Article

Measuring Trends in Racial/Ethnic Health Care Disparities

Cambridge Health Alliance/Harvard Medical School, Somerville, MA, USA.
Medical Care Research and Review (Impact Factor: 2.57). 10/2008; 66(1):23-48. DOI: 10.1177/1077558708323607
Source: PubMed

ABSTRACT Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black-White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic-White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.

Full-text

Available from: Benjamin L Cook, Jun 16, 2015
0 Followers
 · 
89 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. We examined potential pathways by which time in the U.S. may relate to differences in rates of last year psychiatric disorder among Latino immigrants as compared to U.S. born Latinos. Methods. Using logistic regression analyses, we estimated the predicted rates for U.S.-born and immigrant groups with varying time in the U.S. adjusting for different combinations of covariates as a way to test six different potential pathways by which time in the U.S. may increase/decrease the risk for psychiatric disorders. Results. Exposure to the U.S. increases predicted rates of psychiatric disorder among Latino immigrants. After adjustment for relevant covariates, differences disappear between U.S.-born and immigrant Latinos. Discrimination and family cultural conflict appear to play a significant mediating role in the relationship between time in the U.S. and rates of psychiatric disorder. Conclusions. Findings suggest that increasing discrimination and family cultural conflict are pathways by which time in the U.S. increases probability of having psychiatric disorder in the last year. Adjustment methods described here can be applied to future studies analyzing pathways between time in the U.S. and mental health.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
  • Journal of Social and Clinical Psychology 01/2014; 33(1):1-24. DOI:10.1521/jscp.2014.33.1.1 · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: A limited literature on racial/ethnic disparities in the treatment of substance use disorders suggests that quality of treatment may differ based on client's race/ethnicity. This study examined whether (a) disparities exist in the probability of treatment engagement, a performance measure for substance use disorders, and (b) treatment engagement is associated with similar reductions in likelihood of arrest for Whites, Blacks, Latinos, and American Indians. Method: Adult clients who began an outpatient treatment episode in 2008 in public sector specialty treatment facilities in Connecticut, New York, Oklahoma, and Washington made up the sample (N = 108,654). Administrative treatment data were linked to criminal justice data. The criminal justice outcome was defined as an arrest within a year after beginning treatment. Engagement is defined as receiving a treatment service within 14 days of beginning a new outpatient treatment episode and at least two additional services within the next 30 days. Two-step Heckman probit models and hierarchical time-to-event models were used in the analyses. Results: Black clients in New York and American Indian clients in Washington had significantly lower likelihood of engagement than White clients. As moderators of engagement, race/ethnicity had inconsistent effects across states on the hazard of arrest. Conclusions: Racial/ethnic minority groups may benefit from additional treatment support to reduce criminal justice involvement. States should examine whether disparities exist within their treatment system and incorporate disparities reduction in their quality improvement initiatives. (J. Stud. Alcohol Drugs, 76, 57-67, 2015).
    Journal of studies on alcohol and drugs 01/2015; 76(1):57-67. DOI:10.15288/jsad.76.1.57 · 2.27 Impact Factor