workforce, Disparities, Racial and 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.
AHRQ-funded; HS026006.
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.
AHRQ-funded; HS026038.
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
