Update in Health Equity and Health Disparities

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Update in Health Equity and Health Disparities

• Judith A. Long, MD
• Virginia W. Chang, MD, PhD
• Said A. Ibrahim, MD MPH
• David A. Asch, MD

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Organizing Principle The Evolution of Health
Equity Research
Document the existence of health and health care
disparities.

First Generation
Second Generation
Explain reasons for disparities.
Provide solutions for reducing or eliminating
inappropriate disparities in health and health
care.
Third Generation
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Racial Disparities in Preventive Services Among
Medicare Enrollees
p p p p Shneider et al in JAMA 2002, 2871288-1294
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Racial Disparities in Veteran MI Care
p p p Peterson et al in Med Care 200240I86-96.
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Mortality Among Veterans with MI
Peterson et al in Med Care 200240I86-96.
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Disparities in Rates of Knee Arthroplasty Among
Medicare Patients
p p Rate/1000 patients
Skinner et al in NEJM 2003 20033491350-1359.
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Regional Variation in Racial/Ethnic Disparities

• Within regions, black men almost always had lower
  rates of arthroplasty than white men
  
• In some regions, Hispanic men and women and black
  women received less, the same, or more procedures
  than their white counterparts.
  
• Observed differences were lower in regions with
  higher income and lower levels of residential
  segregation
  
• Amelioration did not occur equally by sex or
  race/ethnicity.

Skinner et al in NEJM 2003 20033491350-1359.
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Exercise Habits Among Black and White Adolescent
Girls
Activity Questionnaire Scores Over Time by Age
and Race
Kimm et al in NEJM 2002347709-715.
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Organizing Principle The Evolution of Health
Equity Research
First Generation
Explain reasons for disparities. Based on the
articles selected, the authors divided this
generation as follows patient level factors,
physician level factors, system level factors.
Second Generation
Third Generation
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Blood and Cadaveric Organ Donation
Differences in Organ and Blood Donation
Reasons for Differences Spirituality and relig
ion helped explain differences in willingness to
be an organ donor among all groups as compared to
white men Medical mistrust and perceived discrim
ination helped explain differences in willingnes
s to donate blood for black men
explained the remaining difference in willingness
to be an organ donor for black women
Boulware et al in Med Care 2002285-95.
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Knowledge and Beliefs about Joint Replacement
Among Veterans
Ibrahim et al in Med Care 200240I44-I51.
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Veterans Beliefs about Lung Cancer Surgery
Margolis et al in Annals of Intern Med 2003
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Organizing Principle The Evolution of Health
Equity Research
First Generation
Explain reasons for disparities. Based on the
articles selected, the authors divided this
generation as follows patient level factors,
physician level factors, system level factors.
Second Generation
Third Generation
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Physician/Patient Race Concordance
Race-concordant visits were 2.2 minutes longer,
contained slower speech, and had higher positive
patient affect scores. Patients in race-concord
ant visits rated their physicians as more
participatory and were more likely to be
satisfied with the visit. Physician communicati
on behaviors did not explain patients
perceptions of how participatory their physician
was or their satisfaction with their physicians.

Cooper et al in Ann Intern Med 2003139907-915
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Patient Satisfaction and Disparities
Satisfaction and preventive services lower for
Hispanics and Asians Adjustment for demographics
, health status, and quality of the
physician-patient interaction explained
differences in satisfaction Adjustment for source
of care explained differences in preventive
services for Hispanics. Quality of the physician-
patient interaction failed to explain differences
in preventive service use.
Saha et al in Am J Public Health
2003931713-1719

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Organizing Principle The Evolution of Health
Equity Research
First Generation
Explain reasons for disparities. Based on the
articles selected, the authors divided this
generation as follows patient level factors,
physician level factors, system level factors.
Second Generation
Third Generation
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Disparities in Cancer Mortality
excluding breast, uterine corpus, and bladder
Bach et al in JAMA 20022872106-2113.
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Common Causes for Mortality Disparities Between
Blacks and Whites
Wong et al in NEJM 20023471585-1592.
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Organizing Principle The Evolution of Health
Equity Research
First Generation
Second Generation
Provide solutions for reducing or eliminating
inappropriate disparities in health and health
care.
Third Generation
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Although some might argue that intervention
studies are premature, well designed
interventions that either fail or succeed will
teach us more about the pathways that lead to
racial disparities and will lead us closer to
improving health and health care for all
Americans, which is ultimately how the field of
health equity research will be judged.