National Healthcare Quality and Disparities Report
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- Access to Care (2)
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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 22 of 22 Research Studies DisplayedKim 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
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
Song Zhang, Zhang X, Patterson LJ
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
This study assessed assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Medicare claims from the Social Security Administration was used to determine in-hospital mortality and mortality inclusive of discharges to hospice and discharges to postacute care. Over 31 million Medicare recipients in the database were analyzed with over 14 million hospitalizations from January 2019 to February 2021. There was a decline in non-COVID-19 and an emergence of COVID-19 hospitalizations among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital mortality was not significantly different among Black patients relative to White patients but was 3.5 percentage points higher among Hispanic patients and other racial and ethnic minority groups. There were disparities in discharges to hospice and postacute care as well.
AHRQ-funded; HS024072.
Citation: Song Zhang, Zhang X, Patterson LJ .
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
JAMA Health Forum 2021 Dec 23;2(12):e214223. doi: 10.1001/jamahealthforum.2021.4223..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Medicare, Hospitalization, Outcomes, Mortality
Dixon BE, Grannis SJ, Lembcke LR
The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.
Researchers sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Data were taken from a statewide cohort of adult residents in Indiana tested for SARS-CoV-2 infection. The researchers found that, by the fall of 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Cumulative morbidity and mortality were highest among minority groups and in rural communities. They concluded that the synchronicity of disparities in COVID-19 by race and geography suggested that health officials explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.
AHRQ-funded; HS025502.
Citation: Dixon BE, Grannis SJ, Lembcke LR .
The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.
PLoS One 2021 Jul 23;16(7):e0255063. doi: 10.1371/journal.pone.0255063..
Keywords: COVID-19, Disparities, Racial and Ethnic Minorities, Hospitalization, Mortality, Rural Health
Burris HH, Passarella M, Handley SC
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
This study’s objective was to determine whether black-white disparities in maternal in-hospital mortality during delivery vary across hospital types (black-serving vs non-black and teaching vs non-teaching) and whether overall maternal mortality differs across hospital types. The authors performed a population-based, retrospective cohort study of 5,679,044 deliveries among black (14.2%) and white patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. Examination of black-white disparities found that after risk adjustment, black patients had significantly greater risk of death and that the disparity was similar within each of the hospital types. At teaching hospitals, mortality was similar in black-serving and nonblack-serving hospitals. Among non-teaching hospitals, mortality was significantly higher in black-serving vs nonblack-serving hospitals. Over half (53%) of black patients delivered in nonteaching black-serving hospitals compared with just 19% of white patients.
AHRQ-funded; HS018661.
Citation: Burris HH, Passarella M, Handley SC .
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
Am J Obstet Gynecol 2021 Jul;225(1):83.e1-83.e9. doi: 10.1016/j.ajog.2021.01.004..
Keywords: Maternal Care, Pregnancy, Mortality, Women, Racial and Ethnic Minorities, Disparities, Hospitals
Coley RY, Johnson E, Simon GE
Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits.
This study looked at racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visit. The main outcome measured was the suicide rate within 90 days after a mental health visit. The study used a 50% sample of visits from a random set of outpatients at 7 large integrated health care systems by patients 13 years and older (6,984,184 visits). Suicide rates were highest for visits by patients with no race/ethnicity recorded, followed by Asian, White, American Indian/Alaskan Native, Hispanic, and Black. Sensitivity of both models used were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients with no race/ethnicity recorded.
AHRQ-funded; HS026369.
Citation: Coley RY, Johnson E, Simon GE .
Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits.
JAMA Psychiatry 2021 Jul;78(7):726-34. doi: 10.1001/jamapsychiatry.2021.0493..
Keywords: Disparities, Racial and Ethnic Minorities, Behavioral Health, Mortality, Risk
Kim D, Lee Y, Thorsness R
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
This national study estimated excess deaths for the kidney failure population by race and ethnicity from March 1 through August 1, 2020. Findings showed that, among the US kidney failure population, the number of excess deaths was 16% higher than expected, similar to reports for the general population. However, results showed that the relative increase in deaths among Black and Hispanic patients was more than 4-fold higher than that observed among White patients. The magnitude of these disparities was larger than corresponding relative ratios reported among COVID-19–associated deaths in the general population.
AHRQ-funded; HS028285.
Citation: Kim D, Lee Y, Thorsness R .
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
Am J Kidney Dis 2021 May;77(5):827-29. doi: 10.1053/j.ajkd.2021.02.003..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Mortality, Kidney Disease and Health, Chronic Conditions, Social Determinants of Health
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
Jarman MP, Pollack Porter K, Curriero FC
Factors mediating demographic determinants of injury mortality.
The authors investigated the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. They found that distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
AHRQ-funded; HS000029.
Citation: Jarman MP, Pollack Porter K, Curriero FC .
Factors mediating demographic determinants of injury mortality.
Ann Epidemiol 2019 Jun;34:58-64.e2. doi: 10.1016/j.annepidem.2019.03.013..
Keywords: Access to Care, Disparities, Injuries and Wounds, Mortality, Racial and Ethnic Minorities, Sex Factors, Social Determinants of Health, Trauma
McClellan CB
Disparities in opioid related mortality between United States counties from 2000 to 2014.
This study examines disparities in opioid related mortality between United States counties from 2000 to 2014. Unfortunately, counties that had lower rates in 2000 had caught up by 2014. The authors suggest that prevention measures need to be broader in scope and be implemented in areas where the opioid crisis doesn’t seem as prevalent.
AHRQ-authored.
Citation: McClellan CB .
Disparities in opioid related mortality between United States counties from 2000 to 2014.
Drug Alcohol Depend 2019 Apr 25;199:151-58. doi: 10.1016/j.drugalcdep.2019.03.005..
Keywords: Disparities, Medication, Mortality, Opioids, Substance Abuse
Jarman MP, Haut ER, Curriero FC
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. The investigators concluded identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes.
AHRQ-funded; HS000029.
Citation: Jarman MP, Haut ER, Curriero FC .
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
J Trauma Acute Care Surg 2018 Jul;85(1):54-61. doi: 10.1097/ta.0000000000001883..
Keywords: Disparities, Injuries and Wounds, Mortality, Social Determinants of Health, Trauma
Jones JM, Fingar KR, Miller MA
AHRQ Author: Miller MA; Heslin KC
Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013.
The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in in-hospital sepsis mortality rates by race/ethnicity. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white, black, and Hispanic patients.
AHRQ-authored.
Citation: Jones JM, Fingar KR, Miller MA .
Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013.
Crit Care Med 2017 Dec;45(12):e1209-e17. doi: 10.1097/ccm.0000000000002699.
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Keywords: Disparities, Healthcare Cost and Utilization Project (HCUP), Mortality, Racial and Ethnic Minorities, Sepsis
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
Farias AJ, Du XL
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
The purpose of this study was to determine whether racial/ethnic differences in use and discontinuation of adjuvant endocrine therapy (AET) differed by hormone receptor status and whether discontinuation was associated with mortality. There are racial/ethnic differences in AET use and discontinuation. Discontinuing treatment was associated with higher risk of all-cause and cancer-specific mortality regardless of hormone receptor status.
AHRQ-funded; HS018956.
Citation: Farias AJ, Du XL .
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
Cancer Epidemiol Biomarkers Prev 2017 Aug;26(8):1266-75. doi: 10.1158/1055-9965.epi-17-0280.
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Keywords: Cancer: Breast Cancer, Disparities, Elderly, Mortality, Racial and Ethnic Minorities
Rice WS, Goldfarb SS, Brisendine AE
Disparities in infant mortality by race among Hispanic and non-Hispanic infants.
This study explored possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. It concluded that the risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes.
AHRQ-funded; HS013852.
Citation: Rice WS, Goldfarb SS, Brisendine AE .
Disparities in infant mortality by race among Hispanic and non-Hispanic infants.
Matern Child Health J 2017 Jul;21(7):1581-88. doi: 10.1007/s10995-017-2290-3.
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Keywords: Disparities, Newborns/Infants, Mortality, Newborns/Infants, Racial and Ethnic Minorities
Rust G, Zhang S, Yu Z
Counties eliminating racial disparities in colorectal cancer mortality.
The researchers attempted to identify county-level variations in racial-ethnic disparities in colorectal cancer mortality rates. They found that county-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. They concluded that counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all.
AHRQ-funded; HS022444.
Citation: Rust G, Zhang S, Yu Z .
Counties eliminating racial disparities in colorectal cancer mortality.
Cancer 2016 Jun 1;122(11):1735-48. doi: 10.1002/cncr.29958.
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Keywords: Cancer: Colorectal Cancer, Disparities, Mortality, Racial and Ethnic Minorities
Spatz ES, Beckman AL, Wang Y
Geographic variation in trends and disparities in acute myocardial infarction hospitalization and mortality by income levels, 1999-2013.
The researchers sought to determine whether trends in US county-level, risk-standardized acute myocardial infarction (AMI) hospitalization and mortality rates varied by county-based median income level. They concluded that hospitalization and mortality rates of AMI declined among counties of all income levels, although hospitalization rates among low-income counties lag behind those of the higher income groups.
AHRQ-funded; HS023000.
Citation: Spatz ES, Beckman AL, Wang Y .
Geographic variation in trends and disparities in acute myocardial infarction hospitalization and mortality by income levels, 1999-2013.
JAMA Cardiol 2016 Jun 1;1(3):255-65. doi: 10.1001/jamacardio.2016.0382.
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Keywords: Disparities, Hospitalization, Heart Disease and Health, Mortality, Social Determinants of Health
Sheetz KH, Dimick JB, Ghaferi AA
Impact of hospital characteristics on failure to rescue following major surgery.
This study determined the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries. It found that although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals. This suggests that microsystem characteristics may play a larger role in improving a hospital's ability to manage postoperative complications.
AHRQ-funded; HS023621.
Citation: Sheetz KH, Dimick JB, Ghaferi AA .
Impact of hospital characteristics on failure to rescue following major surgery.
Ann Surg 2016 Apr;263(4):692-7. doi: 10.1097/sla.0000000000001414.
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Keywords: Surgery, Elderly, Adverse Events, Disparities, Mortality
Rust G, Zhang S, Malhotra K
Paths to health equity: local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009.
The researchers examined county-level, age-adjusted breast cancer mortality rates for women who were 35 to 74 years old during the period of 1989-2010. They found that more than half of the counties (54%) showed persistent, unchanging disparities. Roughly 1 in 4 (24%) had a divergent pattern of worsening black/white disparities.
AHRQ-funded; HS022444.
Citation: Rust G, Zhang S, Malhotra K .
Paths to health equity: local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009.
Cancer 2015 Aug 15;121(16):2765-74. doi: 10.1002/cncr.29405..
Keywords: Cancer: Breast Cancer, Disparities, Racial and Ethnic Minorities, Mortality, Racial and Ethnic Minorities
Chhatre S, Malkowicz SB, Schwartz JS
Understanding the racial and ethnic differences in cost and mortality among advanced stage prostate cancer patients (STROBE).
The aims of the study were to understand the racial/ethnic differences in cost of care and mortality in Medicare elderly with advanced stage prostate cancer. It found that relationship between race/ethnicity, cost of care, and mortality is intricate. For non-Hispanic black men, disparity in mortality can be attributed to treatment differences.
AHRQ-funded; HS024106.
Citation: Chhatre S, Malkowicz SB, Schwartz JS .
Understanding the racial and ethnic differences in cost and mortality among advanced stage prostate cancer patients (STROBE).
Med Health 2015 Aug;94(32):e1353. doi: 10.1097/md.0000000000001353..
Keywords: Cancer: Prostate Cancer, Mortality, Racial and Ethnic Minorities, Elderly, Disparities
Hines AL, Andrews RM, Moy E
AHRQ Author: Andrews RM, Moy E
Disparities in rates of inpatient mortality and adverse events: race/ethnicity and language as independent contributors.
The authors investigated inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compared quality of care by language with patterns by race/ethnicity. They found that speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality, except for a higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients, while Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Hines AL, Andrews RM, Moy E .
Disparities in rates of inpatient mortality and adverse events: race/ethnicity and language as independent contributors.
Int J Environ Res Public Health 2014 Dec;11(12):13017-34. doi: 10.3390/ijerph111213017.
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Keywords: Communication, Disparities, Healthcare Cost and Utilization Project (HCUP), Mortality, Racial and Ethnic Minorities