National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (37)
- Adverse Drug Events (ADE) (1)
- Adverse Events (4)
- Ambulatory Care and Surgery (1)
- Arthritis (1)
- Asthma (3)
- Behavioral Health (19)
- Blood Pressure (1)
- Brain Injury (1)
- Breast Feeding (1)
- Cancer (21)
- Cancer: Breast Cancer (10)
- Cancer: Colorectal Cancer (1)
- Cancer: Lung Cancer (3)
- Cancer: Prostate Cancer (5)
- Cardiovascular Conditions (10)
- Care Coordination (1)
- Caregiving (2)
- Care Management (1)
- Children/Adolescents (22)
- Chronic Conditions (15)
- Clinician-Patient Communication (6)
- Communication (3)
- Community-Based Practice (4)
- Comparative Effectiveness (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (3)
- COVID-19 (14)
- Critical Care (2)
- Cultural Competence (7)
- Data (2)
- Dementia (2)
- Dental and Oral Health (2)
- Depression (4)
- Diabetes (11)
- Diagnostic Safety and Quality (4)
- Dialysis (2)
- Digestive Disease and Health (2)
- Disabilities (2)
- (-) Disparities (268)
- Ear Infections (1)
- Education: Continuing Medical Education (1)
- Education: Curriculum (2)
- Education: Patient and Caregiver (4)
- Elderly (16)
- Electronic Health Records (EHRs) (4)
- Emergency Department (7)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (3)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (16)
- Healthcare Costs (7)
- Healthcare Delivery (9)
- Healthcare Utilization (8)
- Health Information Technology (HIT) (6)
- Health Insurance (16)
- Health Literacy (1)
- Health Promotion (4)
- Health Services Research (HSR) (3)
- Health Status (16)
- Health Systems (1)
- Heart Disease and Health (6)
- Home Healthcare (4)
- Hospital Discharge (3)
- Hospitalization (14)
- Hospital Readmissions (2)
- Hospitals (6)
- Human Immunodeficiency Virus (HIV) (7)
- Imaging (4)
- Implementation (3)
- Infectious Diseases (2)
- Injuries and Wounds (2)
- Inpatient Care (2)
- Kidney Disease and Health (13)
- Labor and Delivery (2)
- Lifestyle Changes (1)
- Long-Term Care (6)
- Low-Income (11)
- Maternal Care (8)
- Medicaid (15)
- Medical Devices (1)
- Medical Expenditure Panel Survey (MEPS) (15)
- Medicare (14)
- Medication (10)
- Medication: Safety (1)
- Men's Health (4)
- Mortality (17)
- Newborns/Infants (3)
- Nursing Homes (4)
- Nutrition (1)
- Obesity (6)
- Obesity: Weight Management (4)
- Opioids (5)
- Orthopedics (1)
- Osteoporosis (2)
- Outcomes (12)
- Pain (3)
- Palliative Care (5)
- Patient-Centered Healthcare (4)
- Patient-Centered Outcomes Research (12)
- Patient Adherence/Compliance (3)
- Patient and Family Engagement (2)
- Patient Experience (7)
- Patient Safety (3)
- Patient Self-Management (1)
- Payment (1)
- Policy (9)
- Practice Patterns (5)
- Pregnancy (7)
- Pressure Ulcers (1)
- Prevention (12)
- Primary Care (6)
- Primary Care: Models of Care (1)
- Provider Performance (2)
- Public Reporting (1)
- Quality Improvement (4)
- Quality Indicators (QIs) (6)
- Quality Measures (3)
- Quality of Care (21)
- Quality of Life (2)
- (-) Racial and Ethnic Minorities (268)
- Research Methodologies (4)
- Respiratory Conditions (1)
- Risk (7)
- Rural Health (2)
- Screening (9)
- Sepsis (1)
- Sex Factors (7)
- Sexual Health (3)
- Shared Decision Making (7)
- Social Determinants of Health (41)
- Social Stigma (3)
- Stroke (6)
- Substance Abuse (4)
- Surgery (18)
- Telehealth (4)
- Transitions of Care (1)
- Transplantation (8)
- Trauma (2)
- Treatments (2)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Uninsured (4)
- Urban Health (4)
- Vaccination (1)
- Vulnerable Populations (5)
- Web-Based (2)
- Women (16)
- Workforce (1)
- Young Adults (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 268 Research Studies DisplayedParikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Jindal M, Barnert E, Chomilo N
AHRQ Author: Mistry KB
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
This partly AHRQ-authored paper is part of a series on Racism and Child Health in the USA, which builds on Paper 1's summary of existing disparities in health-care delivery and highlights policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improves the health of racially and ethnically minoritized children. The authors discuss current and historical policy approaches across housing, employment, health insurance, immigration, and criminal which have the potential to affect child health equity. They commented that these policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. If these policy efforts do not directly address structural racism, they will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism.
AHRQ-authored.
Citation: Jindal M, Barnert E, Chomilo N .
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
Lancet Child Adolesc Health 2024 Feb; 8(2):159-74. doi: 10.1016/s2352-4642(23)00262-6..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Policy
Chin MH, Afsar-Manesh N, Bierman AS
AHRQ Author: Bierman AS, Chang C, Jain A, Umscheid C
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
A panel of experts was convened by AHRQ and the National Institute for Minority Health and Health Disparities to provide a conceptual framework and guiding principles for preventing bias in health care algorithms to promote health care equity. Multiple stakeholders can mitigate bias at each phase of the algorithm life cycle. Five principles should guide these efforts: promoting health and health care equity during all phases of the algorithm life cycle; ensuring algorithm use is transparent and explainable; engaging patients and communities during all phases of the algorithm life cycle to earn trustworthiness; identifying algorithmic fairness issues and establishing accountability for equity and fairness in outcomes from health care algorithms.
AHRQ-authored; AHRQ-funded.
Citation: Chin MH, Afsar-Manesh N, Bierman AS .
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
JAMA Netw Open 2023 Dec; 6(12):e2345050. doi: 10.1001/jamanetworkopen.2023.45050..
Keywords: Racial and Ethnic Minorities, Disparities
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y .
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Cheng TL, Mistry KB
AHRQ Author: Mistry KB
Clarity on disparity: who, what, when, where, why, and how.
This purpose of this article was to explain a comprehensive framework of health disparities descriptors that can offer a systematic approach to advance the understanding of causes of health disparities and facilitate action steps to ensure health equity.
AHRQ-authored.
Citation: Cheng TL, Mistry KB .
Clarity on disparity: who, what, when, where, why, and how.
Pediatr Clin North Am 2023 Aug; 70(4):639-50. doi: 10.1016/j.pcl.2023.03.003..
Keywords: Disparities, Social Determinants of Health, Newborns/Infants, Mortality, Health Status, Racial and Ethnic Minorities, Access to Care
Bonner SN, Powell CA, Stewart JW
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
The purpose of this review was to explore effective interventions to reduce inequities and identify gaps in intervention-based research with a goal of increasing awareness of surgeons, surgical trainees, researchers, and policy makers of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. The researchers reviewed the PubMed database for English-language studies published from January 2012 through June 2022 to evaluate interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of literature was conducted identifying interventions that have been related with reduction in racial and ethnic disparities in surgical care. The study found that attaining surgical equity will necessitate implementing evidence-based interventions to improve quality for racial and ethnic minorities, prioritizing funding for intervention-based research, utilizing implementation science and community based-participatory research methods, and principles of learning health systems.
AHRQ-funded; HS026030.
Citation: Bonner SN, Powell CA, Stewart JW .
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
Ann Surg 2023 Aug 1; 278(2):184-92. doi: 10.1097/sla.0000000000005858..
Keywords: Racial and Ethnic Minorities, Disparities, Surgery
Olfson M, Zuvekas SH, McClellan C
AHRQ Author: Zuvekas SH, McClellan C
Racial-ethnic disparities in outpatient mental health care in the United States.
Using data from the 2018-19 Medical Expenditure Panel Survey, researchers compared national rates and patterns of use for outpatient mental health care among Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Analyses focused on individuals using psychotropic medications, psychotherapy, or both, and receipt of minimally adequate mental health care. The results showed that the rate of outpatient mental health service use was more than twice as high for White individuals, and that Black and Hispanic patients were significantly less likely to receive psychotropic medications; Black and Hispanic patients were more likely to receive psychotherapy. No significant differences were found in patients who received minimally adequate treatment for depression, anxiety, attention-deficit hyperactivity disorder, or disruptive behavior disorders. The authors concluded that achieving racial-ethnic equity will require dedicated efforts to promote greater mental health service access for Black and Hispanic persons in need.
AHRQ-authored.
Citation: Olfson M, Zuvekas SH, McClellan C .
Racial-ethnic disparities in outpatient mental health care in the United States.
Psychiatr Serv 2023 Jul; 74(7):674-83. doi: 10.1176/appi.ps.20220365..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Disparities, Behavioral Health, Ambulatory Care and Surgery
Weiner SG, Lo YC, Carroll AD
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
The objective of this study was to evaluate the presence of stigmatizing language in clinical notes related to patients with substance use disorders and to detect patient- and provider-level differences. Results showed that the majority of patients with substance-related diagnoses had at least one note containing stigmatizing language. There were also several patient characteristic disparities associated with patients who had stigmatizing language in their notes. The author concluded that more clinician interventions about use of stigmatizing language are needed.
AHRQ-funded; HS026753.
Citation: Weiner SG, Lo YC, Carroll AD .
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
J Addict Med 2023 Jul-Aug; 17(4):424-30. doi: 10.1097/adm.0000000000001145..
Keywords: Disparities, Cultural Competence, Substance Abuse, Behavioral Health, Racial and Ethnic Minorities
Blebu BE, Liu PY, Harrington M
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
The purpose of this mixed methods design study was to integrate the perspectives of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership developed for the purpose of addressing social and structural determinants in pregnancy. The researchers utilized in-depth interviews and social network analysis to incorporate the perspectives of healthcare clinicians and staff with the views of community-based partner organizations to identify implementation factors related to cross-sector partnerships. The study identified 7 implementation variables related to 3 themes: strengths of a network approach to cross-sector collaboration, relationship-centered care, and barriers and facilitators of cross-sector partnerships. The study results highlighted establishing relationships between healthcare staff, patients, and community-based partner organizations.
AHRQ-funded; HS026407.
Citation: Blebu BE, Liu PY, Harrington M .
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
Front Public Health 2023 Jun 16; 11:1106740. doi: 10.3389/fpubh.2023.1106740..
Keywords: Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Maternal Care, Women, Implementation
Jain A, Brooks JR, Alford CC
AHRQ Author: Jain A, Alford CC, Chang CS, Mueller NM, Umscheid CA, Bierman AS
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
This AHRQ-authored study examined the increased use of health care algorithms in health decision tools, and whether including a patient's race or ethnicity among their inputs can lead clinicians and decision-makers to make choices that vary by race and potentially affect inequities. This qualitative survey included 42 organization representatives (e.g., clinical professional societies, universities, government agencies, payers, and health technology organizations) and individuals. The respondents identified 18 algorithms currently in use with the potential for bias. Seven qualitative themes with 31 subthemes were identified including: (1) algorithms are in widespread use and have significant repercussions, (2) bias can result from algorithms whether or not they explicitly include race, (3) clinicians and patients are often unaware of the use of algorithms and potential for bias, (4) race is a social construct used as a proxy for clinical variables, (5) there is a lack of standardization in how race and social determinants of health are collected and defined, (6) bias can be introduced at all stages of algorithm development, and (7) algorithms should be discussed as part of shared decision-making between the patient and clinician.
AHRQ-authored.
Citation: Jain A, Brooks JR, Alford CC .
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
JAMA Health Forum 2023 Jun 2; 4(6):e231197. doi: 10.1001/jamahealthforum.2023.1197..
Keywords: Racial and Ethnic Minorities, Disparities, Healthcare Delivery, Evidence-Based Practice
Griesemer I, Birken SA, Rini C
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
The purpose of this study was to explore the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) program, which altered systems of care at two United States cancer centers and eliminated the Black-White racial disparity in treatment completion in patients with early-stage breast and lung cancer. The study objective was to identify and document critical characteristics of ACCURE to enable translation of the intervention to other care settings. The researchers conducted semi-structured interviews with 18 participants who were involved in the design and implementation of ACCURE. The study found that participants described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key features. Intervention features were designed to improve either institutional transparency or accountability of the care system to community values and patient needs for minimally biased, tailored communication, and support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Birken SA, Rini C .
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
SSM Qual Res Health 2023 Jun; 3:100204. doi: 10.1016/j.ssmqr.2022.100204..
Keywords: Racial and Ethnic Minorities, Disparities, Quality Improvement, Quality of Care
Feyman Y, Avila CJ, Auty S
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
This study examined whether minority veterans experienced higher rates of all-cause mortality than White veterans during the COVID-19 pandemic. The authors used administrative data from the Veterans Health Administration’s Corporate Data Warehouse. Veterans were excluded in the analysis if they were missing county of residence or race-ethnicity data. Overall, veteran mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. Non-Hispanic White veterans experienced the smallest relative increase in mortality (17%), while Native American veterans had the highest increase (40%). Black Veterans (32%) and Hispanic Veterans (26%) had somewhat lower excess mortality, although these changes were significantly higher compared to White veterans. Disparities were smaller compared to the general population.
AHRQ-funded; HS026395.
Citation: Feyman Y, Avila CJ, Auty S .
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
Health Serv Res 2023 Jun; 58(3):642-53. doi: 10.1111/1475-6773.14112..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities, Disparities
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Khor S, Heagerty PJ, Basu A
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
This study examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, the authors identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. The recurrence proxy was found to have excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower among Hispanic patients and 4.3% lower among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6%. Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91). The authors theorize that higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns.
AHRQ-funded; HS013853.
Citation: Khor S, Heagerty PJ, Basu A .
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
JCO Clin Cancer Inform 2023 Jun; 7:e2300004. doi: 10.1200/cci.23.00004..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Disparities
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
Griesemer I, Lightfoot AF, Eng E
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
This paper discussed an intervention that was conducted to eliminate racial disparity in cancer treatment through a program called Accountability for Cancer Care through Undoing Racism and Equity (ACCURE). The program successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. It used specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Thematic analysis on all clinical notes that were written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162) was conducted by community and academic research partners. The authors identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Those themes include: (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Lightfoot AF, Eng E .
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
Health Promot Pract 2023 May; 24(3):415-25. doi: 10.1177/15248399221136534..
Keywords: Cancer, Racial and Ethnic Minorities, Disparities, Health Promotion
Richmond J, Murray MH, Milder CM
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
The purpose of this study was to identify factors contributing to racial disparities in stage of lung cancer stage diagnosis in low-income adults. The researchers identified cases of incident lung cancer from the prospective observational Southern Community Cohort Study by linking them with state cancer registries in 12 southeastern states. A subset of participants who answered psychosocial questions such as those related to racial discrimination experiences were assessed to determine if model predictive power improved. The study identified 1,572 patients with incident lung cancer with available lung cancer stage. Compared with White participants Black participants with lung cancer reflected higher unadjusted odds of distant stage diagnosis. Higher neighborhood area deprivation was related with distant stage diagnosis. No significant differences were found in distant stage disease for Black vs White participants after controlling for individual- and area-level factors, but participants with COPD showed decreased odds of distant stage diagnosis in the primary model.
AHRQ-funded; HS026122.
Citation: Richmond J, Murray MH, Milder CM .
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
Chest 2023 May; 163(5):1314-27. doi: 10.1016/j.chest.2022.11.025..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
AHRQ-funded; HS026957.
Citation: Sanghavi P, Chen Z .
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Agochukwu-Mmonu N, Qin Y, Kaufman S
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
This study examined the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. The authors used a 20% sample of national Medicare data to identify beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. They then linked urologists to their practices with tax identification numbers and patients to their practices based on their primary urologist. They identified 54,443 patients with incident prostate cancer, with most (87%) White and 9% Black. They found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years). Black patients had lower odds of definitive therapy and underwent less treatment than White patients in every practice context. Black patients had lower predicted probability of treatment (66%) than White patients (69%).
AHRQ-funded; HS025707.
Citation: Agochukwu-Mmonu N, Qin Y, Kaufman S .
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
JCO Oncol Pract 2023 May; 19(5):e763-e72. doi: 10.1200/op.22.00147..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Disparities, Racial and Ethnic Minorities
Taylor Gangnon, R R, Powell WR
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
This national retrospective cohort study examined Medicare beneficiaries hospitalized with diabetic foot ulcers. Investigators sought to determine what proportion of rural patients, particularly those identifying as black, received specialty care in comparison with the national proportion. Their findings indicated that a smaller proportion of rural patients, particularly those identified as black, received specialty care compared with the overall cohort. They concluded that this might contribute to disparities in major amputations, but future studies are required to determine causality.
AHRQ-funded; HS026279.
Citation: Taylor Gangnon, R R, Powell WR .
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
BMJ Open Diabetes Res Care 2023 Apr; 11(2). doi: 10.1136/bmjdrc-2022-003185..
Keywords: Rural Health, Racial and Ethnic Minorities, Diabetes, Chronic Conditions, Disparities
Eneanya ND, Adingwupu OM, Kostelanetz S
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
The rationale behind the disparity in blood creatinine levels between Black and non-Black individuals factored into previous GFR prediction formulas remains unclear. The purpose of this study was to investigate if social health determinants could explain this gap. The researchers conducted a secondary examination of the initial data from the Modification of Diet in Renal Disease and Chronic Renal Insufficiency Cohort investigations. Data from these cohorts were divided based on racial characteristics (Black versus non-Black). The study initially assessed the degree to which the Black race coefficient in the GFR estimation from creatinine is influenced by the interrelation of race with social health determinants and non-GFR creatinine determinants. Researchers then assessed whether the discrepancy in adjusted mean creatinine between racial groups could be attributed to social health determinants and non-GFR creatinine determinants. The study found that in models that associated measured GFR with creatinine, age, sex, and race, the Black race coefficient was 21% in the Modification of Diet in Renal Disease study and 13% in the Chronic Renal Insufficiency Cohort, and was not weakened by the inclusion of social health determinants, either singularly or in combination. In both studies, the Black race coefficient was more pronounced at lower income levels as compared to higher ones. In models associating creatinine with measured GFR, age, and sex, average creatinine was elevated in Black participants in comparison with non-Black participants in both studies, with social health determinants having no impact.
AHRQ-funded; HS026122.
Citation: Eneanya ND, Adingwupu OM, Kostelanetz S .
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
Clin J Am Soc Nephrol 2023 Apr; 18(4):446-54. doi: 10.2215/cjn.0000000000000109..
Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Kidney Disease and Health, Disparities
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
AHRQ Author: 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