National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Behavioral Health (1)
- Breast Feeding (1)
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- Cancer: Breast Cancer (2)
- Cancer: Ovarian Cancer (1)
- Depression (3)
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- Patient Adherence/Compliance (1)
- Pregnancy (5)
- Racial and Ethnic Minorities (4)
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- Screening (3)
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- (-) Social Determinants of Health (14)
- Stroke (1)
- Telehealth (1)
- (-) Women (14)
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 14 of 14 Research Studies DisplayedNeerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Beck D, Hall S, Costa DK
Leveraging population health datasets to advance maternal health research.
Researchers reviewed a sample of population health datasets and highlighted recommended changes to the datasets to identify existing gaps in maternal health research and help address maternal morbidity and mortality. Their findings showed insufficient representation of pregnant and postpartum individuals across all datasets. They recommended that pregnant and postpartum individuals should be oversampled in population health data to facilitate rapid policy and program evaluation and that individuals with pregnancies resulting in outcomes other than livebirth be included or asked about their experiences.
AHRQ-funded; HS027640.
Citation: Beck D, Hall S, Costa DK .
Leveraging population health datasets to advance maternal health research.
Matern Child Health J 2023 Oct; 27(10):1683-88. doi: 10.1007/s10995-023-03695-4..
Keywords: Maternal Care, Women, Social Determinants of Health
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
Field C, Lynch CD, Fareed N
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
The role of community walkability in influencing glycemic regulation in expectant individuals with pre-existing diabetes is yet to be established. The purpose of this study was to explore the relationship between the walkability of a neighborhood at the community level and glycemic control, as indicated by hemoglobin A1c (A1C), in pregnant individuals with pregestational diabetes. The researchers conducted a retrospective examination of expectant individuals with pregestational diabetes who participated in a combined prenatal and diabetic care program from 2012 to 2016. The determinant of interest was community walkability, determined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which includes intersection concentration (design), closeness to transit stops (distance), and a combination of job and household varieties (diversity). Participants from the most walkable neighborhoods were contrasted with those from less walkable neighborhoods as per the National Environmental Protection Agency's definition. The outcomes were glycemic control, including A1C, measured both in early and late pregnancy, and the average change in A1C throughout pregnancy. The study found that out of 417 expectant individuals, 10% resided in the most walkable areas. All 417 participants had an A1C assessment in early pregnancy, and 376 had another A1C assessment in late pregnancy. Pregnant individuals living in the most walkable areas were more likely to have an A1C <6.0% in early pregnancy, and an A1C <6.5% in late pregnancy compared with those in less walkable areas. The change in A1C across pregnancy was not related to walkability. The study concluded that individuals with pre-existing diabetes residing in more walkable areas demonstrated better glycemic control during both early and late pregnancy.
AHRQ-funded; HS028822.
Citation: Field C, Lynch CD, Fareed N .
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
Am J Obstet Gynecol MFM 2023 May; 5(5):100898. doi: 10.1016/j.ajogmf.2023.100898..
Keywords: Diabetes, Maternal Care, Social Determinants of Health, Women
Lee CI, Zhu W, Onega T
Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.
This study looked at access to digital breast tomography (DBT) versus regular mammography and whether women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early adoption period and persistently lower DBT use over time. This cross-sectional study included 92 geographically diverse imaging facilities across 5 US states, with over 2.3 million screening examinations performed among women aged 40 to 89 years from January 1, 2011, to December 31, 2017. Data were analyzed from June 2019, to August 2020. Women who used DBT increased for all women from 3.3% in 2011 to 82.6% in 2017. In 2012, Black, Hispanic, Asian American, and women with less than a high school education had lower DBT access compared to White women attending the same facility and also college graduates. Lower DBT access continued over time regardless of the number of years after facility-level DBT adoption.
AHRQ-funded; HS018366.
Citation: Lee CI, Zhu W, Onega T .
Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.
JAMA Netw Open 2021 Feb;4(2):e2037546. doi: 10.1001/jamanetworkopen.2020.37546..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Access to Care, Women, Social Determinants of Health, Racial and Ethnic Minorities, Screening
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
Danilack VA, Brousseau EC, Paulo BA
Characteristics of women without a postpartum checkup among PRAMS participants, 2009-2011.
The authors studied whether sociodemographic characteristics and pregnancy and delivery factors were related to the likelihood of missing a postpartum checkup. They found that, compared to women who attended a postpartum checkup, women who missed the visit were younger, unmarried, less educated, with lower income, without insurance, and smokers. Also, women with intermediate or inadequate prenatal care were more likely to miss the checkup. Additionally, women were more likely to miss this checkup if their infant was born at a residence compared to a hospital and were less likely to miss the checkup if their newborn had a one-week well visit.
AHRQ-funded; HS025013.
Citation: Danilack VA, Brousseau EC, Paulo BA .
Characteristics of women without a postpartum checkup among PRAMS participants, 2009-2011.
Matern Child Health J 2019 Jul;23(7):903-09. doi: 10.1007/s10995-018-02716-x..
Keywords: Healthcare Utilization, Maternal Care, Patient Adherence/Compliance, Pregnancy, Social Determinants of Health, Women
Mehra R, Shebi FM, Cunningham SD
Area-level deprivation and preterm birth: results from a national, commercially-insured population.
This research studied the association between area-level deprivation and preterm birth. A retrospective cohort study was conducted using data obtained from the Health Care Cost Institute that uses national, commercial health claims data from 2011. The highest quartile of area-level deprivation experienced the highest number of preterm birth (24.9%) as opposed to the lowest quarter (9.6%). This was true even among commercially-insured women.
AHRQ-funded; HS017589; HS022242.
Citation: Mehra R, Shebi FM, Cunningham SD .
Area-level deprivation and preterm birth: results from a national, commercially-insured population.
BMC Public Health 2019 Feb 27;19(1):236. doi: 10.1186/s12889-019-6533-7..
Keywords: Health Insurance, Newborns/Infants, Pregnancy, Social Determinants of Health, Women
Childers KK, Maggard-Gibbons M, Macinko J
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
Identifying mutation carriers is critical for treatment decisions, cancer prevention, and early detection. This study analyzed the 2015 US National Health Interview Survey (NHIS), a cross-sectional in-person interview gathering self-reported health data for the US population. The study found that while cancer genetic testing seems to reach a broad geographic and sociodemographic population in the national survey, there remain underrepresented groups, including Hispanics, the uninsured, noncitizens, and those with less education.
AHRQ-funded; HS025079.
Citation: Childers KK, Maggard-Gibbons M, Macinko J .
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
JAMA Oncol 2018 Jun;4(6):876-79. doi: 10.1001/jamaoncol.2018.0340..
Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Genetics, Racial and Ethnic Minorities, Screening, Social Determinants of Health, Women
Saavedra-Avendano B, Schiavon R, Sanhueza P
Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?
This study identified socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City's public sector first trimester abortion program. Adult women had significantly lower odds than adolescents of presenting past the limit. There was an educational gradient across all age groups.
AHRQ-funded; HS022981.
Citation: Saavedra-Avendano B, Schiavon R, Sanhueza P .
Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?
PLoS One 2018 Feb 7;13(2):e0192547. doi: 10.1371/journal.pone.0192547.
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Keywords: Education, Pregnancy, Social Determinants of Health, Women
Gordon M, Henderson R, Holmes JH
Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.
Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice.
AHRQ-funded; HS022441.
Citation: Gordon M, Henderson R, Holmes JH .
Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.
J Am Med Inform Assoc 2016 Jan;23(1):105-9. doi: 10.1093/jamia/ocv109.
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Keywords: Telehealth, Women, Pregnancy, Depression, Social Determinants of Health
Kadakia A, Joyner B, Tender J
Breastfeeding in African Americans may not depend on sleep arrangement: a mixed-methods study.
The researchers described the association between breastfeeding and bedsharing, elucidating barriers to breastfeeding in African Americans. They found that lower socioeconomic status mothers were more likely to breastfeed exclusively or at all if they bedshared; however, bedsharing was not associated with breastfeeding among higher socioeconomic status mothers. Breast pain, lack of support, and maternal skepticism about breastfeeding benefits were barriers.
AHRQ-funded; HS016892.
Citation: Kadakia A, Joyner B, Tender J .
Breastfeeding in African Americans may not depend on sleep arrangement: a mixed-methods study.
Clin Pediatr 2015 Jan;54(1):47-53. doi: 10.1177/0009922814547565.
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Keywords: Breast Feeding, Racial and Ethnic Minorities, Sleep Problems, Social Determinants of Health, Women, Maternal Care
Diaz OV, Guendelman S, Kuppermann M
Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems.
The investigators sought to examine the effect of community and national subjective social status (SSS) on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions. They found that low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions.
AHRQ-funded; HS011657.
Citation: Diaz OV, Guendelman S, Kuppermann M .
Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems.
Womens Health Issues 2014 Nov-Dec;24(6):649-55. doi: 10.1016/j.whi.2014.07.003.
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Keywords: Depression, Health Status, Pain, Social Determinants of Health, Women
Bushnell CD, Reeves MJ, Zhao X
Sex differences in quality of life after ischemic stroke.
This study compared quality of life (QOL) in men and women at 3 and 12 months after stroke, and the change in QOL over time between men and women. It found that women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables and stroke severity.
AHRQ-funded; HS016964.
Citation: Bushnell CD, Reeves MJ, Zhao X .
Sex differences in quality of life after ischemic stroke.
Neurology 2014 Mar 18;82(11):922-31. doi: 10.1212/wnl.0000000000000208..
Keywords: Stroke, Disparities, Women, Social Determinants of Health