Missing race/ethnicity data in Veterans Health Administration based disparities research: a systematic review.
ABSTRACT Many studies evaluating racial disparities in health come from the Veterans Health Administration (VHA) and are based on secondary and administrative data. Often race/ethnicity data are missing in these sources. Knowing how investigators treat missing data is critical in evaluating potential biases. The objectives of this systematic review were to quantify: (1) the data sources for VHA racial/ethnic disparity studies; (2) how missing race/ethnicity data were handled; and (3) the extent of missing race/ethnicity data. Two trained reviewers independently abstracted 114 articles. The Patient Treatment File was the most common source of race/ethnicity data (n=49). For just over half of the articles we were unable to determine if there were missing race/ethnicity data (n=58). When missing race/ethnicity data were quantified, the proportion of instances for which the data were missing ranged from 0% to 48%. Missing race/ethnicity data are frequently present in VHA secondary and administrative data sources, but, the proportion of instances for which such data are missing is explicitly discussed or quantified in only about 50% of all articles using these sources.
SourceAvailable from: Judith B Kaplan[Show abstract] [Hide abstract]
ABSTRACT: Implicit assumptions about the quality of data on “race” and “ethnicity” underlie the design of much of today’s research on health disparities. Health researchers, policy makers, and practitioners tend to take it for granted that racial/ethnic categories are clearly and consistently defined; that individual race/ethnicity can be easily, validly, and reliably determined; and that categories capture population groups that are so inherently different from each other that any reported racial/ethnic difference can automatically be generalized to the US population as a whole. This article outlines a series of issues that challenge these assumptions about the quality of race/ethnicity data. While race/ethnicity classifications can approximate socially constructed identities for some groups of people under some circumstances, these classifications are inherently too imprecise to allow meaningful statements to be made about underlying biological or genetic differences between groups. Findings of racial/ethnic differences should be reported with appropriate caveats and interpreted with caution. Particular caution should be exercised in hypothesizing genetic differences between groups in the absence of convincing genetic evidence.Race and Social Problems 09/2014; 6(3). DOI:10.1007/s12552-014-9121-6
[Show abstract] [Hide abstract]
ABSTRACT: Background Cardiovascular disease (CVD) is the leading cause of mortality for U.S. women. Racial minorities are a particularly vulnerable population. The increasing female veteran population has an higher prevalence of certain cardiovascular risk factors compared with non-veteran women; however, little is known about gender and racial differences in cardiovascular risk factor control among veterans. Methods We used analysis of variance, adjusting for age, to compare gender and racial differences in three risk factors that predispose to CVD (diabetes, hypertension, and hyperlipidemia) in a cohort of high-risk veterans eligible for enrollment in a clinical trial, including 23,955 men and 1,010 women. Findings Low-density lipoprotein (LDL) values were higher in women veterans than men with age-adjusted estimated mean values of 111.7 versus 97.6 mg/dL (p < .01). Blood pressures (BPs) were higher among African-American than White female veterans with age-adjusted estimated mean systolic BPs of 136.3 versus 133.5 mmHg, respectively (p < .01), and diastolic BPs of 82.4 versus 78.9 mmHg (p < .01). African-American veterans with diabetes had worse BP, LDL values, and hemoglobin A1c levels, although the differences were only significant among men. Conclusions Female veterans have higher LDL cholesterol levels than male veterans and African-American veterans have higher BP, LDL cholesterol, and A1c levels than Whites after adjusting for age. Further examination of CVD gender and racial disparities in this population may help to develop targeted treatments and strategies applicable to the general population.Women s Health Issues 10/2014; 24(5):477–483. DOI:10.1016/j.whi.2014.05.005 · 1.61 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objectives Patients with schizophrenia experience risks for metabolic dysregulation from medications and lifestyle behaviors. While most patients with schizophrenia in the Veterans Health Administration (VA) receive antipsychotics, variation in monitoring metabolic dysregulation by race/ethnicity has not been assessed. This study analyzed differential monitoring of metabolic parameters by minority status. Design The retrospective study approximated the five components of metabolic syndrome (fasting glucose, HDL, triglycerides, blood pressure, and large waistline) using archival data, substituting body mass index for waistline. Setting and Participants: VA patients with schizophrenia age 50 or older October 1, 2001 were followed through September 2009 (N=30,258). Measurements Covariates included age, gender, race (White, Black), Hispanic ethnicity, region, married, VA priority status, comorbidity, and antipsychotic type. Repeated measures analysis assessed the association of race/ethnicity with metabolic monitoring. Results Patients averaged 59 years (SD 9; range 50-101), 97% were men, 70% White, 30% Black, and 8% Hispanic. At baseline, 6% were monitored on all five metabolic components; this increased to 29% by 2005. In adjusted models, Blacks were less likely to be monitored on all parameters, while Hispanics were less likely to have glucose and HDL monitored but more likely to have triglycerides tested. By 2009, lab assays were similar across race and ethnicity. Conclusions Guideline-concordant monitoring metabolic parameters appears to be equitable but low and somewhat at odds with racial/ethnic risk among older patients with schizophrenia. Physicians should discuss lipids, weight, and glucose with patients at risk for developing heart disease, diabetes, and other sequelae of the metabolic syndrome.American Journal of Geriatric Psychiatry 07/2014; 23(6). DOI:10.1016/j.jagp.2014.07.007 · 3.52 Impact Factor