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Zakeri M, Lal LS, Abughosh SM, Sansgiry S, Essien EJ, Sansgiry SS. Racial and Ethnic Disparity in Healthcare Expenditure and Resource Utilization Among Patients with Cardiovascular Diseases. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02125-7. [PMID: 39141246 DOI: 10.1007/s40615-024-02125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Despite extensive research, significant gaps remain in understanding racial disparity among individuals with cardiovascular diseases (CVD). These disparities, influenced by factors such as access to care and comorbid conditions, necessitate further investigation to develop targeted interventions. AIM To evaluate the factors contributing to racial and ethnic disparities in healthcare resource utilization and total healthcare expenditure among individuals with CVD. METHODS Using data from the Medical Expenditure Panel Survey spanning 2014-2021, total healthcare expenditure and having a CVD visit were compared among Hispanic, Black, and White adults with CVD. Descriptive analysis, linear regression, and logistic regression models were used to compare the results. Multivariable models were used to evaluate the effect of demographic and socioeconomic factors on total healthcare expenditure and the likelihood of having a CVD visit among different races. RESULTS With a weighted sample of 17,722,706, the study found that Hispanic and Black cohorts had 23% and 11% lower healthcare expenditures (both p < 0.001). Hispanic and Black cohorts also had lower odds of having a CVD visit (odds ratio [OR] = 0.61, 95% confidence interval [CI]:0.55-0.68; OR = 0.58, 95% CI: 0.52-0.65, respectively) compared to the White cohort. Key predictors included physical and cognitive limitations, insurance status, income, region, and the year of data collection. CONCLUSION This study highlights the need for targeted interventions to address healthcare disparities and promote health equity among minority populations with CVD.
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Affiliation(s)
- Marjan Zakeri
- Pharmaceutical Health Outcomes and Policy Department, College of Pharmacy, University of Houston, Texas Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX, 77204-5047, USA
| | - Lincy S Lal
- Adjunct Faculty, Department of Management, Policy Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Susan M Abughosh
- Pharmaceutical Health Outcomes and Policy Department, College of Pharmacy, University of Houston, Texas Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX, 77204-5047, USA
| | - Shubhada Sansgiry
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center Houston, Houston, TX, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Ekere James Essien
- Pharmaceutical Health Outcomes and Policy Department, College of Pharmacy, University of Houston, Texas Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX, 77204-5047, USA
| | - Sujit S Sansgiry
- Pharmaceutical Health Outcomes and Policy Department, College of Pharmacy, University of Houston, Texas Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX, 77204-5047, USA.
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Abdus S, Selden TM. Racial and Ethnic Disparities in Attendance to Well-Child Visit Recommendations during COVID-19. Acad Pediatr 2024; 24:922-929. [PMID: 38614214 DOI: 10.1016/j.acap.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To measure the impact of the COVID-19 pandemic on racial and ethnic disparities in attendance to well-child visit recommendations. METHODS We used the nationally representative Medical Expenditure Panel Survey (MEPS) to compare pre-pandemic (2018-2019) and pandemic (2020 and 2021) ratios of well-child visits to age-based recommendations, presenting both unadjusted and adjusted attendance disparities over time. We also used the 1996-2021 MEPS to place the pandemic changes in an historical context. RESULTS Average attendance decreased from 66.6% in 2018-2019 (95% confidence interval [CI]: 64.1, 69.1) to 58.6% in 2020 (95% CI: 55.5, 61.6), rebounding to 65.1% in 2021 (95% CI: 61.5, 68.7). The unadjusted disparity in attendance between White non-Hispanic and Black non-Hispanic children widened from 9.6 percentage points in 2018-2019 (95% CI: 2.8, 16.4) to 24.8 percentage points in 2020 (95% CI: 17.5, 32.2) and 21.4 percentage points in 2021 (95% CI: 11.2, 31.5). The unadjusted disparity in attendance between White non-Hispanic and Hispanic children widened from 14.8 percentage points in 2018-2019 (95% CI: 9.7, 19.8) to 26.3 percentage points in 2020 (95% CI: 19.9, 32.7) and 24.9 percentage points in 2021 (95% CI: 17.5, 32.3). Changes in disparities were large even when we controlled for health status, demographic and socioeconomic characteristics, health insurance, and state of residence. Magnitudes of the racial and ethnic attendance disparities during the pandemic's first two years were unprecedented since 1996. CONCLUSIONS Widening attendance disparities during the pandemic highlight the need to build a more equitable health care system for all children.
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Affiliation(s)
- Salam Abdus
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md.
| | - Thomas M Selden
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md
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Honaker MD, Burch AE, Wong JH, Akram WM, Irish WD. A Novel Approach to Analyze Disparities in Colorectal Cancer Screening and Mortality. J Surg Res 2024; 298:347-354. [PMID: 38663261 DOI: 10.1016/j.jss.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Reducing disparities in colorectal cancer (CRC) screening rates and mortality remains a priority. Mitigation strategies to reduce these disparities have largely been unsuccessful. The primary aim is to determine variables in models of healthcare utilization and their association with CRC screening and mortality in North Carolina. METHODS A cross-sectional analysis of publicly available data across North Carolina using variable reduction techniques with clustering to evaluate association of CRC screening rates and mortality was performed. RESULTS Three million sixty-five thousand five hundred thirty-seven residents (32.1%) were aged 50 y or more. More than two-thirds (68.8%) were White, while 20.5% were Black. Approximately 61% aged 50 y or more underwent CRC screening (range: 44.0%-80.5%) and had a CRC mortality of 44.8 per 100,000 (range 22.8 to 76.6 per 100,000). Cluster analysis identified two factors, designated social economic education index (factor 1) and rural provider index (factor 2) for inclusion in the multivariate analysis. CRC screening rates were associated with factor 1, consisting of socioeconomic and education variables, and factor 2, comprised of the number of providers per 10,000 individuals aged 50 y or more and rurality. An increase in both factors 1 and 2 by one point would result in an increase in CRC screening rated by 6.8%. CRC mortality was associated with factor 2. An increase in one point in factor 1 results in a decrease in mortality risk by 10.9%. CONCLUSIONS In North Carolina, using variable reduction with clustering, CRC screening rates were associated with the inter-relationship of the number of providers and rurality, while CRC mortality was associated with the inter-relationship of social, economic, and education variables.
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Affiliation(s)
- Michael D Honaker
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina
| | - Jan H Wong
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Warqaa M Akram
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Public Health, East Carolina University, Greenville, North Carolina
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Merianos AL, Mahabee-Gittens EM, Montemayor BN, Sherman LD, Goidel RK, Bergeron CD, Smith ML. Current tobacco use patterns associated with healthcare utilization among non-Hispanic Black and Hispanic men with chronic conditions. Addict Behav 2023; 143:107695. [PMID: 37001260 PMCID: PMC10131488 DOI: 10.1016/j.addbeh.2023.107695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Tobacco use disparities persist among U.S. adults who are male, racially/ethnically diverse, and have chronic conditions. This study assessed current tobacco use patterns associated with past year healthcare utilization among non-Hispanic Black and Hispanic men ≥40 years old with ≥1 chronic condition. METHODS Data were collected from a sample of 1,904 non-Hispanic Black and Hispanic men from across the U.S. using an internet-delivered survey. Participants were categorized into four tobacco use groups: nontobacco users, exclusive cigarette smokers, dualtobacco users (cigarettes + one other tobacco product), and polytobacco users (cigarettes + ≥2 other tobacco products). Logistic regression analyses were conducted to assess current tobacco use patterns with past year primary care visits, emergency department (ED) visits, and overnight hospital stays. Adjusted models included participants' age, race/ethnicity, education level, marital status, health insurance coverage, body mass index, and number of chronic conditions. RESULTS Relative to nontobacco users, exclusive cigarette smokers were at decreased odds of having a past year primary care visit (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI] = 0.47-0.99). Exclusive cigarette smokers (AOR = 1.66, 95%CI = 1.25-2.19), dualtobacco users (AOR = 1.75, 95%CI = 1.23-2.50), and polytobacco users (AOR = 4.10, 95%CI = 2.46-6.84) were at increased odds of having a past year ED visit compared to nontobacco users. Additionally, polytobacco users were at increased odds of having a past year overnight hospital stay (AOR = 2.72, 95%CI = 1.73-4.29) compared to nontobacco users. CONCLUSIONS Findings suggest current tobacco use patterns are uniquely associated with past year healthcare utilization among non-Hispanic Black and Hispanic men, while taking into consideration important factors including complex disease profiles.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Benjamin N Montemayor
- Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA.
| | - Ledric D Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA.
| | - R Kirby Goidel
- Department of Political Science, Texas A&M University, 4348 TAMU, College Station, TX 77843, USA.
| | | | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA.
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Siapno AED, Gaither TW, Tandel MD, Kwan L, Meng YY, Connor SE, Maliski SL, Fink A, George S, Litwin MS. Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer. Urology 2023; 172:89-96. [PMID: 36400270 DOI: 10.1016/j.urology.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance. METHODS We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression. RESULTS Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points. CONCLUSION Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.
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Affiliation(s)
- Allen Enrique D Siapno
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Megha D Tandel
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ying-Ying Meng
- Center for Health Policy Research, University of California, Los Angeles, CA
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Arlene Fink
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Sheba George
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA; Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
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