National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 39 Research Studies DisplayedApathy NC, Dixit RA, Boxley CL
Variations in physician telemedicine provision.
This study’s objective was to quantify physician variation in telemedicine provisions and the extent to which telemedicine use is explainable by the individual physician, adjusting for temporal, patient, and visit factors. This cross-sectional study used data on adult primary care visits across MedStar Health, Stanford Health Care, and Intermountain Healthcare systems. Primary care physicians who conducted at least 1000 visits between March 13, 2020 and December 31, 2021 were included. Primary care visits were defined in the electronic health record and scheduling systems as completed outpatient visits with those included primary care physicians. The sample consisted of 2,410,471 visits total, with 25.6% via telemedicine seen by 729 physicians. Substantial variation in telemedicine provision was shown across physicians. At least 237 physicians (32.5%) had at least 1 high-outlier week of telemedicine provision. Patient demographics only accounted for 2.3% of the variation in telemedicine use, with the site accounting for 16.3% of the variation. Residual (unexplained) variation accounted for more than half of the explanations. Telemedicine use has slowly declined, largely due to the lack of physical examinations.
AHRQ-funded; HS028255.
Citation: Apathy NC, Dixit RA, Boxley CL .
Variations in physician telemedicine provision.
JAMA Netw Open 2023 Jul; 6(7):e2321955. doi: 10.1001/jamanetworkopen.2023.21955..
Keywords: Low-Income, Social Determinants of Health, Outcomes, Risk
Soulsby WD, Lawson E, Pantell MS
Cumulative social disadvantage associated with childhood arthritis: a cross-sectional analysis of the National Survey of Children's Health.
The purpose of this cross-sectional analysis study was to explore cumulative social disadvantage on childhood arthritis. The researchers developed a cumulative social disadvantage score, assigning 1 point to each of the following variables with a maximum total score of 4: low guardian education (high school or less), low household income level (0-199% of federal poverty level), underinsured status (public or uninsured), and a high adverse childhood experience (ACE) score of 4 or greater. The study found that of the 131,774 surveys completed, a total of 365 children reported current arthritis. Of those 365, cumulative social disadvantage was related with an arthritis diagnosis, with the greatest odds in those with a total score of 4. Cumulative social disadvantage also was related with higher odds of moderate-to-severe arthritis severity.
AHRQ-funded; HS026383.
Citation: Soulsby WD, Lawson E, Pantell MS .
Cumulative social disadvantage associated with childhood arthritis: a cross-sectional analysis of the National Survey of Children's Health.
Arthritis Care Res 2023 Jan; 75(1):3-8. doi: 10.1002/acr.24991..
Keywords: Children/Adolescents, Arthritis, Social Determinants of Health, Low-Income
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Fleming MD, Shim JK, Yen I
Managing the "hot spots": health care, policing, and the governance of poverty in the US.
This research looked at a form of surveillance and intervention by health care systems known as “hot spotting”, which targets high-cost patients who are super-utilizers of emergency departments with intensive health and social services. An ethnographic investigation of hot spotting’s modes of distribution and its workings in the lives of patients and providers found that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. The boundaries between them are shifting as a financialized logic of governance has come to dominate both the health and criminal justice systems.
AHRQ-funded; HS027648.
Citation: Fleming MD, Shim JK, Yen I .
Managing the "hot spots": health care, policing, and the governance of poverty in the US.
Am Ethnol 2021 Nov;48(4):474-88. doi: 10.1111/amet.13032..
Keywords: Low-Income, Social Determinants of Health, Vulnerable Populations
Walter LA, Schoenfeld EM, Smith CH
Emergency department-based interventions affecting social determinants of health in the United States: a scoping review.
Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. In this study, the investigators sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative social determinants of health.
AHRQ-funded; HS025701; HS013852.
Citation: Walter LA, Schoenfeld EM, Smith CH .
Emergency department-based interventions affecting social determinants of health in the United States: a scoping review.
Acad Emerg Med 2021 Jun;28(6):666-74. doi: 10.1111/acem.14201..
Keywords: Emergency Department, Social Determinants of Health, Vulnerable Populations, Low-Income
Patel SA, Krasnow M, Long K
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Researchers examined whether neighborhood environment modifies the disparity in 30-day heart failure (HF) readmissions and mortality between Black and White patients in the Southeastern United States. They created a geocoded retrospective cohort of patients hospitalized for acute HF from 2010-2018 within Emory Healthcare. They found that excess 30-day HF readmissions and mortality were present among Black patients in every neighborhood strata and increased with progressive neighborhood socioeconomic deprivation.
AHRQ-funded; HS026081.
Citation: Patel SA, Krasnow M, Long K .
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Circ Heart Fail 2020 Dec;13(12):e007947. doi: 10.1161/circheartfailure.120.007947..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Racial and Ethnic Minorities, Mortality, Social Determinants of Health, Low-Income, Disparities
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.
AHRQ-funded; HS022998.
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 and Ethnic Minorities, Disparities, Low-Income, Vulnerable Populations, Social Determinants of Health
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.
AHRQ-funded; HS026727.
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, Social Determinants of Health, Low-Income, Racial and Ethnic Minorities
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.
AHRQ-funded; HS025198.
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 and Ethnic Minorities, Cardiovascular Conditions, Cancer, Low-Income, Social Determinants of Health, Mortality
Fiori KP, Rehm CD, Sanderson D
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
This study used logistic regression to identify factors associated with successful social service uptake in an urban pediatric practice. Out of 4948 households screened for social needs from December 2017 to November 2018, 20% self-reported at least one factor. Only 43% of the 287 households with unmet needs reported social service uptake. Greater than 4 outreach encounters were significantly associated with successful referrals. This study suggests the need for additional research and an opportunity for further program optimization.
AHRQ-funded; HS026396.
Citation: Fiori KP, Rehm CD, Sanderson D .
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
Clin Pediatr 2020 Jun;59(6):547-56. doi: 10.1177/0009922820908589..
Keywords: Children/Adolescents, Community-Based Practice, Primary Care, Social Determinants of Health, Implementation, Low-Income
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.
AHRQ-funded; HS026370.
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.
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Keywords: Depression, Pregnancy, Women, Low-Income, Social Determinants of Health, Screening, Behavioral Health, Maternal Care, Disparities, Diagnostic Safety and Quality
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.
AHRQ-funded; HS000029.
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, Social Determinants of Health
Bass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Zullo AR, Adams JW, Gantenberg JR
Examining neighborhood poverty-based disparities in HIV/STI prevalence: an analysis of Add Health data.
The purpose of the study was to estimate the effect of exposure to neighborhood poverty in adolescence on HIV/STI prevalence in early adulthood. The investigators found that strong evidence for neighborhood poverty-based differences in HIV/STI prevalence was not observed. They suggest that researchers should continue to investigate the effect of neighborhood-level socioeconomic position measures and, if warranted, identify etiologically relevant exposure periods.
AHRQ-funded; HS022998.
Citation: Zullo AR, Adams JW, Gantenberg JR .
Examining neighborhood poverty-based disparities in HIV/STI prevalence: an analysis of Add Health data.
Ann Epidemiol 2019 Nov;39:8-14.e4. doi: 10.1016/j.annepidem.2019.09.010..
Keywords: Children/Adolescents, Low-Income, Vulnerable Populations, Disparities, Social Determinants of Health, Human Immunodeficiency Virus (HIV), Infectious Diseases, Young Adults, Health Status
Sonik RA, Parish SL, Mitra M
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
The objective of this study was to assess patterns of food insecurity before and after initial receipt of Supplemental Security Income (SSI) benefits. The investigators concluded that food insecurity rose prior to SSI entry but may be alleviated by programme benefits. They suggest that greater nutritional supports for SSI applicants awaiting decisions may reduce the burden of food insecurity in this population and improve health outcomes.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
Public Health Nutr 2019 Jul;22(10):1909-13. doi: 10.1017/s1368980019000570..
Keywords: Nutrition, Low-Income, Disabilities, Vulnerable Populations, Social Determinants of Health
Gorski Findling MT, Wolfson JA, Rimm EB
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
The authors sought to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. Using data from the National Household Food Acquisition and Purchase Survey, 2012-2013, they found that the odds of childhood overweight/obesity were higher with greater access to combination grocery/other stores overall and for children in SNAP. Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores. The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages. They concluded that greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
AHRQ-funded; HS000055.
Citation: Gorski Findling MT, Wolfson JA, Rimm EB .
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
Obesity 2018 Jun;26(6):1063-71. doi: 10.1002/oby.22184.
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Keywords: Children/Adolescents, Low-Income, Nutrition, Obesity, Social Determinants of Health
Goodman SM, Mandi LA, Mehta B
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
The authors assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. They found that having no college was associated with worse pain and function at baseline and 2 years and that living in a poor neighborhood was associated with worse 2-year pain and function. There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college; in wealthy communities, college was associated with a 1-point difference in pain. Function was similar. The authors recommended further study on how education protects those in impoverished communities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandi LA, Mehta B .
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
Arthritis Care Res 2018 Jun;70(6):884-91. doi: 10.1002/acr.23442..
Keywords: Arthritis, Education, Low-Income, Orthopedics, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Cardet JC, Louisias M, King TS
Income is an independent risk factor for worse asthma outcomes.
The authors investigated whether low income, low education, and high perceived stress were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. They found that participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
AHRQ-funded; HS022986.
Citation: Cardet JC, Louisias M, King TS .
Income is an independent risk factor for worse asthma outcomes.
J Allergy Clin Immunol 2018 Feb;141(2):754-60.e3. doi: 10.1016/j.jaci.2017.04.036..
Keywords: Asthma, Chronic Conditions, Low-Income, Outcomes, Patient-Centered Outcomes Research, Risk, Social Determinants of Health
Akwo EA, Kabagambe EK, Harrell FE, Jr.
Neighborhood deprivation predicts heart failure risk in a low-income population of blacks and whites in the southeastern United States.
The researchers investigated whether neighborhood deprivation predicts risk of incident heart failure (HF) beyond individual socioeconomic status in a low-income population. They concluded that, in a low-income population from the Southern Community Cohort Study, scant neighborhood resources compounded the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors.
AHRQ-funded; HS022990.
Citation: Akwo EA, Kabagambe EK, Harrell FE, Jr. .
Neighborhood deprivation predicts heart failure risk in a low-income population of blacks and whites in the southeastern United States.
Circ Cardiovasc Qual Outcomes 2018 Jan;11(1):e004052. doi: 10.1161/circoutcomes.117.004052.
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Keywords: Heart Disease and Health, Low-Income, Racial and Ethnic Minorities, Risk, Social Determinants of Health
Tung EL, Cagney KA, Peek ME
Spatial context and health inequity: reconfiguring race, place, and poverty.
The authors build on the Chicago School of Sociology's contributions in urban research and one of its contemporary elaborations, often described as the "neighborhood effects approach," to propose a three-axis model of health inequity. This model, in alignment with Chicago School theory, postulates a dynamic and adaptive relationship between spatial context and health inequity. Compositional axes of race and poverty form the foundation of the model.
AHRQ-funded; HS023007.
Citation: Tung EL, Cagney KA, Peek ME .
Spatial context and health inequity: reconfiguring race, place, and poverty.
J Urban Health 2017 Dec;94(6):757-63. doi: 10.1007/s11524-017-0210-x.
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Keywords: Disparities, Low-Income, Racial and Ethnic Minorities, Social Determinants of Health, Urban Health
Lines LM, Rosen AB, Ash AS
Enhancing administrative data to predict emergency department utilization: the role of neighborhood sociodemographics.
Much of emergency department (ED) use is avoidable, and high-quality primary care can reduce it, but performance measures related to ED use may be inadequately risk-adjusted. To explore associations between ED use and neighborhood poverty, a secondary analysis of Massachusetts managed care network data, 2009-2011, was conducted.
AHRQ-funded; HS022194.
Citation: Lines LM, Rosen AB, Ash AS .
Enhancing administrative data to predict emergency department utilization: the role of neighborhood sociodemographics.
J Health Care Poor Underserved 2017;28(4):1487-508. doi: 10.1353/hpu.2017.0129..
Keywords: Emergency Department, Low-Income, Social Determinants of Health, Healthcare Utilization
Xavier Moore J, Donnelly JP, Griffin R
Community characteristics and regional variations in sepsis.
This study aimed to determine the influence of community characteristics upon regional variations in sepsis incidence and case fatality. The study concluded that regional variations in sepsis incidence may be partly explained by community poverty. Other community characteristics do not explain regional variations in sepsis incidence or case fatality.
AHRQ-funded; HS013852.
Citation: Xavier Moore J, Donnelly JP, Griffin R .
Community characteristics and regional variations in sepsis.
Int J Epidemiol 2017 Oct 1;46(5):1607-17. doi: 10.1093/ije/dyx099..
Keywords: Disparities, Low-Income, Mortality, Sepsis, Social Determinants of Health
Arora A, Spatz E, Herrin J
Population well-being measures help explain geographic disparities in life expectancy at the county level.
This study investigated whether population well-being - a comprehensive measure of physical, mental, and social health - helps explain geographic variation in life expectancy. At the county level, it found that for every 1-standard-deviation (4.2-point) increase in the well-being score, life expectancy was 1.9 years higher for females and 2.6 years higher for males.
AHRQ-funded; HS023000.
Citation: Arora A, Spatz E, Herrin J .
Population well-being measures help explain geographic disparities in life expectancy at the county level.
Health Aff 2016 Nov 01;35(11):2075-82. doi: 10.1377/hlthaff.2016.0715.
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Keywords: Disparities, Health Status, Low-Income, Social Determinants of Health
Nieman CL, Tunkel DE, Boss EF
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
The study’s objective was to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for tympanostomy tube (TT). It found that among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of chronic otitis media with effusion (OME) as opposed to recurrent acute otitis media (RAOM).
AHRQ-funded; HS022932.
Citation: Nieman CL, Tunkel DE, Boss EF .
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
Int J Pediatr Otorhinolaryngol 2016 Sep;88:98-103. doi: 10.1016/j.ijporl.2016.06.029.
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Keywords: Children/Adolescents, Ear Infections, Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Low-Income
Steve SL, Tung EL, Schlichtman JJ
Social disorder in adults with type 2 diabetes: building on race, place, and poverty.
The authors reported on their narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. They also proposed a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes.
AHRQ-funded; HS000078.
Citation: Steve SL, Tung EL, Schlichtman JJ .
Social disorder in adults with type 2 diabetes: building on race, place, and poverty.
Curr Diab Rep 2016 Aug;16(8):72. doi: 10.1007/s11892-016-0760-4.
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Keywords: Diabetes, Low-Income, Health Status, Racial and Ethnic Minorities, Social Determinants of Health