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Wickersham A, Das-Munshi J, Ford T, Jewell A, Stewart R, Downs J. Impact of inconsistent ethnicity recordings on estimates of inequality in child health and education data: a data linkage study of Child and Adolescent Mental Health Services in South London. BMJ Open 2024; 14:e078788. [PMID: 38443076 PMCID: PMC10916132 DOI: 10.1136/bmjopen-2023-078788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES Ethnicity data are critical for identifying inequalities, but previous studies suggest that ethnicity is not consistently recorded between different administrative datasets. With researchers increasingly leveraging cross-domain data linkages, we investigated the completeness and consistency of ethnicity data in two linked health and education datasets. DESIGN Cohort study. SETTING South London and Maudsley NHS Foundation Trust deidentified electronic health records, accessed via Clinical Record Interactive Search (CRIS) and the National Pupil Database (NPD) (2007-2013). PARTICIPANTS N=30 426 children and adolescents referred to local Child and Adolescent Mental Health Services. PRIMARY AND SECONDARY OUTCOME MEASURES Ethnicity data were compared between CRIS and the NPD. Associations between ethnicity as recorded from each source and key educational and clinical outcomes were explored with risk ratios. RESULTS Ethnicity data were available for 79.3% from the NPD, 87.0% from CRIS, 97.3% from either source and 69.0% from both sources. Among those who had ethnicity data from both, the two data sources agreed on 87.0% of aggregate ethnicity categorisations overall, but with high levels of disagreement in Mixed and Other ethnic groups. Strengths of associations between ethnicity, educational attainment and neurodevelopmental disorder varied according to which data source was used to code ethnicity. For example, as compared with White pupils, a significantly higher proportion of Asian pupils achieved expected educational attainment thresholds only if ethnicity was coded from the NPD (RR=1.46, 95% CI 1.29 to 1.64), not if ethnicity was coded from CRIS (RR=1.11, 0.98 to 1.26). CONCLUSIONS Data linkage has the potential to minimise missing ethnicity data, and overlap in ethnicity categorisations between CRIS and the NPD was generally high. However, choosing which data source to primarily code ethnicity from can have implications for analyses of ethnicity, mental health and educational outcomes. Users of linked data should exercise caution in combining and comparing ethnicity between different data sources.
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Affiliation(s)
- Alice Wickersham
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Amelia Jewell
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ter-Minassian M, DiNucci AJ, Barrie IS, Schoeplein R, Chakravarty A, Hernández-Muñoz JJ. Improving data capture of race and ethnicity for the Food and Drug Administration Sentinel database: a narrative review. Ann Epidemiol 2023; 86:80-89.e2. [PMID: 37479122 DOI: 10.1016/j.annepidem.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE The U.S. Food and Drug Administration's Sentinel System is a national medical product safety surveillance system consisting of a large multisite distributed database of administrative claims supplemented by electronic health-care record data. The program seeks to improve data capture of race and ethnicity for pharmacoepidemiology studies. METHODS We conducted a narrative literature review of published research on data augmentation and imputation methods to improve race and ethnicity capture in U.S. health-care systems databases. We focused on methods with limited (five-digit ZIP codes only) or full patient identifiers available to link to external sources of self-reported data. We organized the literature by themes: (1) variation in data capture of self-reported data, (2) data augmentation from external sources of self-reported data, and (3) imputation methods, including Bayesian analysis and multiple regression. RESULTS Researchers reduced data missingness with high validity for Asian, Black, White, and Pacific Islander racial groups and Hispanic ethnicity. Native American and multiracial groups were difficult to validate due to relatively small sample sizes. CONCLUSIONS Limitations on accessible self-reported data for validation will dictate methods to improve race and ethnicity data capture. We recommend methods leveraging multiple sources that account for variations in geography, age, and sex.
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Affiliation(s)
| | | | | | - Ryan Schoeplein
- Harvard Pilgrim Health Care Institute, Harvard Medical School Department of Population Medicine, Boston, MA
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3
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Johnson JA, Moore B, Hwang EK, Hickner A, Yeo H. The accuracy of race & ethnicity data in US based healthcare databases: A systematic review. Am J Surg 2023; 226:463-470. [PMID: 37230870 DOI: 10.1016/j.amjsurg.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/14/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The availability and accuracy of data on a patient's race/ethnicity varies across databases. Discrepancies in data quality can negatively impact attempts to study health disparities. METHODS We conducted a systematic review to organize information on the accuracy of race/ethnicity data stratified by database type and by specific race/ethnicity categories. RESULTS The review included 43 studies. Disease registries showed consistently high levels of data completeness and accuracy. EHRs frequently showed incomplete and/or inaccurate data on the race/ethnicity of patients. Databases had high levels of accurate data for White and Black patients but relatively high levels of misclassification and incomplete data for Hispanic/Latinx patients. Asians, Pacific Islanders, and AI/ANs are the most misclassified. Systems-based interventions to increase self-reported data showed improvement in data quality. CONCLUSION Data on race/ethnicity that is collected with the purpose of research and quality improvement appears most reliable. Data accuracy can vary by race/ethnicity status and better collection standards are needed.
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Affiliation(s)
- Josh A Johnson
- Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | | | - Eun Kyeong Hwang
- State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andy Hickner
- Samuel J. Wood Library, Weill Cornell Medicine, New York, NY, USA
| | - Heather Yeo
- Department of Surgery, Department of Population Health Sciences, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
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4
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Williams P. Retaining Race in Chronic Kidney Disease Diagnosis and Treatment. Cureus 2023; 15:e45054. [PMID: 37701164 PMCID: PMC10495104 DOI: 10.7759/cureus.45054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
The best overall measure of kidney function is glomerular filtration rate (GFR) as commonly estimated from serum creatinine concentrations (eGFRcr) using formulas that correct for the higher average creatinine concentrations in Blacks. After two decades of use, these formulas have come under scrutiny for estimating GFR differently in Blacks and non-Blacks. Discussions of whether to include race (Black vs. non-Black) in the calculation of eGFRcr fail to acknowledge that the original race-based eGFRcr provided the same CKD treatment recommendations for Blacks and non-Blacks based on directly (exogenously) measured GFR. Nevertheless, the National Kidney Foundation and the American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease removed race in CKD treatment guidelines and pushed for the immediate adoption of a race-free eGFRcr formula by physicians and clinical laboratories. This formula is projected to negate CKD in 5.51 million White and other non-Black adults and reclassify CKD to less severe stages in another 4.59 million non-Blacks, in order to expand treatment eligibility to 434,000 Blacks not previously diagnosed and to 584,000 Blacks previously diagnosed with less severe CKD. This review examines: 1) the validity of the arguments for removing the original race correction, and 2) the performance of the proposed replacement formula. Excluding race in the derivation of eGFRcr changed the statistical bias from +3.7 to -3.6 ml/min/1.73m2 in Blacks and from +0.5 to +3.9 in non-Blacks, i.e., promoting CKD diagnosis in Blacks at the cost of restricting diagnosis in non-Blacks. By doing so, the revised eGFRcr greatly exaggerates the purported racial disparity in CKD burden. Claims that the revised formulas identify heretofore undiagnosed CKD in Blacks are not supported when studies that used kidney failure replacement therapy and mortality are interpreted as proxies for baseline CKD. Alternatively, a race-stratified eGFRcr (i.e., separate equations for Blacks and non-Blacks) would provide the least biased eGFRcr for both Blacks and non-Blacks and the best medical treatment for all patients.
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Affiliation(s)
- Paul Williams
- Life Sciences, Lawrence Berkeley National Laboratory, Berkeley, USA
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5
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Januska MN, Langfelder-Schwind E, Plachta A, Demarco T, Walker PA, Berdella MN. Center-level self-study identifies opportunities to advance equity in cystic fibrosis clinical trial participation. J Cyst Fibros 2023; 22:665-668. [PMID: 37208235 DOI: 10.1016/j.jcf.2023.05.008] [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: 12/13/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
Clinical trials are a necessary tool for evaluating the effectiveness of newly developed treatments and interventions for cystic fibrosis (CF). Prior work demonstrated a proportional underrepresentation of people with CF (pwCF) identifying as part of a minoritized racial or ethnic group in clinical trials. In order to establish a baseline for improvement efforts, we undertook a center-level self-study to evaluate if the racial and ethnic backgrounds of pwCF participating in clinical trials at our CF Center in New York City reflect our overall patient diversity (N = 200; 55 pwCF identifying as part of a minoritized racial or ethnic group and 145 pwCF identifying as non-Hispanic White). A smaller proportion of pwCF identifying as part of a minoritized racial or ethnic group participated in a clinical trial as compared to pwCF identifying as non-Hispanic White (21.8% vs. 35.9%, P = 0.06). A similar trend was present for pharmaceutical clinical trials (9.1% vs. 16.6%, P = 0.3). When limiting the study population to the pwCF most likely to be eligible for a CF pharmaceutical clinical trial, a larger proportion of pwCF identifying as part of a minoritized racial or ethnic group participated in a pharmaceutical clinical trial as compared to pwCF identifying as non-Hispanic White (36.4% vs. 19.6%, P = 0.2). No pwCF identifying as part of a minoritized racial or ethnic group participated in an offsite clinical trial. Efforts to improve the racial and ethnic diversity of pwCF in clinical trials, both onsite and offsite, will require a shift in how recruitment opportunities are identified and communicated to pwCF.
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Affiliation(s)
- Megan N Januska
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elinor Langfelder-Schwind
- Lenox Hill Hospital Cystic Fibrosis Center / Northwell Health, New York, NY, USA; Department of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Amy Plachta
- Lenox Hill Hospital Cystic Fibrosis Center / Northwell Health, New York, NY, USA; Department of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Teresa Demarco
- Lenox Hill Hospital Cystic Fibrosis Center / Northwell Health, New York, NY, USA; Department of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Patricia A Walker
- Lenox Hill Hospital Cystic Fibrosis Center / Northwell Health, New York, NY, USA; Department of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Maria N Berdella
- Lenox Hill Hospital Cystic Fibrosis Center / Northwell Health, New York, NY, USA; Department of Medicine, Lenox Hill Hospital, New York, NY, USA; Department of Pediatrics, Lenox Hill Hospital, New York, NY, USA
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Pothuri B, Blank SV, Myers TK, Hines JF, Randall LM, O'Cearbhaill RE, Slomovitz BM, Eskander RN, Alvarez Secord A, Coleman RL, Walker JL, Monk BJ, Moore KN, O'Malley DM, Copeland LJ, Herzog TJ. Inclusion, diversity, equity, and access (IDEA) in gynecologic cancer clinical trials: A joint statement from GOG foundation and Society of Gynecologic Oncology (SGO). Gynecol Oncol 2023; 174:278-287. [PMID: 37315373 DOI: 10.1016/j.ygyno.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Affiliation(s)
- B Pothuri
- NYU Langone Health and Laura & Isaac Perlmutter Cancer Center, New York, NY, USA.
| | - S V Blank
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, Blavatnik Family Women's Health Research Institute, New York, MY, USA
| | - T K Myers
- University of Massachusetts-Baystate, Springfield, MA, USA
| | - J F Hines
- University of Connecticut Health System, Farmington, CT, USA
| | - L M Randall
- Virginia Commonwealth University, Richmond, VA, USA
| | - R E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, NY, USA
| | | | - R N Eskander
- University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - A Alvarez Secord
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - R L Coleman
- Texas Oncology, US Oncology Network, The Woodlands, TX, USA
| | - J L Walker
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - B J Monk
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - K N Moore
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - D M O'Malley
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - L J Copeland
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - T J Herzog
- University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, OH, USA
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7
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Xu X, Chen L, Nunez-Smith M, Clark M, Wright JD. Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries. J Natl Cancer Inst 2023; 115:636-643. [PMID: 36788453 PMCID: PMC10248843 DOI: 10.1093/jnci/djad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To inform reasons contributing to Black-White disparity in early diagnosis of uterine cancer, we compared the quality of diagnostic evaluation received by Black vs White patients with abnormal uterine bleeding (AUB) ultimately diagnosed with uterine cancer. METHODS Using 2008-2019 MarketScan Multi-State Medicaid Database, we identified Black (n = 858) and White (n = 1749) patients with uterine cancer presenting with AUB. Quality of diagnostic evaluation was measured by delayed diagnosis (>1 year after AUB reporting), not receiving guideline-recommended diagnostic procedures, delayed time to first diagnostic procedure (>2 months after AUB reporting), number of diagnostic procedures received, and number of evaluation and management visits for AUB. The association between race and quality indicators was examined by multivariable regressions adjusting for patient characteristics. RESULTS Black patients were more likely than White patients to experience delayed diagnosis (11.3% vs 8.3%, P = .01; adjusted odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.27 to 2.29) or to not receive guideline-recommended diagnostic procedures (10.1% vs 5.0%, P < .001; adjusted OR = 1.94, 95% CI = 1.40 to 2.68). Even when they did receive recommended diagnostic procedures, Black patients were more likely than White patients to experience delay in time to the first diagnostic procedure (adjusted OR = 1.46, 95% CI = 1.09 to 1.97). In addition, Black patients underwent more evaluation and management visits for AUB before getting diagnosed compared with White patients (adjusted mean ratio = 1.13, 95% CI = 1.04 to 1.23). CONCLUSIONS Black and White patients with uterine cancer differed in the quality of diagnostic evaluation received. Improving equity in this area may help reduce Black-White disparity in stage at diagnosis.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Mitchell Clark
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Pomerantz A, De Souza HG, Hall M, Neuman MI, Goyal MK, Samuels-Kalow ME, Aronson PL, Alpern ER, Simon HK, Hoffmann JA, Wells JM, Shanahan KH, Gutman CK, Peltz A. Racial and Ethnic Differences in Insurer Classification of Nonemergent Pediatric Emergency Department Visits. JAMA Netw Open 2023; 6:e2311752. [PMID: 37140920 PMCID: PMC10160869 DOI: 10.1001/jamanetworkopen.2023.11752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Importance Government and commercial health insurers have recently enacted policies to discourage nonemergent emergency department (ED) visits by reducing or denying claims for such visits using retrospective claims algorithms. Low-income Black and Hispanic pediatric patients often experience worse access to primary care services necessary for preventing some ED visits, raising concerns about the uneven impact of these policies. Objective To estimate potential racial and ethnic disparities in outcomes of Medicaid policies for reducing ED professional reimbursement based on a retrospective diagnosis-based claims algorithm. Design, Setting, and Participants This simulation study used a retrospective cohort of pediatric ED visits (aged 0-18 years) for Medicaid-insured children and adolescents appearing in the Market Scan Medicaid database between January 1, 2016, and December 31, 2019. Visits missing date of birth, race and ethnicity, professional claims data, and Current Procedural Terminology codes of billing level of complexity were excluded, as were visits that result in admission. Data were analyzed from October 2021 to June 2022. Main Outcomes and Measures Proportion of ED visits algorithmically classified as nonemergent and simulated per-visit professional reimbursement after applying a current reimbursement reduction policy for potentially nonemergent ED visits. Rates were calculated overall and compared by race and ethnicity. Results The sample included 8 471 386 unique ED visits (43.0% by patients aged 4-12 years; 39.6% Black, 7.7% Hispanic, and 48.7% White), of which 47.7% were algorithmically identified as potentially nonemergent and subject to reimbursement reduction, resulting in a 37% reduction in ED professional reimbursement across the study cohort. More visits by Black (50.3%) and Hispanic (49.0%) children were algorithmically identified as nonemergent when compared with visits by White children (45.3%; P < .001). Modeling the impact of the reimbursement reductions across the cohort resulted in expected per-visit reimbursement that was 6% lower for visits by Black children and 3% lower for visits by Hispanic children relative to visits by White children. Conclusions and Relevance In this simulation study of over 8 million unique ED visits, algorithmic approaches for classifying pediatric ED visits that used diagnosis codes identified proportionately more visits by Black and Hispanic children as nonemergent. Insurers applying financial adjustments based on these algorithmic outputs risk creating uneven reimbursement policies across racial and ethnic groups.
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Affiliation(s)
- Alexander Pomerantz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | | | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC
| | | | - Paul L. Aronson
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Harold K. Simon
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jordee M. Wells
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Kristen H. Shanahan
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Colleen K. Gutman
- Department of Emergency Medicine, University of Florida, Gainesville
- Department of Pediatrics, University of Florida, Gainesville
| | - Alon Peltz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Alegría M, Falgas-Bague I, Fukuda M, Zhen-Duan J, Weaver C, O’Malley I, Layton T, Wallace J, Zhang L, Markle S, Lincourt P, Hussain S, Lewis-Fernández R, John DA, McGuire T. Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography. Med Care 2022; 60:806-812. [PMID: 36038524 PMCID: PMC9588705 DOI: 10.1097/mlr.0000000000001768] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). DATA SOURCE Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC. RESEARCH DESIGN We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. RESULTS We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. CONCLUSIONS Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Cole Weaver
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Isabel O’Malley
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Timothy Layton
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Sheri Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Pat Lincourt
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Shazia Hussain
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | | | - Thomas McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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10
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Kleinman LC, Howell EA. Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment. Pediatrics 2022; 149:184822. [PMID: 35230433 DOI: 10.1542/peds.2020-045948g] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lawrence C Kleinman
- Division of Population Health, Quality, and Implementation Sciences, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; and
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Zhu C, Weiss M, Scribbick FW, Johnson DA, Kheirkhah A. Occurrence of Occult Neoplasia in Pterygium Specimens among Hispanic and Non-Hispanic Patients. Curr Eye Res 2022; 47:978-981. [PMID: 35180019 DOI: 10.1080/02713683.2022.2035403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia (OSSN) in pterygium specimens. METHODS This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of OSSN were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult OSSN in pterygium specimens. RESULTS There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 71% and non-Hispanic in 29%. Among all specimens, 18 (3.6%) were positive for occult OSSN. The prevalence of occult OSSN in pterygium specimens was higher in Hispanics compared to Non-Hispanics (4.8% versus 0.7%, respectively, P = 0.025). The prevalence of occult OSSN in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (P = 0.57). There were also no statistically significant differences between those with or without occult OSSN regarding age or sex. CONCLUSIONS A significant but low rate of occult OSSN was found in pterygium specimens. The percentage of those with OSSN in pterygium specimens was significantly greater in Hispanics compared to Non-Hispanics. As treatment and prognosis of pterygium and OSSN differ, histopathologic evaluation of all pterygium specimens is warranted.
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Affiliation(s)
- Christopher Zhu
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Menachem Weiss
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Frank W Scribbick
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
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Hernandez SE, Sylling PW, Mor MK, Fine MJ, Nelson KM, Wong ES, Liu CF, Batten AJ, Fihn SD, Hebert PL. Developing an Algorithm for Combining Race and Ethnicity Data Sources in the Veterans Health Administration. Mil Med 2021; 185:e495-e500. [PMID: 31603222 DOI: 10.1093/milmed/usz322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Racial/ethnic disparities exist in the Veterans Health Administration (VHA), despite financial barriers to care being largely mitigated and Veterans Administration's (VA) organizational commitment to health equity. Accurately identifying minority veterans is critical to monitoring progress toward equity as the VHA treats an increasingly racially and ethnically diverse veteran population. Although the VHA's completeness of race and ethnicity data is generally better than its public sector and private counterparts, the accuracy of the race and ethnicity in the various databases available to VHA is variable, as is the accuracy in identifying specific minority groups. The purpose of this article was to develop an algorithm for constructing race and ethnicity variables from data sources available to VHA researchers, to present demographic differences cross the data sources, and to apply the algorithm to one study year. MATERIALS AND METHODS We used existing VHA survey data from the Survey of Healthcare Experiences of Patients (SHEP) and three commonly used administrative databases from 2003 to 2015: the VA Corporate Data Warehouse (CDW), VA Defense Identity Repository (VADIR), and Medicare. Using measures of agreement such as sensitivity, specificity, positive and negative predictive values, and Cohen kappa, we compared self-reported race and ethnicity from the SHEP and each of the other data sources. Based on these results, we propose an algorithm for combining data on race and ethnicity from these datasets. We included VHA patients who completed a SHEP and had race/ethnicity recorded in CDW, VADIR, and/or Medicare. RESULTS Agreement between SHEP and other sources was high for Whites and Blacks and substantially lower for other minority groups. The CDW demonstrated better agreement than VADIR or Medicare. CONCLUSIONS We developed an algorithm of data source precedence in the VHA that improves the accuracy of the identification of historically under-identified minorities: (1) SHEP, (2) CDW, (3) Department of Defense's VADIR, and (4) Medicare.
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Affiliation(s)
- Susan E Hernandez
- Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660.,Assessment, Policy Development & Evaluation Unit, Public Health-Seattle & King County, 401 5th Ave, Suite #1300, Seattle, WA 98104
| | - Philip W Sylling
- King County Department of Community and Human Services, Performance Measurement and Evaluation, 401 5th Ave, Suite #500, Seattle, WA 98104
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System University Drive (151C), Pittsburgh, PA 15240.,Biostatistics, Informatics, and Computing Core (BICC), Pittsburgh CHERP, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240.,Pitt Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261
| | - Michael J Fine
- VA Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System University Drive (151C), Pittsburgh, PA 15240.,Center for Research on Health Care, School of Medicine, University of Pittsburgh, Pittsburgh, PA.,School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Karin M Nelson
- PACT Demonstration Laboratory Initiative, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108.,School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Edwin S Wong
- Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660.,Health Sciences Research & Development, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108
| | - Chuan-Fen Liu
- Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660.,Health Sciences Research & Development, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108
| | - Adam J Batten
- PACT Demonstration Laboratory Initiative, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108
| | - Stephan D Fihn
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195.,VHA Office of Clinical Systems Development and Evaluation, 1700 N Wheeling St, Aurora, CO 80045
| | - Paul L Hebert
- Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660.,Health Sciences Research & Development, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108
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Aseltine RH, Wang W, Benthien RA, Katz M, Wagner C, Yan J, Lewis CG. Reductions in Race and Ethnic Disparities in Hospital Readmissions Following Total Joint Arthroplasty from 2005 to 2015. J Bone Joint Surg Am 2019; 101:2044-2050. [PMID: 31764367 DOI: 10.2106/jbjs.18.01112] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Racial and ethnic disparities in hospital readmissions following total joint arthroplasty present opportunities for reducing cost and improving health equity. Despite efforts to reduce readmissions following total joint arthroplasty in the general population, no studies have documented the impact of these efforts on racial and ethnic disparities in total joint arthroplasty readmissions. The purpose of this study was to determine whether comprehensive efforts to reduce hospital readmissions following total joint arthroplasty have impacted racial and ethnic disparities in readmission rates during the period from 2005 to 2015. METHODS We conducted a retrospective analysis comparing patients readmitted and not readmitted to the hospital within 30 days of a total joint arthroplasty by estimating logistic regression models for clustered data using generalized estimating equations (GEEs) in R. Connecticut hospital discharge data for patients admitted for International Classification of Diseases, Ninth Revision (ICD-9) procedure codes 81.51 and 81.54 (Current Procedural Terminology [CPT] codes 27130 and 27447) during the 2005 to 2015 U.S. Centers for Medicare & Medicaid Services (CMS) fiscal years were analyzed. Models included quadratic terms to capture nonlinear time trends in readmissions, as well as terms for the statistical interaction between race or ethnicity and both the linear and quadratic time trends in predicting the odds of readmission. RESULTS There were 102,510 total admissions to Connecticut hospitals for total joint arthroplasty from 2005 to 2015. The 30-day (all-cause) readmission rate declined from 5.1% in 2005 to 3.6% in 2015, with a steeper downward trend observed from 2009 to 2015. The results from logistic models indicated that black patients (odds ratio [OR], 1.68; p < 0.0001) and Hispanic patients (OR, 1.48; p < 0.0001) were significantly more likely to be readmitted within 30 days of discharge following a total joint arthroplasty than white patients over the study period. The significant interaction of black race and the quadratic time trend in models capturing nonlinear trends in readmission over time indicated that the readmission rates for black patients increased compared with those for white patients from 2005 through 2008 and decreased relative to those for white patients from 2009 to 2015 (OR, 0.24; p = 0.030). CONCLUSIONS Data from Connecticut hospitals show that 30-day readmissions following a total joint arthroplasty declined by 1.5 percentage points from 2005 to 2015, and that this decline was much more pronounced among black patients, resulting in the narrowing of racial disparities in readmission following a surgical procedure. CLINICAL RELEVANCE Racial and ethnic minorities have historically been at increased risk for complications and readmission following hospital-based surgical care. This analysis of readmission following total joint arthroplasty reveals that such disparities are remediable and should foster further research on the primary drivers of and remedies for readmission disparities.
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Affiliation(s)
- Robert H Aseltine
- Division of Behavioral Science and Community Health, UConn Health, Farmington, Connecticut
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Wenjie Wang
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Ross A Benthien
- Hartford Healthcare Bone & Joint Institute, Hartford, Connecticut
| | - Matthew Katz
- Connecticut State Medical Society, New Haven, Connecticut
| | | | - Jun Yan
- Center for Population Health, UConn Health, Farmington, Connecticut
- Department of Statistics, University of Connecticut, Storrs, Connecticut
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Adedinsewo D, Xu J, Agasthi P, Oderinde A, Adekeye O, Sachdeva R, Rust G, Onwuanyi A. Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:e004573. [PMID: 28500174 DOI: 10.1161/circep.116.004573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 04/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recently published analysis of contemporary atrial fibrillation (AF) cohorts showed an association between digoxin and increased mortality and hospitalizations; however, other studies have demonstrated conflicting results. Many AF cohort studies did not or were unable to examine racial differences. Our goal was to examine risk factors for hospitalizations and mortality with digoxin use in a diverse real-world AF patient population and evaluate racial differences. METHODS AND RESULTS We performed a retrospective cohort analysis of claims data for Medicaid beneficiaries, aged 18 to 64 years, with incident diagnosis of AF in 2008 with follow-up until December 31, 2009. We created Kaplan-Meier curves and constructed multivariable Cox proportional hazard models for mortality and hospitalization. We identified 11 297 patients with an incident diagnosis of AF in 2008, of those, 1401 (12.4%) were on digoxin. Kaplan-Meier analysis demonstrated an increased risk of hospitalization with digoxin use overall and within race and heart failure groups. In adjusted models, digoxin was associated with an increased risk of hospitalization (adjusted hazard ratio, 1.54; 95% confidence interval, 1.39-1.70) and mortality (adjusted hazard ratio, 1.50; 95% confidence interval, 1.05-2.13). Overall, blacks had a higher risk of hospitalization but similar mortality when compared with whites regardless of digoxin use. We found no significant interaction between race and digoxin use for mortality (P=0.4437) and hospitalization (P=0.7122). CONCLUSIONS Our study demonstrates an overall increased risk of hospitalizations and mortality with digoxin use but no racial/ethnic differences in outcomes were observed. Further studies including minority populations are needed to critically evaluate these associations.
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Affiliation(s)
- Demilade Adedinsewo
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Junjun Xu
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Pradyumna Agasthi
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Adesoji Oderinde
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Oluwatoyosi Adekeye
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Rajesh Sachdeva
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - George Rust
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.)
| | - Anekwe Onwuanyi
- From the Department of Internal Medicine (D.A., P.A., A.O.), National Center for Primary Care (J.X.), Department of Community Health and Preventive Medicine (O.A.), and Section of Cardiology (R.S., A.O.), Morehouse School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA (D.A., P.A., A.O., R.S., A.O.); and Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee (G.R.).
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Reynolds JC, McKernan SC, Sukalski JMC, Damiano PC. Evaluation of enrollee satisfaction with Iowa's Dental Wellness Plan for the Medicaid expansion population. J Public Health Dent 2017; 78:78-85. [PMID: 28771746 DOI: 10.1111/jphd.12243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dental coverage for Iowa's Medicaid expansion population is provided through the Dental Wellness Plan (DWP), implemented in May 2014. The plan targets healthy behavior incentives via an earned benefits structure, whereby additional services are covered if enrollees return every 6-12 months for routine dental visits. This study examines enrollee satisfaction with the DWP. METHODS We surveyed a random sample of DWP enrollees 1 year after program implementation about their experiences. Survey items covered dental plan satisfaction, self-rated measures of health, and knowledge and attitudes toward the earned benefits approach. RESULTS Dental plan satisfaction was rated as low by 38 percent of respondents (n = 416), moderate by 25 percent (n = 276), and high by 37 percent (n = 402). A majority of respondents (66 percent) did not know about the earned benefits structure. Regression analysis indicated that respondents most likely to have low plan satisfaction were those who felt it was difficult to earn benefits (OR 3.66, P < 0.001) and those who were unable to find (OR 3.17, P < 0.001), or did not try to find (OR 3.51, P < 0.001), a regular dentist in the plan. CONCLUSIONS Satisfaction with a new model of dental insurance was influenced by whether enrollees had a regular source of care and their perceived ability to return for regular checkups in order to earn covered benefits.
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Affiliation(s)
- Julie C Reynolds
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Susan C McKernan
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Jennifer M C Sukalski
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Peter C Damiano
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
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Zhang Y. The Impact of the Share 35 Policy on Racial and Ethnic Disparities in Access to Liver Transplantation for Patients with End Stage Liver Disease in the United States: An Analysis from UNOS Database. Int J Equity Health 2017; 16:55. [PMID: 28340592 PMCID: PMC5366147 DOI: 10.1186/s12939-017-0552-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Share 35 policy was instituted in June 2013 by the United Network for Organ Sharing (UNOS) in order to reduce death on liver transplant waiting list. The effect of this policy on racial and ethnic disparities in access to liver transplantation has not been examined. METHODS A total of 14,585 adult patients registered for liver transplantation between 2012 and 2015 were identified from UNOS database. Logistic and proportional hazards models were used to model the effects of race and ethnicity on access to liver transplantation. Stratification on pre- and post-Share 35 periods was performed to compare the first 18 months of Share 35 policy to an equivalent time period before. RESULTS Comparison of the pre- and post-Share 35 periods showed significantly decreased time on waiting list and increased numbers of minorities having access to liver transplantation. Hispanic recipients still experienced significantly longer waiting time (HR: 0.69, 95% CI: 0.53-0.88) before they received liver transplantation after Share 35 policy took effect. CONCLUSION The Share 35 policy did not lead to improved access to liver transplantation among minorities but eliminated the previously observed racial and ethnic disparities in transplant rates as well as shortened the waiting time.
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Affiliation(s)
- Yefei Zhang
- Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, RAS-E803f, Houston, TX, 77030, USA.
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Withrow DR, Pole JD, Nishri ED, Tjepkema M, Marrett LD. Cancer Survival Disparities Between First Nation and Non-Aboriginal Adults in Canada: Follow-up of the 1991 Census Mortality Cohort. Cancer Epidemiol Biomarkers Prev 2016; 26:145-151. [DOI: 10.1158/1055-9965.epi-16-0706] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/04/2016] [Indexed: 11/16/2022] Open
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Schmidt J, Dubey S, Dalton L, Nelson M, Lee J, Kennedy MO, Kim-Gervey C, Powers L, Geenen S. Who Am I? Who Do You Think I Am? Stability of Racial/Ethnic Self-Identification among Youth in Foster Care and Concordance with Agency Categorization. CHILDREN AND YOUTH SERVICES REVIEW 2015; 56:61-67. [PMID: 26240471 PMCID: PMC4521220 DOI: 10.1016/j.childyouth.2015.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
While it has been well documented that racial and ethnic disparities exist for children of color in child welfare, the accuracy of the race and ethnicity information collected by agencies has not been examined, nor has the concordance of this information with youth self-report. This article addresses a major gap in the literature by examining: 1) the racial and ethnic self-identification of youth in foster care, and the rate of agreement with child welfare and school categorizations; 2) the level of concordance between different agencies (school and child welfare); and 3) the stability of racial and ethnic self-identification among youth in foster care over time. Results reveal that almost 1 in 5 youth change their racial identification over a one-year period, high rates of discordance exist between the youth self-report of Native American, Hispanic and multiracial youth and how agencies categorize them, and a greater tendency for the child welfare system to classify a youth as White, as compared to school and youth themselves. Information from the study could be used to guide agencies towards a more youth-centered and flexible approach in regards to identifying, reporting and affirming youth's evolving racial and ethnic identity.
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Affiliation(s)
- Jessica Schmidt
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Shanti Dubey
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Larry Dalton
- Oregon Department of Human Services, Children, Adults and Families, 2446 SE Ladd Avenue, Portland, OR 97214
| | - May Nelson
- Portland Public Schools, 501 N. Dixon Street, Portland, OR 97227
| | - Junghee Lee
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Molly O. Kennedy
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Connie Kim-Gervey
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Laurie Powers
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
| | - Sarah Geenen
- Regional Research Institute for Human Services, Portland State University, PO Box 751, Portland, OR 97207-0751
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Accuracy of race, ethnicity, and language preference in an electronic health record. J Gen Intern Med 2015; 30:719-23. [PMID: 25527336 PMCID: PMC4441665 DOI: 10.1007/s11606-014-3102-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 10/08/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Collection of data on race, ethnicity, and language preference is required as part of the "meaningful use" of electronic health records (EHRs). These data serve as a foundation for interventions to reduce health disparities. OBJECTIVE Our aim was to compare the accuracy of EHR-recorded data on race, ethnicity, and language preference to that reported directly by patients. DESIGN/SUBJECTS/MAIN MEASURES Data collected as part of a tobacco cessation intervention for minority and low-income smokers across a network of 13 primary care clinics (n = 569). KEY RESULTS Patients were more likely to self-report Hispanic ethnicity (19.6 % vs. 16.6 %, p < 0.001) and African American race (27.0 % vs. 20.4 %, p < 0.001) than was reported in the EHR. Conversely, patients were less likely to complete the survey in Spanish than the language preference noted in the EHR suggested (5.1 % vs. 6.3 %, p < 0.001). Thirty percent of whites self-reported identification with at least one other racial or ethnic group, as did 37.0 % of Hispanics, and 41.0 % of African Americans. Over one-third of EHR-documented Spanish speakers elected to take the survey in English. One-fifth of individuals who took the survey in Spanish were recorded in the EHR as English-speaking. CONCLUSION We demonstrate important inaccuracies and the need for better processes to document race/ ethnicity and language preference in EHRs.
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Gezmu T, Schneider D, Demissie K, Lin Y, Gizzi MS. Risk factors for acute stroke among South Asians compared to other racial/ethnic groups. PLoS One 2014; 9:e108901. [PMID: 25268987 PMCID: PMC4182514 DOI: 10.1371/journal.pone.0108901] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/28/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies of racial/ethnic variations in stroke rarely consider the South Asian population, one of the fastest growing sub-groups in the United States. This study compared risk factors for stroke among South Asians with those for whites, African-Americans, and Hispanics. METHODS Data on 3290 stroke patients were analyzed to examine risk differences among the four racial/ethnic groups. Data on 3290 patients admitted to a regional stroke center were analyzed to examine risk differences for ischemic stroke (including subtypes of small and large vessel disease) among South Asians, whites, African Americans and Hispanics. RESULTS South Asians were younger and had higher rates of diabetes mellitus, blood pressure, and fasting blood glucose levels than other race/ethnicities. Prevalence of diabetic and antiplatelet medication use, as well as the incidence of small-artery occlusion ischemic stroke was also higher among South Asians. South Asians were almost a decade younger and had comparable socioeconomic levels as whites; however, their stroke risk factors were comparable to that of African Americans and Hispanics. DISCUSSION Observed differences in stroke may be explained by dietary and life style choices of South Asian-Americans, risk factors that are potentially modifiable. Future population and epidemiologic studies should consider growing ethnic minority groups in the examination of the nature, outcome, and medical care profiles of stroke.
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Affiliation(s)
- Tefera Gezmu
- Edward J. Bloustein School of Planning and Public Policy, Rutgers the State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Dona Schneider
- Edward J. Bloustein School of Planning and Public Policy, Rutgers the State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Kitaw Demissie
- Rutgers-School of Public Health, Department of Epidemiology, Piscataway, New Jersey, United States of America
| | - Yong Lin
- Rutgers-School of Public Health, Department of Epidemiology, Piscataway, New Jersey, United States of America
| | - Martin S. Gizzi
- The New Jersey Neuroscience Institute at the John F. Kennedy Medical Center and Seton Hall University, Edison, New Jersey, United States of America
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Khera N, Chang YH, Hashmi S, Slack J, Beebe T, Roy V, Noel P, Fauble V, Sproat L, Tilburt J, Leis JF, Mikhael J. Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014; 20:1375-81. [PMID: 24867778 DOI: 10.1016/j.bbmt.2014.05.011] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
Although allogeneic hematopoietic cell transplantation (HCT) is an expensive treatment for hematological disorders, little is known about the financial consequences for the patients who undergo this procedure. We analyzed factors associated with its financial burden and its impact on health behaviors of allogeneic HCT recipients. A questionnaire was retrospectively mailed to 482 patients who underwent allogeneic HCT from January 2006 to June 2012 at the Mayo Clinic, to collect information regarding current financial concerns, household income, employment, insurance, out-of-pocket expenses, and health and functional status. A multivariable logistic regression analysis identified factors associated with financial burden and treatment nonadherence. Of the 268 respondents (56% response rate), 73% reported that their sickness had hurt them financially. All patients for whom the insurance information was available (missing, n = 13) were insured. Forty-seven percent of respondents experienced financial burden, such as household income decreased by >50%, selling/mortgaging home, or withdrawing money from retirement accounts. Three percent declared bankruptcy. Younger age and poor current mental and physical functioning increased the likelihood of financial burden. Thirty-five percent of patients reported deleterious health behaviors because of financial constraints. These patients were likely to be younger, have lower education, and with a longer time since HCT. Being employed decreased the likelihood of experiencing financial burden and treatment nonadherence due to concern about costs. A significant proportion of allogeneic HCT survivors experience financial hardship despite insurance coverage. Future research should investigate potential interventions to help at-risk patients and prevent adverse financial outcomes after this life-saving procedure.
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Affiliation(s)
- Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
| | - Yu-hui Chang
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Shahrukh Hashmi
- Division of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - James Slack
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Timothy Beebe
- Health Sciences Research Division, Mayo Clinic, Rochester, Minnesota
| | - Vivek Roy
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida
| | - Pierre Noel
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Veena Fauble
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Lisa Sproat
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jon Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jose F Leis
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Joseph Mikhael
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
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Roen EL, Copeland GE, Pinagtore NL, Meza R, Soliman AS. Disparities of cancer incidence in Michigan's American Indians: spotlight on breast cancer. Cancer 2014; 120:1847-53. [PMID: 24676851 DOI: 10.1002/cncr.28589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND In American Indians (AIs), cancer is a leading cause of mortality, yet their disease burden is not fully understood due to unaddressed racial misclassification in cancer registries. This study describes cancer trends among AIs in Michigan, focusing on breast cancer, in a linked data set of Indian Health Service (IHS), tribal, and state cancer registry data adjusted for misclassification. METHODS AI status was based on reported race and linkage to IHS data and tribal registries. Data with complete linkage on all incident cancer cases in Michigan from 1995 to 2004 was used to calculate age-standardized incidence estimates for invasive all-site and female breast cancers stratified by racial group. For female breast cancers, stage- and age-specific incidence and percent distributions of early- versus late-stage cancers and age of diagnosis were calculated. RESULTS More than 50% of all AI cases were identified through IHS and/or tribal linkage. In the linked data, AIs had the lowest rates of all-sites and breast cancer. For breast cancers, AI women had a greater late-stage cancer burden and a younger mean age of diagnosis as compared to whites. Although the age-specific rate for whites was greater than for AI women in nearly all age groups, the difference in hazard ratio increased with increasing age. CONCLUSIONS Our state-specific information will help formulate effective, tailored cancer prevention strategies to this population in Michigan. The data linkages used in our study are crucial for generating accurate rates and can be effective in addressing misclassification of the AI population and formulating cancer prevention strategies for AI nationwide.
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Affiliation(s)
- Emily L Roen
- University of Michigan School of Public Health, Ann Arbor, Michigan
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Lee DJ, Tannenbaum SL, Koru-Sengul T, Miao F, Zhao W, Byrne MM. Native American race, use of the Indian Health Service, and breast and lung cancer survival in Florida, 1996-2007. Prev Chronic Dis 2014; 11:E35. [PMID: 24602589 PMCID: PMC3945077 DOI: 10.5888/pcd11.130162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We evaluated associations of race, primary payer at diagnosis, and survival among patients diagnosed in Florida with lung cancer (n = 148,140) and breast cancer (n = 111,795), from 1996 through 2007. In multivariate models adjusted for comorbidities, tumor characteristics, and treatment factors, breast cancer survival was worse for Native American women than for white women (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.05–2.20) and for women using the Indian Health Service than for women using private insurance (HR, 1.71; 95% CI, 1.33–2.19). No survival association was found for Native American compared with white lung cancer patients or those using the Indian Health Service versus private insurance in fully adjusted models. Additional resources are needed to improve surveillance strategies and to reduce cancer burden in these populations.
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Affiliation(s)
- David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, PO Box 016069 (R-699), Miami, FL 33101. E-mail:
| | - Stacey L Tannenbaum
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine, Miami, Florida
| | - Tulay Koru-Sengul
- University of Miami Miller School of Medicine Department of Public Health Sciences and Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Feng Miao
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret M Byrne
- University of Miami Miller School of Medicine Department of Public Health Sciences and Sylvester Comprehensive Cancer Center, Miami, Florida
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Shippee ND, Shippee TP, Hess EP, Beebe TJ. An observational study of emergency department utilization among enrollees of Minnesota Health Care Programs: financial and non-financial barriers have different associations. BMC Health Serv Res 2014; 14:62. [PMID: 24507761 PMCID: PMC3922188 DOI: 10.1186/1472-6963-14-62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. METHODS This observational study uses linked administrative-survey data for enrollees of Minnesota Health Care Programs to examine patterns in ED use-specifically, enrollee self-report of the ED as usual source of care, and past-year count of 0, 1, or 2+ ED visits from administrative data. Main independent variables included a count of seven enrollee-reported financial concerns about healthcare costs and coverage, and a count of seven enrollee-reported non-financial, practical barriers to access (e.g., limited office hours, problems with childcare). Covariates included health, health care, and demographic measures. RESULTS In multivariate regression models, only financial concerns were positively associated with reporting ED as usual source of care, but only non-financial barriers were significantly associated with greater ED visits. Regression-adjusted values indicated notable differences in ED visits by number of non-financial barriers: zero non-financial barriers meant an adjusted 78% chance of having zero ED visits (95% C.I.: 70.5%-85.5%), 15.9% chance of 1(95% C.I.: 10.4%-21.3%), and 6.2% chance (95% C.I.: 3.5%-8.8%) of 2+ visits, whereas having all seven non-financial barriers meant a 48.2% adjusted chance of zero visits (95% C.I.: 30.9%-65.6%), 31.8% chance of 1 visit (95% C.I.: 24.2%-39.5%), and 20% chance (95% C.I.: 8.4%-31.6%) of 2+ visits. CONCLUSIONS Financial barriers were associated with identifying the ED as one's usual source of care but non-financial barriers were associated with actual ED visits. Outreach/literacy efforts may help reduce reliance on/perception of ED as usual source of care, whereas improved targeting/availability of covered services may help curb frequent actual visits, among publicly insured individuals.
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Affiliation(s)
- Nathan D Shippee
- Division of Health Policy and Management, University of Minnesota, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Tetyana P Shippee
- Division of Health Policy and Management, University of Minnesota, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Timothy J Beebe
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Henry AJ, Hevelone ND, Lipsitz S, Nguyen LL. Comparative methods for handling missing data in large databases. J Vasc Surg 2013; 58:1353-1359.e6. [DOI: 10.1016/j.jvs.2013.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
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Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kraemer KL. Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics 2013; 132:e851-8. [PMID: 24062370 PMCID: PMC4074647 DOI: 10.1542/peds.2012-3127] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs). METHODS Secondary analysis of data from the 2006-2009 National Hospital Ambulatory Medical Care Survey regarding 2298 visits by patients ≤ 21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as ≥ 7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission. RESULTS Of patient visits, 70.1% were female, 52.6% were from non-Hispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from "other" racial/ethnic groups; patients' mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.43-0.87) or a narcotic analgesic (OR: 0.38; 95% CI: 0.18-0.81) than non-Hispanic white patients (referent group). This finding was also true for non-Hispanic black and "other" race/ethnicity patients with severe pain (ORs [95% CI]: 0.43 [0.22-0.87] and 0.02 [0.00-0.19], respectively). Non-Hispanic black and Hispanic patients were more likely to have a prolonged LOS than non-Hispanic white patients (ORs [95% CI]: 1.68 [1.13-2.51] and 1.64 [1.09-2.47], respectively). No significant race/ethnicity-based disparities were identified in documentation of pain score, use of diagnostic procedures, 72-hour return visits, or hospital admissions. CONCLUSIONS Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care.
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Affiliation(s)
- Tiffani J. Johnson
- Division of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, and,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Sonya Borrero
- Division of General Internal Medicine, Department of Medicine, and,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Esa M. Davis
- Division of General Internal Medicine, Department of Medicine, and
| | - Larissa Myaskovsky
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Noel S. Zuckerbraun
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Kevin L. Kraemer
- Department of Emergency Medicine,,Division of General Internal Medicine, Department of Medicine, and
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Pintova S, Cohen HW, Billett HH. Sickle cell trait: is there an increased VTE risk in pregnancy and the postpartum? PLoS One 2013; 8:e64141. [PMID: 23717554 PMCID: PMC3661437 DOI: 10.1371/journal.pone.0064141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/08/2013] [Indexed: 12/04/2022] Open
Abstract
Blacks are purported to have a higher venous thromboembolism (VTE) risk than whites. We hypothesized that this might be due, in part, to the greater presence of sickle cell trait (SCT) among blacks. We investigated whether the presence of SCT resulted in a higher VTE incidence in a population predisposed to VTE, the pregnant/postpartum women. Methods: Using a mirrored clinical database that prospectively gathered in- and out-patient information for the years 1998–2008, we collected demographic data, including hemoglobin electrophoreses, on all pregnant/postpartum non-Hispanic women who delivered at a large, diverse, urban hospital. We identified those women who developed VTE either while pregnant or postpartum during those 11 years. Charts initially identified as potential VTE cases were subjected to review to ensure accuracy of VTE coding. Results: Of 12,429 women, 679 non-Hispanic SCT black women, 5,465 non-Hispanic Hemoglobin AA (women with HbA as the only hemoglobin present on electrophoresis, with normal amounts of the minor hemoglobins) black women and 1,162 non-Hispanic HbAA white women were included in the analysis. SCT prevalence was high (11.1%) within this black population as compared to 8.3% in the general non-white population. Proportions with VTE were similar for black SCT and black HbAA groups: 0.44% for the SCT group, 0.49% for non-Hispanic black HbAA women. Black HbAA women had a non-significantly higher proportion of VTE than white HbAA women 0.49% vs 0.26% (RR 1.9, 95%CI:0.6,6.3, p = 0.28). Women with VTE were older than those without VTE (32.2 vs. 27.6 years, p = 0.0002) and the majority of VTE occurred postpartum in all groups, and significantly in the HbAA groups. There was no increase in the incidence of pulmonary emboli in the SCT group. Conclusion: In the largest analysis to date, we could not detect a meaningful difference in peripartum VTE incidence between women with and without sickle cell trait.
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Affiliation(s)
- Sofya Pintova
- Department of Medicine, Mountt Sinai Medical Center, New York, New York, United States of America
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29
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Boscoe FP, Schymura MJ, Zhang X, Kramer RA. Heuristic algorithms for assigning Hispanic ethnicity. PLoS One 2013; 8:e55689. [PMID: 23405197 PMCID: PMC3566036 DOI: 10.1371/journal.pone.0055689] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/02/2013] [Indexed: 11/18/2022] Open
Abstract
We compared several techniques for assigning Hispanic ethnicity to records in data systems where this information may be missing, variously making use of country of origin, surname, race, and county of residence. We considered an algorithm in use by the North American Association of Central Cancer Registries (NAACCR), a variation of this developed by the authors, a "fast and frugal" algorithm developed with the aid of recursive partitioning methods, and conventional logistic regression. With the exception of logistic regression, each approach was rule-based: if specific criteria were met, an ethnicity assignment was made; otherwise, the next criterion was considered, until all records were assigned. We evaluated the algorithms on a sample of over 500,000 female clients from the New York State Cancer Services Program for whom self-reported Hispanic ethnicity was known. We found that all approaches yielded similarly high accuracy, sensitivity, and positive predictive value in all parts of the state, from areas with very low to very high Hispanic populations. An advantage of the fast and frugal method is that it consists of a small number of easily remembered steps.
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Affiliation(s)
- Francis P Boscoe
- New York State Cancer Registry, New York State Department of Health, Albany, New York, United States of America.
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Henry AJ, Hevelone ND, Belkin M, Nguyen LL. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. J Vasc Surg 2011; 53:330-9.e1. [PMID: 21163610 PMCID: PMC3282120 DOI: 10.1016/j.jvs.2010.08.077] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/18/2010] [Accepted: 08/25/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Disparities in limb salvage procedures may be driven by socioeconomic status (SES) and access to high-volume hospitals. We sought to identify SES factors associated with major amputation in the setting of critical limb ischemia (CLI). METHODS The 2003-2007 Nationwide Inpatient Sample was queried for discharges containing lower extremity revascularization (LER) or major amputation and chronic CLI (N = 958,120). The Elixhauser method was used to adjust for comorbidities. Significant predictors in bivariate logistic regression were entered into a multivariate logistic regression for the dependent variable of amputation vs LER. RESULTS Overall, 24.2% of CLI patients underwent amputation. Significant differences were seen between both groups in bivariate and multivariate analysis of SES factors, including race, income, and insurance status. Lower-income patients were more likely to be treated at low-LER-volume institutions (odds ratio [OR], 1.74; P < .001). Patients at higher-LER-volume centers (OR, 15.16; P <.001) admitted electively (OR, 2.19; P < .001) and evaluated with diagnostic imaging (OR, 10.63; P < .001) were more likely to receive LER. CONCLUSIONS After controlling for comorbidities, minority patients, those with lower SES, and patients with Medicaid were more likely receive amputation for CLI in low-volume hospitals. Addressing SES and hospital factors may reduce amputation rates for CLI.
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Affiliation(s)
- Antonia J. Henry
- Division of Vascular & Endovascular Surgery, Brigham & Women’s Hospital, Harvard Medical School
- Center for Surgery and Public Health, Brigham & Women’s Hospital, Harvard Medical School
| | - Nathanael D. Hevelone
- Center for Surgery and Public Health, Brigham & Women’s Hospital, Harvard Medical School
| | - Michael Belkin
- Division of Vascular & Endovascular Surgery, Brigham & Women’s Hospital, Harvard Medical School
| | - Louis L. Nguyen
- Division of Vascular & Endovascular Surgery, Brigham & Women’s Hospital, Harvard Medical School
- Center for Surgery and Public Health, Brigham & Women’s Hospital, Harvard Medical School
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Sandberg TJ, Wilson AR, Rodin H, Garrett NA, Bargman EP, Dobmeyer D, Plocher DW. Improving the Imputation of Race: Evaluating the Benefits of Stratifying by Age. Popul Health Manag 2009; 12:325-31. [DOI: 10.1089/pop.2009.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Amy R. Wilson
- Blue Cross Blue Shield of Minnesota, Eagan, Minnesota
| | - Holly Rodin
- Blue Cross Blue Shield of Minnesota, Eagan, Minnesota
| | | | | | | | - David W. Plocher
- Blue Cross Blue Shield of Minnesota, Eagan, Minnesota
- Present address: Ingenix, Eden Prairie, Minnesota
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Tribal linkage and race data quality for American Indians in a state cancer registry. Am J Prev Med 2009; 36:549-54. [PMID: 19356888 PMCID: PMC4274940 DOI: 10.1016/j.amepre.2009.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 12/12/2008] [Accepted: 01/31/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Racial misclassification of American Indian and Alaska Native (AI/AN) individuals as non-AI/AN in cancer registries presents problems for cancer surveillance, research, and public health practice. The aim of this study was to investigate the efficiency of tribal linkages in enhancing the quality of racial information in state cancer registries. METHODS Registry Plus Link Plus 2.0 probabilistic record linkage software was used to link the Michigan state cancer registry data (1985-2004; 1,031,168 cancer cases) to the tribal membership roster (40,340 individuals) in July of 2007. A data set was created containing AI/AN cancer cases identified by the state registry, Indian Health Service (IHS) linkages, and tribal linkage. The differences between these three groups of individuals were compared by distribution of demographic, diagnostic, and county-level characteristics using multilevel analysis (conducted in 2007-2008). RESULTS From 1995 to 2004, the tribal enrollment file showed linkages to 670 cancer cases (583 individuals) and the tribal linkage led to the identification of 190 AI/AN cancer cases (168 individuals) that were classified as non-AI/AN in the registry. More than 80% of tribal members were reported as non-AI/AN to the registry. Individuals identified by IHS or tribal linkages were different from those reported to be AI/AN in terms of stage at diagnosis, tumor confirmation, and characteristics of the county of diagnosis, including contract health services availability, tribal health services availability, and proportion of AI/AN residents. CONCLUSIONS The data linkage between tribal and state cancer registry data sets improved racial classification validity of AI/AN Michigan cancer cases. Assessing tribal linkages is a simple, noninvasive way to improve the accuracy of state cancer data for AI/AN populations and to generate tribe-specific cancer information.
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Subramanian S. Methods and approaches in using secondary data sources to study race and ethnicity factors. Methods Mol Biol 2009; 471:227-237. [PMID: 19109783 DOI: 10.1007/978-1-59745-416-2_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Race and ethnicity are increasing used in cancer research to assess differences in cancer incidence and response to therapy. In this chapter, we discuss the measurement and methodologic issues that should be addressed to minimize bias and derive valid estimates when performing such assessments. These issues include 1) lack of national standards for race and ethnicity categories; 2) difficulty in comparing race and ethnic categories in longitudinal assessments; 3) broad categorization of race and ethnicity groups that do not provide adequate details for meaningful assessments; 4) inaccuracies in race and ethnicity data collection, and 5) confounding by socioeconomic and other factors. Recommendations for improving race and ethnicity data collection also are discussed.
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Race and nicotine replacement treatment outcomes among low-income smokers. Am J Prev Med 2008; 35:S442-8. [PMID: 19012837 DOI: 10.1016/j.amepre.2008.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/06/2008] [Accepted: 09/05/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prior research suggests that racial/ethnic minority smokers experience more difficulty with cessation than white smokers and access formal treatment less often. Minority smokers may respond differently to treatment interventions than white smokers. This prospective, observational cohort study compared long-term cessation outcomes among four racial/ethnic groups after an aided quit attempt using nicotine replacement therapy (NRT). METHODS A random cohort of smokers (N=1782) who recently filled a prescription for NRT was selected, stratified by race, using Minnesota Health Care Programs (e.g., Medicaid) pharmacy claims databases between July 2005 and September 2006. The primary outcome was 7-day point prevalence abstinence, which was assessed about 8 months after the NRT index prescription fill date using a mixed-mode survey protocol. RESULTS The overall survey response was 58.2%. Overall, abstinence outcomes did not significantly vary by race. Unadjusted comparisons show that among survey respondents, at 8 months, 7-day point prevalence abstinence was 13.8% among whites, 13.6% among blacks, 14.1% among American Indians/Alaska Natives, and 20.7% among Asians (p=0.42). Similarly, the 30-day duration abstinence was 10.0% among whites, 11.5% among blacks, 8.9% among American Indians/Alaska Natives, and 18.3% among Asians (p=0.14). In multivariate analysis using propensity adjustment for potential confounding and response bias, there was no evidence that the effectiveness of NRT was lower for racial/ethnic minority smokers compared to white smokers. CONCLUSIONS These findings indicate that racial/ethnic minorities are as likely to quit smoking at a level similar to whites when using cessation treatment that includes NRT. Given documented disparities in the use of evidence-based cessation treatments such as NRT, interventions are sorely needed to improve access and utilization of these treatments in racial/ethnic minority groups.
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