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Disparities
Kinds of Disparities Selected AbstractsInter-State Disparities in Health Outcomes in Rural India: An Analysis Using a Stochastic Production Frontier ApproachDEVELOPMENT POLICY REVIEW, Issue 2 2005Vinish Kathuria In an era of reforms in the health sector and with the role of government in health provision diminishing, emphasis is shifting to making the sector efficient. This article analyses the performance of the rural public health systems of 16 major States in India, using stochastic production frontier techniques and panel data for the period 1986-97. The results show that States differ not only in capacity-building in terms of health infrastructure created, but also in efficiency in using these inputs. There is scope for health systems to re-orient their strategies in order to provide the best health in the most efficient way or at the lowest possible cost. [source] Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain InjuryACADEMIC EMERGENCY MEDICINE, Issue 11 2003Jeffrey J. Bazarian MD Abstract Objectives: To identify racial, ethnic, and gender disparities in the emergency department (ED) care for mild traumatic brain injury (mTBI). Methods: A secondary analysis of ED visits in the National Hospital Ambulatory Medical Care Survey for the years 1998 through 2000 was performed. Cases of mTBI were identified using ICD-9 codes 800.0, 800.5, 850.9, 801.5, 803.0, 803.5, 804.0, 804.5, 850.0, 850.1, 850.5, 850.9, 854.0, and 959.01. ED care variables related to imaging, procedures, treatments, and disposition were analyzed along racial, ethnic, and gender categories. The relationship between race, ethnicity, and selected ED care variables was analyzed using multivariate logistic regression with control for associated injuries, geographic region, and insurance type. Results: The incidence of mTBI was highest among men (590/100,000), Native Americans/Alaska Natives (1026.2/100,000), and non-Hispanics (391.1/100,000). After controlling for important confounders, Hispanics were more likely than non-Hispanics to receive a nasogastric tube (OR, 6.36; 95% CI = 1.2 to 33.6); nonwhites were more likely to receive ED care by a resident (OR, 3.09; 95% CI = 1.9 to 5.0) and less likely to be sent back to the referring physician after ED discharge (OR, 0.47; 95% CI = 0.3 to 0.9). Men and women received equivalent ED care. Conclusions: There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post-mTBI outcome need to be examined. [source] Racial and Ethnic Disparities in Health: An Emergency Medicine PerspectiveACADEMIC EMERGENCY MEDICINE, Issue 11 2003Janice C. Blanchard MD Abstract Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient,doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting. [source] Using Community-Based Participatory Research (CBPR) to Target Health Disparities in FamiliesFAMILY RELATIONS, Issue 4 2009Jerica M. Berge Community-based participatory research (CBPR) is an action research approach that emphasizes collaborative partnerships between community members, community organizations, health care providers, and researchers to generate knowledge and solve local problems. Although relatively new to the field of family social science, family and health researchers have been using CBPR for over a decade. This paper introduces CBPR methods, illustrates the usefulness of CBPR methods in families and health research, describes two CBPR projects related to diabetes, and concludes with lessons learned and strengths and weaknesses of CBPR. [source] A Micro-Simulation Approach to Modelling Spatial Unemployment DisparitiesGROWTH AND CHANGE, Issue 3 2010DAVID PHILIP MCARTHUR ABSTRACT This paper aims to construct a comprehensive model capable of simulating spatial unemployment disparities. The key feature of the model is that it simultaneously deals with commuting and migration. Much of the existing literature simply models one adjustment mechanism at a time. This paper adopts a micro-simulation approach to build a model which can deal with equilibrium and disequilibrium unemployment disparities in a context where commuting and migration are possible. The model is then used to demonstrate the importance of considering both types of flows and to guide future empirical and theoretical work in the area. [source] The Impact of Trade Liberalization on Regional Disparities in MexicoGROWTH AND CHANGE, Issue 1 2002Javier Sánchez-Reaza After a long period of industrialization based on import substitution (ISI), Mexico started to open up its economy by accessing the General Agreement on Tariffs and Trade (GATT) in 1986. The export-promotion strategy was transformed into one of regional integration with the signing of the North American Free Trade Agreement (NAFTA) in 1994. The paper explores the impact of the opening of the economy on regional disparities in Mexico using , and ,-convergence analyses. Four different samples have been employed to control for possible data bias linked to the inclusion of oil-producing and maquiladora-based states. The results show that whereas the final stages of the ISI period were dominated by convergence trends, trade liberalization (GATT) and economic integration (NAFTA) have led to divergence. In particular, the NAFTA period is related to divergence regardless of the type of analysis chosen and the sample used. [source] A New Method for Estimating Race/Ethnicity and Associated Disparities Where Administrative Records Lack Self-Reported Race/EthnicityHEALTH SERVICES RESEARCH, Issue 5p1 2008Marc N. Elliott Objective. To efficiently estimate race/ethnicity using administrative records to facilitate health care organizations' efforts to address disparities when self-reported race/ethnicity data are unavailable. Data Source. Surname, geocoded residential address, and self-reported race/ethnicity from 1,973,362 enrollees of a national health plan. Study Design. We compare the accuracy of a Bayesian approach to combining surname and geocoded information to estimate race/ethnicity to two other indirect methods: a non-Bayesian method that combines surname and geocoded information and geocoded information alone. We assess accuracy with respect to estimating (1) individual race/ethnicity and (2) overall racial/ethnic prevalence in a population. Principal Findings. The Bayesian approach was 74 percent more efficient than geocoding alone in estimating individual race/ethnicity and 56 percent more efficient in estimating the prevalence of racial/ethnic groups, outperforming the non-Bayesian hybrid on both measures. The non-Bayesian hybrid was more efficient than geocoding alone in estimating individual race/ethnicity but less efficient with respect to prevalence (p<.05 for all differences). Conclusions. The Bayesian Surname and Geocoding (BSG) method presented here efficiently integrates administrative data, substantially improving upon what is possible with a single source or from other hybrid methods; it offers a powerful tool that can help health care organizations address disparities until self-reported race/ethnicity data are available. [source] Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?HEALTH SERVICES RESEARCH, Issue 4 2008Sarah T. Hawley Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons). Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient,physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer. [source] Effects of Poverty and Lack of Insurance on Perceptions of Racial and Ethnic Bias in Health CareHEALTH SERVICES RESEARCH, Issue 3 2008Irena Stepanikova Objective. To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care. Data Source. 2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556). Study Design. We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups. Principal Findings. Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician,patient communication is negatively associated with perceived racial and ethnic bias. Conclusions. Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups. [source] Health Care Organizations' Use of Data on Race/Ethnicity to Address Disparities in Health CareHEALTH SERVICES RESEARCH, Issue 4p1 2006David R. Nerenz First page of article [source] Addressing Racial and Ethnic Disparities in Health Care: Using Federal Data to Support Local Programs to Eliminate DisparitiesHEALTH SERVICES RESEARCH, Issue 4p1 2006Thomas D. Sequist To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data. [source] Racial Disparities in Care: Looking Beyond the Clinical EncounterHEALTH SERVICES RESEARCH, Issue 6p1 2005Mary L. Fennell First page of article [source] Strengthening the Health Services Research to Reduce Racial and Ethnic Disparities in Health careHEALTH SERVICES RESEARCH, Issue 5 2003Carolyn M. Clancy First page of article [source] Molecular systematics of Scaphirhynchinae: an assessment of North American and Central Asian Freshwater Sturgeon SpeciesJOURNAL OF APPLIED ICHTHYOLOGY, Issue 4 2007C. B. Dillman Summary The sturgeon subfamily Scaphirhynchinae contains two genera of obligate freshwater sturgeon: Scaphirhynchus and Pseudoscaphirhynchus, from North America and Central Asia, respectively. Both genera contain morphologically variable species. A novel data set containing multiple individuals representing four diagnosable morphological variants for two species of Pseudoscaphirhynchus, P. hermanni and P. kaufmanni, was generated. These data were used to test taxonomic hypotheses of monophyly for the subfamily Scaphirhynchinae, monophyly of both Scaphirhynchus and Pseudoscaphirhynchus, monophyly of P. hermanni and P. kaufmanni, and monophyly of the recognized morphological variants. Monophyly of the subfamily Scaphirhynchinae is consistently rejected by all phylogenetic reconstruction methodologies with the molecular character set while monophyly of both river sturgeon genera is robustly supported. The molecular data set also rejects hypotheses of monophyly for sampled species of Pseudoscaphirhynchus as well as monophyly for the recognized intraspecific morphological variants. Interestingly both Scaphirhynchus and Pseudoscaphirhynchus demonstrate the same general pattern in reconstructed topologies; a lack of phylogenetic structure in the clade with respect to recognized diversity. Despite rejection of monophyly for the subfamily Scaphirhynchinae with molecular data, reconstructed hypotheses from morphological character sets consistently support monophyly for this subfamily. Disparities among the data sets, as well as reasons for rejection of monophyly for Scaphirhynchinae and species of Scaphirhynchus and Pseudoscaphirhynchus with molecular characters are examined and a decreased rate of molecular evolution is found to be most consistent with the data. [source] Health and Psychiatric Disparities in Children with Cognitive and Developmental Delays: Implications for Health Policy in QuebecJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2009Jennifer S. Nachshen Background, Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low-income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods, A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results, The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions, The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status. [source] NIH Summit: The Science of Eliminating Health DisparitiesJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2009Edilma L. Yearwood PhD, FAAN Assistant Professor, PMHCNS [source] Overcoming Racial and Ethnic Disparities in Blood Pressure Control: A Patient-Centered Approach to Cross-Cultural CommunicationJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2008Michael J. Bloch MD "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.",William Osler1 [source] Racial Disparities in HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 9 2005Daniel T. Lackland DrPH No abstract is available for this article. [source] Gender Disparities in the Control of Cardiovascular Risk Factors in People With DiabetesJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2005Samy I McFarlane MD No abstract is available for this article. [source] Message Effects and Social Determinants of Health: Its Application to Cancer DisparitiesJOURNAL OF COMMUNICATION, Issue 2006K. Viswanath Recent work on message effects theories offers a fruitful way to systematically explore how features, formats, structures of messages may attract audience attention and influence the audience and is of great relevance to public health communications. Much of this work, however, has been pursued primarily at the individual level of analysis. It is our contention that message effects on health outcomes could potentially be moderated and mediated by social contextual factors in public health such as social class, social organizations and neighborhoods among others, leading to differential effects among different audience sub-groups. This essay, through a selective review of literatures in communication and social epidemiology, will explore how major message effects may moderate and mediate the role of social determinants of health on cancer control, specifically cancer-related health disparities. [source] Health Disparities Related to Race and EthnicityJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2006Sue Thomas Hegyvary Editor [source] Health Disparities: Why Communication MattersJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2005Barbara J. Guthrie RN, FAAN Guest Editor No abstract is available for this article. [source] Disparities in Alcohol-Related Problems Among White, Black, and Hispanic AmericansALCOHOLISM, Issue 4 2009Nina Mulia Background:, This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods:, We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol-related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results:, African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions:, These findings suggest that to eliminate racial/ethnic disparities in alcohol-related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems. [source] Interregional Disparities in Productivity and the Choice of Fiscal RegimeJOURNAL OF PUBLIC ECONOMIC THEORY, Issue 3 2009KIMIKO TERAI Two districts with divergent productivity levels engage in policy-making on the provision of local public goods that enhance future income and hence create a dynamic linkage across periods. The policy choices of district representatives are derived under alternative fiscal systems, and the relative merits of the systems are evaluated. It is predicted that a decentralized system is more likely to be selected in a more equal society. On the other hand, when a great deal of benefit spills over from a local public good, or when policy makers are expected to care solely about the immediate effects of their decisions on their districts, a centralized system is more likely to be selected. [source] Self-Esteem and Socioeconomic Disparities in Self-Perceived Oral HealthJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2009David Locker Abstract Objective: To determine if psychosocial factors explain the socioeconomic disparities in self-perceived oral health that persist after controlling for oral status variables. Methods: Data came from the participants in the Canadian Community Health Survey 2003 who were residents in the city of Toronto. Oral health variables included self-rated oral health, a 13-item oral health scale, denture wearing, and having a tooth extracted in the previous year. The last two measures were regarded as proxy indicators of tooth loss. Psychosocial variables included a self-esteem scale, a depression scale, and single items measuring life satisfaction, life stress, and sense of cohesion. Socioeconomic status was assessed using total annual household income. Results: Interviews were completed with 2,754 dentate persons aged 20 years and over. Bivariate analyses confirmed that there were income gradients in self-rated oral health and scores on the oral health scale. Linear regression analyses confirmed that these persisted after controlling for age, gender, denture wearing, and having a tooth extracted in the previous year. In the model predicting self-rated oral health self-esteem, life satisfaction, stress, a sense of cohesion, and depression also contributed to the model, increased its explanatory power, and reduced the strength of but did not eliminate the association between income and self-rated oral health. Broadly, similar results were obtained when the oral health scale score was used as the dependent variable. In both analyses and all models, denture wearing had the strongest and most enduring effect. Conclusion: Psychosocial factors partly but do not wholly explain the socioeconomic disparities in self-perceived oral health in this population after controlling for tooth loss and denture wearing. Other variables need to be added to the models to increase their explanatory power. [source] Rural and Urban Disparities in Caries Prevalence in Children with Unmet Dental Needs: The New England Children's Amalgam TrialJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2008Nancy Nairi Maserejian ScD Abstract Objectives: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial. Methods: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries. Results: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth. Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location. [source] Measuring the Impact of Oral Health on Quality of Life in Britain Using OHQoL-UK©JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2003BDentSc, Colman McGrath BA, DDPHRCS, FDSRCS, FFDRCSI Abstract Objectives: This study assessed the impact of oral health on quality of life (OHQoL) in Britain and identified disparities in OHQoL among subgroups of the population. Methods: A national survey involved a random probability sample of 2,667 households. Participants were interviewed about their oral health status and sociodemographic information was collected. The impact of oral health on life quality was measured utilizing the OHQoL-UK©. Results: The response rate was 68 percent. Most people in Britain (73%) claimed their oral health did affect their life quality, most frequently through physical influences rather than social or psychological. Disparities in perceived influences of oral health on life quality among subgroups of the population were apparent by age, sex, and social class; OHQoL also was influenced by oral health status (self-reported). Conclusion: Most Britons claim their oral health affects their life quality and OHQoL was associated with sociodemographic and oral health factors. [source] Structural Disparities of Urban Traffic in Southern California: Implications for Vehicle-Related Air Pollution Exposure in Minority and High-Poverty NeighborhoodsJOURNAL OF URBAN AFFAIRS, Issue 5 2004Douglas Houston Emerging atmospheric science and epidemiological research indicates hazardous vehicle-related pollutants (e.g., diesel exhaust) are highly concentrated near major roadways, and the prevalence of respiratory ailments and mortality are heightened in these high-traffic corridors. This article builds on recent findings that low-income and minority children in California disproportionately reside in high-traffic areas by demonstrating how the urban structure provides a critical framework for evaluating the causes, characteristics, and magnitude of traffic, particularly for disadvantaged neighborhoods. We find minority and high-poverty neighborhoods bear over two times the level of traffic density compared to the rest of the Southern California region, which may associate them with a higher risk of exposure to vehicle-related pollutants. Furthermore, these areas have older and more multifamily housing, which is associated with higher rates of indoor exposure to outdoor pollutants, including intrusion of motor vehicle exhaust. We discuss the implications of these patterns on future planning and policy strategies for mitigating the serious health consequences of exposure to vehicle-related air pollutants. [source] Matching Inefficiencies, Regional Disparities, and UnemploymentLABOUR, Issue 3 2009Sanna-Mari Hynninen Our results suggest that there would be a substantial decline in aggregate unemployment if (i) all local labour offices operated with full efficiency or (ii) they shared the same structure of job seekers and vacant jobs as the most favourable office. In the former case an increase in hirings would lower the average unemployment rate by 2.4 percentage points. In the latter case the decrease would be 1.4 percentage points. Further, we find that fixed effects are positively correlated with both a more favourable structure and higher efficiency. This suggests that the fixed effects may capture some part of time-invariant features in the structure and inefficiency. Thus, the role of structural factors and inefficiency in regional unemployment disparities may be higher than estimated. [source] Status Disparities in the Capital of Capital PunishmentLAW & SOCIETY REVIEW, Issue 4 2009Scott Phillips Numerous studies have examined the influence of victim race on capital punishment, with a smaller number focused on victim gender. But death penalty scholars have largely ignored victim social status. Drawing on Black's (1976) multidimensional theoretical concept, the current research examines the impact of victim social status on the district attorney's decision to seek the death penalty and the jury's decision to impose a death sentence. The data include the population of cases indicted for capital murder in Harris County (Houston), Texas, from 1992 to 1999 (n=504). The findings suggest that victim social status has a robust influence on the ultimate state sanction: Death was more likely to be sought and imposed on behalf of high-status victims who were integrated, sophisticated, conventional, and respectable. The research also has implications beyond capital punishment. Because victim social status has rarely been investigated in the broader sentencing literature, Black's concept provides a theoretical tool that could be used to address such an important omission. [source] | ||||||||||||||||||||||||||||||||||||||||||||||