The National Academies Press

Currently Skimming:

Pages 285-383

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 285... ... B Literature Review The study committee conducted an extensive review of literature on racial and ethnic disparities in healthcare (discussed in Chapter 1) Read the entire page →
From page 286... ... 286 UNEQUAL TREATMENT extent of racial and ethnic differences in health care that are not otherwise attributable to known factors such as access to care," only studies that provided some measure of control or adjustment for racial and ethnic differences in insurance status (e.g., ability to pay/insurance coverage or comorbidities) were included in the literature review. Read the entire page →
From page 287... ... 287 B: LITERATURE REVIEW To assess the quality of this evidence base, the committee ranked studies on several criteria: • Adequacy of control for insurance status (studies of patients covered under the same health system or insurance plan were considered to be more rigorous than studies that merely assessed the availability of health insurance among the study population) ; • Use of appropriate indicators for patient socioeconomic status (e.g., studies that measured patients' level of income, education, or other indicators of socioeconomic status) Read the entire page →
From page 288... ... 288 UNEQUAL TREATMENT criteria included the use of adequate control or adjustment for racial and ethnic differences in insurance status; prospective, rather than retrospective data collection; adjustment for racial and ethnic differences in comorbid conditions; adjustment for racial and ethnic differences in disease severity; comparison of rates of cardiovascular services relative to measures of appropriateness; and assessment of patient outcomes. Several caveats should be noted in undertaking this approach. Read the entire page →
From page 289... ... 289 B: LITERATURE REVIEW as noted above. The remaining studies found racial and ethnic disparities in one or more cardiac procedures, following multivariate analysis. Read the entire page →
From page 290... ... 290 UNEQUAL TREATMENT TABLE B-1 Summary of Selected Literature -- Racial and Ethnic Disparities in Health Care Analgesia Source Procedure/Illness Sample Analyses Todd, Deaton, Assessed racial differences in Retrospective cohort study of D'Adamo, and Goe, receipt of analgesia among 217 patients (127 African 2000 patients seen for extremity American, 90 white) seen in fractures in emergency an emergency department in departments. Read the entire page →
From page 291... ... 291 B: LITERATURE REVIEW Analyses Findings Limitations Multiple logistic regressions Nearly three-fourths of white pa- -Moderate sample size. to predict use of analgesia tients (74%) Read the entire page →
From page 292... ... 292 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia Source Procedure/Illness Sample Analyses Cleeland, Gronin, Baez Assessed adequacy of pain 281 minority outpatients (106 et al., 1997 management among minority African American, 94 His patients receiving care in panic, 16 other minority) with settings that primarily serve recurrent or metastatic cancer minorities vs. Read the entire page →
From page 293... ... 293 B: LITERATURE REVIEW Analyses Findings Limitations Compared treatment of Sixty-five percent of patients who -Data regarding pain among this sample reported pain received inadequate race/ethnicity not with a larger, primarily pain medication. Patients treated in available for comwhite sample from a previ- settings where the patient population parison group. Read the entire page →
From page 294... ... 294 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia Source Procedure/Illness Sample Analyses Todd, Lee, and Assessed racial/ethnic differ- Prospective study of 207 paHoffman, 1994 ences in physician's percep- tients (138 white, 69 Hispanic) tions of pain in patients with admitted to ED at UCLA Medi isolated extremity trauma. Read the entire page →
From page 295... ... 295 B: LITERATURE REVIEW Analyses Findings Limitations Analysis of Covariance to No differences found between non- -Patients enrolled evaluate influence of con- Hispanic and Hispanic patients in study primarily in founding variables on the patient pain assessment, physician early evening and relationship between ethnic- pain assessment, or disparity between weekends. ity and differences in pa- patient and physician pain assess- -Moderate samples tient and physician pain ment. Read the entire page →
From page 296... ... 296 UNEQUAL TREATMENT TABLE B-1 Continued Asthma Analgesia Source Procedure/Illness Sample Analyses 5,062 patients (4,328 white, 734 Krishnan et al., 2001 Race/ethnicity and gender African-American) who partici differences in consistency of pated in the Outcomes Manage care with national asthma ment System Asthma Study guidelines within managed between 9/93 and 12/93. Read the entire page →
From page 297... ... 297 B: LITERATURE REVIEW Analyses Findings Limitations Multivariate logistic regres- After controlling for age, education, -Results may not sion to determine whether employment, and symptom frequency apply to patients race/ethnicity and sex were there were no significant race/ with mild asthma. associated with five indica- ethnicity or sex differences in the use -Bias in self-report tors of National Asthma of medication regimen consistent with data. Read the entire page →
From page 298... ... 298 UNEQUAL TREATMENT TABLE B-1 Continued Cancer Analgesia Source Procedure/Illness Sample Analyses Elston Lafata, Cole Assessed sociodemographic 251 patients (157 white, 94 Johnson, Ben- differences in the receipt of minority [largely African Menachem, Morlock et colorectal cancer surveillance American] Read the entire page →
From page 299... ... 299 B: LITERATURE REVIEW Analyses Findings Limitations Kaplan-Meier survival Within 18 months of treatment, over -Racial/ethnic analysis to determine cumu- half of the total cohort received a groups other than lative incidence of service colon examination (55%) , nearly African American receipt; Cox Proportional three-fourths had received carcino- and white not Hazard models to quantify embryonic antigen (CEA) Read the entire page →
From page 300... ... 300 UNEQUAL TREATMENT TABLE B-1 Continued Cancer Analgesia Source Procedure/Illness Sample Analyses Bach, Cramer, Warren, Early stage lung cancer. 10,984 patients (10,124 white, and Begg, 1999 860 African Americans) Read the entire page →
From page 301... ... 301 B: LITERATURE REVIEW Analyses Findings Limitations receiving therapy, few were due to patient refusal (3.76% among whites, 5.88% among blacks) Read the entire page →
From page 302... ... 302 UNEQUAL TREATMENT TABLE B-1 Continued Cancer Analgesia Source Procedure/Illness Sample Analyses Howard, Penchansky, Assessed racial/ethnic differ- 246 women (89 African Ameand Brown, 1998 ences in survival of breast rican, 157 white) who sought cancer. Read the entire page →
From page 303... ... 303 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to pre- No significant racial differences were -Relatively small dict stage of disease at time found in stage of disease, utilization sample. of diagnosis and Cox sur- of health services before diagnosis of -Racial/ethnic vival analysis to assess breast cancer, or receipt of breast groups other than determinants of survival. Read the entire page →
From page 304... ... 304 UNEQUAL TREATMENT TABLE B-1 Continued Cancer Analgesia Source Procedure/Illness Sample Analyses Medicare patients in New tate cancer between 1991 and York state. Read the entire page →
From page 305... ... 305 B: LITERATURE REVIEW Analyses Findings Limitations and Medicare claims for 0.59 in 1991 to 0.86 in 1993; no confi- African American both black and white males. dence intervals provided) Read the entire page →
From page 306... ... 306 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Petersen et al., 2002 Assessed racial differences in Analysis of 606 black and treatment for AMI. 4,005 white VA patients with diagnosed AMI discharged from one of 81 VA hospitals. Read the entire page →
From page 307... ... 307 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to assess No differences between African- -Racial/ethnic use of guideline-based American and white patients in re- groups other than medications, invasive car- ceipt of beta blockers, but African white and African diac procedures, and all- Amercans were more likely to receive American not cause mortality at 30 days, aspirin and were less likely to receive examined. 1 year, and 3 years. Read the entire page →
From page 308... ... 308 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Schneider, Leape, Assess whether racial differ- Stratified weighted random Weissman et al., 2001 ences in cardiac revasculari- sample of 3,960 Medicare zation are due to "overuse" beneficiaries in 173 hospitals of the procedure in white (in five states) who under patients. Read the entire page →
From page 309... ... 309 B: LITERATURE REVIEW Analyses Findings Limitations RAND criteria used to Rates of inappropriate PTCA ranged -Retrospective determine proportion of from 4% to 24% among study states, study examining coronary artery bypass and 0% to 14% for CABG surgery. medical record and graft (CABG) Read the entire page →
From page 310... ... 310 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Underuse and overuse of 356 patients (43% white, 27% Carlisle, Leape, Bickel, diagnostic testing for coro- African American, 19% Bell et al., 1999 nary artery disease. Latino, 9% Asian or Pacific Islander) Read the entire page →
From page 311... ... 311 B: LITERATURE REVIEW Analyses Findings Limitations presentation, and hospital WW/WM – 1.00 (95% CI 0.98 to 1.03) ; -Retrospective characteristics. Read the entire page →
From page 312... ... 312 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Gregory, Rhoads, Assess racial differences in 13,690 New Jersey residents Wilson et al., 1999 rates of cardiac procedures, (1,217 African American, relative to availability of 12,473 white) hospitalized hospital-based invasive car- with a primary diagnosis of diac services. Read the entire page →
From page 313... ... 313 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to pre- For all patients, the likelihood of -Ethnic/racial dict receipt of catheteriza- receiving catherterization within 90 groups other than tion and PTCA/CABG, days of AMI was significantly greater African American after controlling for patient among those hospitalized in facilities and white not clinical and demographic that provided cardiac services. Blacks examined. Read the entire page →
From page 314... ... 314 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses were deemed clinically hospitals who met RAND necessary. criteria for necessary revas cularization. Read the entire page →
From page 315... ... 315 B: LITERATURE REVIEW Analyses Findings Limitations probability that a patient Rates of revascularization were signifi- -Retrospective would receive revasculari- cantly lower, however, among hospitals study. zation as a function of de- that did not provide revascularization -Data obtained by mographic characteristics services (and therefore had to refer record review. Read the entire page →
From page 316... ... 316 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Taylor, Canto, Racial/ethnic differences in Patients from National RegisSanderson, Rogers, management and outcome in try of Myocardial Infarction 2 and Hilbe, 1998 patients with Acute Myocar- (NRMI-2) Read the entire page →
From page 317... ... 317 B: LITERATURE REVIEW Analyses Findings Limitations (odds ratio = 0.72, 95% CI 0.50 to 1.05) and bypass surgery (odds ratio = 0.63, 95% CI 0.38 to 1.04) Read the entire page →
From page 318... ... 318 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses documented coronary dis- can American) with docu ease. Read the entire page →
From page 319... ... 319 B: LITERATURE REVIEW Analyses Findings Limitations bypass surgery. Extension undergo bypass surgery (odds ratio = American not of life associated with by- 0.68, 95% CI 0.56 to 0.82) Read the entire page →
From page 320... ... 320 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses military health services 78 other) with principle or system. Read the entire page →
From page 321... ... 321 B: LITERATURE REVIEW Analyses Findings Limitations differences by patient race admission (odds ratio = 0.96, 95% CI founds such as SES, in rates of catheterization or 0.69 to 1.34) or between white and disease severity, revascularization proce- black patients (odds ratio = 1.19, 95% appropriateness not dures, controlling for age, CI 0.80 to 1.78) Read the entire page →
From page 322... ... 322 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Herholz et al., 1996 Assessed gender and ethnic Discharge data for 982 pa differences in receipt of tients hospitalized for definite cardiovascular medications or possible MI; data are from on discharge from hospital the Corpus Christi Heart following myocardial infarc- Project. tion (MI) Read the entire page →
From page 323... ... 323 B: LITERATURE REVIEW Analyses Findings Limitations (e.g., rural vs. urban, teach- or aspirin (odds ratio = 1.00, 95% CI through record ing vs. Read the entire page →
From page 324... ... 324 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses County residents with pos- hospitals following angiogra sible ischemic heart disease. phy, CABG, or angioplasty. Read the entire page →
From page 325... ... 325 B: LITERATURE REVIEW Analyses Findings Limitations diagnosis, age, gender, were less likely to receive angiograinsurance type, income phy (odds ratio = 0.90, 95% CI 0.85 to (proxy) , co-morbidities, and 0.95) Read the entire page →
From page 326... ... 326 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia Source Procedure/Illness Sample Analyses Peterson, Wright, Racial differences in proce- 33,641 (29,119 white, 4,522 Daley, and Thibault, dure use and survival follow- African American) male 1994 ing acute myocardial infarc- veterans discharged with tion (AMI) Read the entire page →
From page 327... ... 327 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to assess After adjustment, as compared to -Racial ethnic effect of race on use of car- white patient, African Americans 33% groups other than diac catheterization, coronary less likely to undergo cardiac white and African angioplasty, coronary bypass catheterizations within 90 days of AMI American not surgery, and overall coronary (odds ratio = 0.67, 95% CI 0.62 to 0.72) ; included. Read the entire page →
From page 328... ... 328 UNEQUAL TREATMENT TABLE B-1 Continued Cardiovascular Disease Analgesia Source Procedure/Illness Sample Analyses Cerebrovascular Disease Mitchell, Ballard, Assessed rates of tests and Inpatient hospital records of Matchar et al., 2000 treatment for cerebrovascular 17,437 Medicare patients disease: noninvasive cere- (15,929 white and 1,508 brovascular tests, cerebral African American) with a angiography, carotid endart- principal diagnosis of tran erectomy, anticoagulant sient ischemic attack (TIA) Read the entire page →
From page 329... ... 329 B: LITERATURE REVIEW Analyses Findings Limitations Computed state age- and Nationally, CABG rate was 27.1 per -Some veterans in sex-adjusted rates of CABG 10,000 for whites, 7.6 per 10,000 for study obtained care for whites and African African Americans. Racial differences outside of VA. Read the entire page →
From page 330... ... 330 UNEQUAL TREATMENT TABLE B-1 Continued Cerebrovascular Disease Analgesia Source Procedure/Illness Sample Analyses with ICD-9 diagnoses of either transient ischemic attack, ischemic stroke, or amaurosis fugax. Record review of clinical data. Read the entire page →
From page 331... ... 331 B: LITERATURE REVIEW Analyses Findings Limitations for clinical factors (odds ratio = 1.50, cans received linical presentation, antici 95% CI 1.06 to 2.13) Read the entire page →
From page 332... ... 332 UNEQUAL TREATMENT TABLE B-1 Continued Children' Analgesias Health Care Source Procedure/Illness Sample Analyses Furth et al., 2000 Access to kidney transplant 3,284 patients < 20 years of list. age (1,122 black, 2,162 white) Read the entire page →
From page 333... ... 333 B: LITERATURE REVIEW Analyses Findings Limitations Cox proportional hazard Controlling for confounders, black -Racial/ethnic analysis to examine inde- patients were 12% less likely than groups other than pendent effect of race on the white patients to be activated on the African American time from first dialysis for kidney transplant wait list (relative and white not ESRD until first activation hazard = 0.88, 95% CI 0.79 to 0.97) Read the entire page →
From page 334... ... 334 UNEQUAL TREATMENT TABLE B-1 Continued Children' Analgesias Health Care Source Procedure/Illness Sample Analyses tory care visit in 1987. Data were obtained from the Household Component of the National Medical Expendi ture Survey (NMES) Read the entire page →
From page 335... ... 335 B: LITERATURE REVIEW Analyses Findings Limitations children (odds ratio = 1.0) Read the entire page →
From page 336... ... 336 UNEQUAL TREATMENT TABLE B-1 Continued Diabetes Analgesia Source Procedure/Illness Sample Analyses Chin, Zhang, and Assessed quality of care and 1,376 African-American and Merrell, 1998 resource utilization among white Medicare beneficiaries African-American and white with diabetes (14% African patients with diabetes. Americans) Read the entire page →
From page 337... ... 337 B: LITERATURE REVIEW Analyses Findings Limitations Linear and logistic regres- African-American patients were less -Racial/ethnic groups sion to assess independent likely to have measurement of other than African contribution of race to glycosylated hemoglobin (adjusted American and white health status, quality of odds ratio = 0.65, 95% CI 0.48 to not examined. care, and resource utiliza- 0.88) Read the entire page →
From page 338... ... 338 UNEQUAL TREATMENT TABLE B-1 Continued Emergency Analgesia Services Source Procedure/Illness Sample Analyses Eye Care Devgan, Yu, Kim, and Surgical treatment of glau- Retrospective cohort analysis Coleman, 2000 coma in African-American of 30,495 African-American Medicare beneficiaries. and 160,792 white patients over 65 years of age undergo ing argon laser trabeculo plasty or trabeculectomy surgery between 1991 and 1994. Read the entire page →
From page 339... ... 339 B: LITERATURE REVIEW Analyses Findings Limitations African Americans compared with Hispanics) Read the entire page →
From page 340... ... 340 UNEQUAL TREATMENT TABLE B-1 Continued Eye Care Analgesia Source Procedure/Illness Sample Analyses Gallbladder Disease Arozullah, Ferreira, Racial variation in rate of 16,181 patients (14,249 CaucaBennett et al., 1999 adoption of laparoscopic sian and 1,932 African Ameri cholecystectomy procedure in can) diagnosed with gall Department of Veterans bladder or biliary disease Affairs Medical System. Read the entire page →
From page 341... ... 341 B: LITERATURE REVIEW Analyses Findings Limitations 3.1 to 3.4 vs. expected RR of 4.3, 95% CI 3.5 to 5.4) Read the entire page →
From page 342... ... 342 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia HIV/AIDS Source Procedure/Illness Sample Analyses Shapiro, Morton, Assessed racial/ethnic, gen- Multistage probability sample McCaffrey et al., 1999 der, and other sociodemo- of 2,846 individuals, includ graphic variations in care ing African-American and (number of care-seeking visits Hispanic patients, using data and use of protease inhibitors from the HIV Costs and [PI] or nonnucleoside reverse Services Utilization Study. Read the entire page →
From page 343... ... 343 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to pre- Adjusting for insurance status, CD4 -Potential condict use of PI and NNRTI, cell count, sex, age, method of expo- founds such as prophylaxis against pneu- sure to HIV, and region of country, co-morbidities, SES mocyctis carinii pneumonia African-American and Hispanic not assessed. Read the entire page →
From page 344... ... 344 UNEQUAL TREATMENT TABLE B-1 Continued Maternal Analgesia and Infant Health Source Procedure/Illness Sample Analyses Aron, Gordon, Cesarean delivery rates. 25,697 women (19,996 white, DiGiuseppe et al., 2000 5,701 nonwhite) Read the entire page →
From page 345... ... 345 B: LITERATURE REVIEW Analyses Findings Limitations Nested (to account for Overall rates of cesarean delivery -Results may clustering of patients in were similar in white and nonwhite reflect regional individual hospitals and (over 90% African-American) patients. Read the entire page →
From page 346... ... 346 UNEQUAL TREATMENT TABLE B-1 Continued Maternal Analgesia and Infant Health Source Procedure/Illness Sample Analyses Braveman, Egerter, Cesarean delivery rates. 217,461 singleton first live Edmonston, and births (15,529 African AmeriVerdon, 1995 can, 19,142 foreign-born Asian, 62,303 foreign-born Latina, 26,802 U.S.-born Latina, 93,685 white) Read the entire page →
From page 347... ... 347 B: LITERATURE REVIEW Analyses Findings Limitations patients were similar for military and civilian groups, rates for black military groups were significantly lower than their civilian counterparts (RR = 0.80, 95% CI 0.65 to 0.99) Read the entire page →
From page 348... ... 348 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia and Infant Health Maternal Source Procedure/Illness Sample Analyses Kogan, Kotelchuck, Self-reported receipt of 8,310 women (6,782 white Alexander, and prenatal care advice from non-Hispanic and 1,532 black Johnson, 1994 providers. women) Read the entire page →
From page 349... ... 349 B: LITERATURE REVIEW Analyses Findings Limitations -Racial/ethnic Logistic regression to assess After adjustment for covariates, more groups other than contribution of race to white women reported receiving African American mothers' report of receipt of advice for alcohol (odds ratio = 1.29, and white not advice or instructions dur- 95% CI 1.10 to 1.51) and smoking examined. Read the entire page →
From page 350... ... 350 UNEQUAL TREATMENT TABLE B-1 Continued Mental Health Analgesia Source Procedure/Illness Sample Analyses Segal, Bola, and Prescription of antipsychotic 442 patients (256 white, 107 Watson, 1996 medications by physicians African American, 47 His in psychiatric emergency ser- panic, 10 Asian, 22 "other") vices. Read the entire page →
From page 351... ... 351 B: LITERATURE REVIEW Analyses Findings Limitations from mental health pro- receive SSRIs (odds ratio = 0.844, 95% -Information not vider, number of comorbid CI 0.743 to 0.959, p = 0.0093) when available on severconditions. Read the entire page →
From page 352... ... 352 UNEQUAL TREATMENT TABLE B-1 Continued Mental Health Analgesia Source Procedure/Illness Sample Analyses Padgett, Patrick, Burns, 7,768 persons insured by Blue Use of inpatient mental and Schlesinger, 1994 Cross and Blue Shield health services. Association's Federal Em ployees Plan in 1983, who had at least one inpatient psychiatric day and random sample of 5,000 nonusers of mental health services. Read the entire page →
From page 353... ... 353 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression devel- No significant differences were found -Administrative oped for each ethnic group among blacks, whites and Hispanics data. to predict probability of at in the probability of a psychiatric -Retrospective least one day of psychiatric hospitalization or in number of inpa- study. Read the entire page →
From page 354... ... 354 UNEQUAL TREATMENT TABLE B-1 Continued Peripheral Analgesia Vascular Disease Source Procedure/Illness Sample Analyses Pharmacy Morrison, Wallenstein, Differences in white and Random sample of 30% (347) Natale et al., 2000 nonwhite neighborhoods in of New York City pharma pharmacy stocking of opioid cies. Read the entire page →
From page 355... ... 355 B: LITERATURE REVIEW Analyses Findings Limitations Among patients with diabetes, blacks were 48% and 32% less likely to un dergo percutaneous transluminal angioplasty (adjusted odds ratio = 0.52, 95% CI 0.40-0.67) and lower extremity bypass surgery (adjusted odds ratio = 0.68, 95% CI 0.59 to 0.79) Read the entire page →
From page 356... ... 356 UNEQUAL TREATMENT TABLE B-1 Continued Physician Analgesia Perceptions Source Procedure/Illness Sample Analyses June 1997 to June 1998. Re sponse rate 53%. Read the entire page →
From page 357... ... 357 B: LITERATURE REVIEW Analyses Findings Limitations status, weight, and cardiac ejection fraction. Responding physicians asked if they would recommend transplantation given presence of certain criteria. Read the entire page →
From page 358... ... 358 UNEQUAL TREATMENT TABLE B-1 Continued Physician Analgesia Perceptions Source Procedure/Illness Sample Analyses van Ryn and Burke, physician perceptions of 618 patient encounters 2000 patients. at eight New York state hospitals. Read the entire page →
From page 359... ... 359 B: LITERATURE REVIEW Analyses Findings Limitations p = 0.03) and were prescribed refills more often (Χ12 = 107 vs. Read the entire page →
From page 360... ... 360 UNEQUAL TREATMENT TABLE B-1 Continued Radiographs Analgesia Source Procedure/Illness Sample Analyses Selim, Gincke, Ren, Racial and ethnic differences 401 patients (315 white, 22 Deyo et al., 2001 in use of lumbar spine radio- African American, 4 non graphs. white Hispanic, 1 "other") Read the entire page →
From page 361... ... 361 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to assess At higher levels of back pain, non- -Relatively small race, age, education, in- white patients received more spine sample. come, comorbidities, pain films than did white patients (74% -Small number of intensity, radiating leg pain, vs. Read the entire page →
From page 362... ... 362 UNEQUAL TREATMENT TABLE B-1 Continued Rehabilitative Services Analgesia Source Procedure/Illness Sample Analyses Hoenig, Rubenstein, Racial and other sociodemo- 2,762 African-American and and Kahn, 1996 graphic and geographic white Medicare patients (9% differences in use of physical African American) treated in and occupational therapy in 297 randomly-selected hospi elderly Medicare patients tals from five states. Read the entire page →
From page 363... ... 363 B: LITERATURE REVIEW Analyses Findings Limitations Multivariate logistic regres- After controlling for clinical factors, -Small number sion to predict utilization of African-American patients (odds ratio African Americans. physical or occupational = 1.56, 95% CI 1.04 to 2.34) Read the entire page →
From page 364... ... 364 UNEQUAL TREATMENT TABLE B-1 Continued Renal Care Analgesia and Transplantation Source Procedure/Illness Sample Analyses Kasiske, London, and Racial/ethnic differences in 41,596 patients registered Ellison, 1998 early placement on kidney with 238 UNOS centers on transplantation waiting list. the national OPTN kidney and kidney-pancreas waiting list between April 1, 1994, and June 30, 1996. Read the entire page →
From page 365... ... 365 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to assess White patients more likely to be -Retrospective patient and center charac- placed on waiting list before vs. after study utilizing teristics on listing before initiating maintenance dialysis than administrative data. Read the entire page →
From page 366... ... 366 UNEQUAL TREATMENT TABLE B-1 Continued Use of services and procedures -- General Analgesia Source Procedure/Illness Sample Analyses Tai-Seale, Freund, and Effect of mandatory enroll- Data from Medicaid eligibilLoSasso, 2001 ment in managed care (MC) ity, claims, and MC encounter on service use among African data from two counties in one American compared to white state where one county im Medicaid beneficiaries. Read the entire page →
From page 367... ... 367 B: LITERATURE REVIEW Analyses Findings Limitations independent association of admissions pracrace with mortality. tices not assessed. Read the entire page →
From page 368... ... 368 UNEQUAL TREATMENT TABLE B-1 Continued Use of services and procedures -- General Analgesia Source Procedure/Illness Sample Analyses White-Means, 2000 Use of services (paid care- Data are from the National giver, therapist, mental Long Term Care Survey. health, dentist, foot doctor, 527 black and 4,007 white optometrist, chiropractor, ER disabled elderly Medicare visit, doctor visits, prescrip- recipients. Read the entire page →
From page 369... ... 369 B: LITERATURE REVIEW Analyses Findings Limitations examined included insur- particularly among Hispanics. Adance coverage, family justed analyses indicate that the income, age, sex, marital disparity for Hispanics increased by status, education, health 6.5 percentage points (p < 0.01) Read the entire page →
From page 370... ... 370 UNEQUAL TREATMENT TABLE B-1 Continued Use of services and procedures -- General Analgesia Source Procedure/Illness Sample Analyses ing a major therapeutic or male) from the Hospital diagnostic procedure. Read the entire page →
From page 371... ... 371 B: LITERATURE REVIEW Analyses Findings Limitations (identified using ICD-9- than whites to receive a major thera- American not CM codes) Read the entire page →
From page 372... ... 372 UNEQUAL TREATMENT TABLE B-1 Continued Use of services and procedures -- General Analgesia Source Procedure/Illness Sample Analyses Gornick, Eggers, Reilly et Assessed racial differences in mortal- 26.3 million Medial., 1996 ity and use of services among a Medi- care beneficiaries care population. (24.2 million whites, 2.1 million African Americans) Read the entire page →
From page 373... ... 373 B: LITERATURE REVIEW Analyses Findings Limitations maker implant, and auto- (odds ratio = 1.49, 95% CI 1.35 to matic cardioverter-defibril- 1.67) Read the entire page →
From page 374... ... 374 UNEQUAL TREATMENT TABLE B-1 Continued Use of services and procedures -- General Analgesia Source Procedure/Illness Sample Analyses Wilson, May, and Assessed racial differences in Records of nearly 300,000 Kelly, 1994 receipt of total knee arthro- Medicare recipients who plasty among older adults underwent total knee arthro with osteoarthritis. plasty between 1980 and 1988. Read the entire page →
From page 375... ... 375 B: LITERATURE REVIEW Analyses Findings Limitations Natural logarithm transfor- The prevalence of symptomatic os- -Racial/ethnic groups mation method to estimate teoarthritis of the knee was lower other than African confidence intervals for among whites than blacks, although American and white white-to-black ratios of this difference was non-significant. not examined. Read the entire page →
From page 376... ... 376 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia Use of services and procedures -- General Source Procedure/Illness Sample Analyses Women's Health Brown, Perez-Stable, Hormone Replacement 8,986 women (50% white, Whitaker, Posner et al., Therapy (HRT) Read the entire page →
From page 377... ... 377 B: LITERATURE REVIEW Analyses Findings Limitations and those with fee-for- absolute percentage point difference service insurance. in racial disparity between the man aged care and fee-for-service groups (6.3%, 95% CI -4.6% to 17.2%) Read the entire page →
From page 378... ... 378 UNEQUAL TREATMENT TABLE B-1 Continued Analgesia Health Women's Source Procedure/Illness Sample Analyses Burns, McCarthy, Mammography. 3,187,116 women (7% black, Freund, Marwill et al., 93% white) Read the entire page →
From page 379... ... 379 B: LITERATURE REVIEW Analyses Findings Limitations Logistic regression to pre- In every state, at each primary care -Racial/ethnic dict mammography use visit level (one, two, or three or more groups other than according to age, number of visits) black women had mammogra- African American primary care visits, income, phy less often than white women and white not state of residence for black (even across income levels) Read the entire page →
From page 380... ... 380 UNEQUAL TREATMENT TABLE B-2 Selected Studies Exerting Control Over Key Clinical Characteristics Type Prospective/ Adjust for: Disease Author Year of Data Insurance Retrospective Comorbidities? Severity Petersen 2002 Clinical VA healthcare Retrospective Yes et al. Read the entire page →
From page 381... ... 381 B: LITERATURE REVIEW ust for: Disease Assessed Find orbidities? Severity Approriateness Outcomes? Read the entire page →
From page 382... ... 382 UNEQUAL TREATMENT TABLE B-2 Continued Type Prospective/ Adjust for: Disease Author Year of Data Insurance Retrospective Comorbidities? Severity Taylor et al. Read the entire page →
From page 383... ... 383 B: LITERATURE REVIEW ust for: Disease Assessed Find orbidities? Severity Approriateness Outcomes? Read the entire page →

From page 285...

... B Literature Review The study committee conducted an extensive review of literature on racial and ethnic disparities in healthcare (discussed in Chapter 1)