Darrell J Gaskin

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States

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Publications (55)146.31 Total impact

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    ABSTRACT: Objectives. We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. Methods. We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998-2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100 000 or greater (n = 458). Results. Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. Conclusions. Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e8. doi:10.2105/AJPH.2014.301944).
    American journal of public health. 07/2014;
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    ABSTRACT: Little is known about how health insurance contributes to the prevalence of chronic disease in the overlooked population of low-income urban whites. This study uses cross-sectional data on 491 low-income urban non-elderly non-Hispanic whites from the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) study to examine the relationship between insurance status and chronic conditions (defined as participant report of ever being told by a doctor they had hypertension, diabetes, stroke, heart attack, anxiety or depression, asthma or emphysema, or cancer). In this sample, 45.8 % were uninsured, 28.3 % were publicly insured, and 25.9 % had private insurance. Insured participants had similar odds of having any chronic condition (odds ratios (OR) 1.06; 95 % confidence intervals (CI) 0.70-1.62) compared to uninsured participants. However, those who had public insurance had a higher odds of reporting any chronic condition compared to the privately insured (OR 2.29; 95 % CI 1.21-4.35). In low-income urban areas, the health of whites is not often considered. However, this is a significant population whose reported prevalence of chronic conditions has implications for the Medicaid expansion and the implementation of health insurance exchanges.
    Journal of urban health : bulletin of the New York Academy of Medicine. 06/2014;
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    ABSTRACT: Few studies have examined the relationship between education and diabetes among men in the United States and whether this relationship differs by race/ethnicity. This study examined whether racial disparities in diabetes existed by educational attainment in 336,746 non-Hispanic White, non-Hispanic Black, and Hispanic men 18 years of age and older in the United States. Logistic regression models were specified to examine the odds of reporting diabetes by educational attainment. Within race/ethnicity, both White and Hispanic men who had less than a high school education (odds ratio [OR] = 1.42, 95% confidence interval [CI] = [1.19, 1.69], and OR = 1.64, 95% CI = [1.22, 2.21], respectively) had consistently higher odds of diabetes than men with a bachelor's degree or higher level of educational attainment. Educational attainment did not appear to be associated with reporting a diagnosis of diabetes in non-Hispanic Black men. Identifying why educational attainment is associated with diabetes outcomes in some racial/ethnic groups but not others is essential for diabetes treatment and management.
    American journal of men's health 01/2014; · 1.15 Impact Factor
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    ABSTRACT: This article sought to determine whether racial disparities exist in psychotropic drug use and expenditures in a nationally representative sample of men in the United States. Data were extracted from the 2000-2009 Medical Expenditure Panel Survey, a longitudinal survey that covers the U.S. civilian noninstitutionalized population. Full-Year Consolidated, Medical Conditions, and Prescribed Medicines data files were merged across 10 years of data. The sample of interest was limited to adult males aged 18 to 64 years, who reported their race as White, Black, Hispanic, or Asian. This study employed a pooled cross-sectional design and a two-part probit generalized linear model for analyses. Minority men reported a lower probability of psychotropic drug use (Black = -4.3%, 95% confidence interval [CI] = [-5.5, -3.0]; Hispanic = -3.8%, 95% CI = [-5.1, -2.6]; Asian = -4.5%, 95% CI = [-6.2, -2.7]) compared with White men. After controlling for demographic, socioeconomic, and health status variables, there were no statistically significant race differences in drug expenditures. Consistent with previous literature, racial and ethnic disparities in the use of psychotropic drugs present problems of access to mental health care and services.
    American journal of men's health 01/2014; 8(1):82. · 1.15 Impact Factor
  • Christine S Spencer, Darrell J Gaskin, Eric T Roberts
    Health Affairs 01/2014; 33(1):181. · 4.64 Impact Factor
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    ABSTRACT: Objectives. We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalence. Methods. We used data from the 1999-2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial composition and poverty concentration on the odds of having diabetes. Results. We found a race-poverty-place gradient for diabetes prevalence for Blacks and poor Whites. The odds of having diabetes were higher for Blacks than for Whites. Individual poverty increased the odds of having diabetes for both Whites and Blacks. Living in a poor neighborhood increased the odds of having diabetes for Blacks and poor Whites. Conclusions. To address race disparities in diabetes, policymakers should address problems created by concentrated poverty (e.g., lack of access to reasonably priced fruits and vegetables, recreational facilities, and health care services; high crime rates; and greater exposures to environmental toxins). Housing and development policies in urban areas should avoid creating high-poverty neighborhoods. (Am J Public Health. Published online ahead of print November 14, 2013: e1-e9. doi:10.2105/AJPH.2013.301420).
    American Journal of Public Health 11/2013; · 3.93 Impact Factor
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    ABSTRACT: Food store availability may determine the quality of food consumed by residents. Neighborhood racial residential segregation, poverty, and urbanicity independently affect food store availability, but the interactions among them has not been studied. To examine availability of supermarkets, grocery stores, and convenience stores in US census tracts according to neighborhood racial/ethnic composition, poverty, and urbanicity. Data from 2000 US Census and 2001 InfoUSA food store data were combined and multivariate negative binomial regression models employed. As neighborhood poverty increased, supermarket availability decreased and grocery and convenience stores increased, regardless of race/ethnicity. At equal levels of poverty, black census tracts had the fewest supermarkets, white tracts had the most, and integrated tracts were intermediate. Hispanic census tracts had the most grocery stores at all levels of poverty. In rural census tracts, neither racial composition nor level of poverty predicted supermarket availability. Neighborhood racial composition and neighborhood poverty are independently associated with food store availability. Poor predominantly black neighborhoods face a double jeopardy with the most limited access to quality food and should be prioritized for interventions. These associations are not seen in rural areas which suggest that interventions should not be universal but developed locally.
    Preventive Medicine 10/2013; · 3.50 Impact Factor
  • Christine S Spencer, Darrell J Gaskin, Eric T Roberts
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    ABSTRACT: In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safety-net status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.
    Health Affairs 10/2013; 32(10):1731-1739. · 4.64 Impact Factor
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    ABSTRACT: Compared with elective surgical procedures, emergency procedures are associated with higher cost, morbidity, and mortality. This study seeks to investigate potential state-by-state variations in the incidence of emergent versus elective colon resections. A retrospective analysis of all adult patients (aged ≥18 years) included in the Nationwide Inpatient Sample from 2005 to 2009 who underwent hemicolectomy (right or left) or sigmoidectomy was conducted. Discharge-level weights were applied, and generalized linear models were used to assess the odds of a patient undergoing emergent versus elective colon surgery nationally and for each state after adjusting for patient and hospital factors. Odds ratios (ORs) were estimated with the national average as the reference. The final study cohort included 203,050 observations composed of 83,090 emergent and 119,960 elective colectomies. The state with the highest unadjusted proportion of emergent procedures was Nevada (53.6%), whereas Texas had the lowest (2.8%). Compared with the national average, the adjusted odds of undergoing emergency colectomy remained highest in Nevada (OR, 1.70; 95% confidence interval, 1.54-1.87) and lowest in Texas (OR, 0.43; 95% confidence interval, 0.36-0.51). Substantial state variations exist in rates of emergency colon surgery within the United States. Identification of these differences suggests significant variations in practice and a potential to decrease the number of emergent colon operations. Prognostic and epidemiologic study, level III.
    The journal of trauma and acute care surgery. 05/2013; 74(5):1286-91.
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    ABSTRACT: Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health.
    Social Science [?] Medicine 12/2012; · 2.73 Impact Factor
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    ABSTRACT: The study of regional variations in costs of care has been used to identify areas of savings for several diseases and conditions. This study investigates similar potential regional differences in the cost of adult trauma care using an all-payer, nationally representative sample. Trauma patients aged 18 to 64 years in the 2006-2008 Nationwide Inpatient Sample were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. Those with isolated diagnoses for five index conditions (ICs): blunt splenic injury, liver injury, tibia fracture, moderate traumatic brain injury, and pneumothorax/hemothorax were selected. Cost was estimated from charges using a cost-to-charge ratio. Generalized linear modeling was used to compare the mean cost for treating these ICs between US regions (Northeast, South, Midwest, and West), adjusting for hospital factors (size, teaching status, and location), patient demographics, injury severity, length of stay, Charlson comorbidity index, local wage index, and payer. Relative mean cost (RC) was calculated using Northeast as the reference, and sampling weights were applied to obtain regional estimates. Differences in adjusted mortality between regions were also assessed. Adjusted relative costs were estimated for 62,678 patients (South: 28,536; West: 12,975; Midwest: 11,450; and Northeast: 9,717). Mean costs for liver injury were 22%higher in the Midwest compared with the Northeast (RC: 1.22; 95%confidence interval [CI]: 1.10-1.35). Similarly higher costs were seen with other regions and ICs (RC for blunt splenic injury in the South: 1.18; 95% CI: 1.07-1.31; RC for pneumothorax/hemothorax in the West: 1.31; 95% CI: 1.22-1.41). No differences in adjusted mortality by region were noted overall. Even after controlling for factors known to influence medical care cost, as well as controlling for geographic differences in pricing, significant regional differences exist in the cost of trauma care. Exploring these variations may assist in identifying potential areas for cost savings.
    The journal of trauma and acute care surgery. 08/2012; 73(2):516-22.
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    ABSTRACT: Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent's race, ethnicity, age, education, and country of birth.
    Health & Place 05/2012; 18(5):1115-21. · 2.42 Impact Factor
  • Darrell J Gaskin, Patrick Richard
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    ABSTRACT: In 2008, according to the Medical Expenditure Panel Survey (MEPS), about 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis. Pain is costly to the nation because it requires medical treatment and complicates treatment for other ailments. Also, pain lowers worker productivity. Using the 2008 MEPS, we estimated 1) the portion of total U.S. health care costs attributable to pain; and 2) the annual costs of pain associated with lower worker productivity. We found that the total costs ranged from $560 to $635 billion in 2010 dollars. The additional health care costs due to pain ranged from $261 to $300 billion. This represents an increase in annual per person health care costs ranging from $261 to $300 compared to a base of about $4,250 for persons without pain. The value of lost productivity due to pain ranged from $299 to $335 billion. We found that the annual cost of pain was greater than the annual costs of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion). Our estimates are conservative because they do not include costs associated with pain for nursing home residents, children, military personnel, and persons who are incarcerated. PERSPECTIVE: This study estimates that the national cost of pain ranges from $560 to $635 billion, larger than the cost of the nation's priority health conditions. Because of its economic toll on society, the nation should invest in research, education, and training to advocate the successful treatment, management, and prevention of pain.
    The journal of pain: official journal of the American Pain Society 05/2012; 13(8):715-24. · 3.78 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine the association between residential segregation and geographic access to primary care physicians (PCPs) in metropolitan statistical areas (MSAs). DATA SOURCES: We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic, and segregation measures from the 2000 U.S. Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA. METHODS: We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of >3,500. Using logistic regressions, we estimated the association between a zip code's odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA. PRINCIPAL FINDINGS: We found that odds of being a PCP shortage area were 67 percent higher for majority African American zip codes but 27 percent lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes; however, the converse was true for majority Hispanic and Asian zip codes. CONCLUSIONS: Efforts to address PCP shortages should target African American communities especially in segregated MSAs.
    Health Services Research 04/2012; · 2.29 Impact Factor
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    ABSTRACT: Place of residence, particularly residential segregation, has been implicated in health and health care disparities. However, prior studies have not focused on care for diabetes, a prevalent condition for minority populations. To examine the association of residential segregation with a range of access and quality of care outcomes among black and Hispanics with diabetes using a nationally representative US sample. Cross-sectional study using data for 1598 adult patients with diabetes from the 2006 Medical Expenditure Panel Survey linked to residential segregation information for blacks and Hispanics on the basis of the 2000 census. Relationships of 5 dimensions of residential segregation (dissimilarity, isolation, clustering, concentration, and centralization) with access and quality of care outcomes were examined using linear, logistic, and multinomial logistic regression models, controlling for respondent characteristics and community utilization and hospital capacity. Black and Hispanics with diabetes had comparable or better access to providers, but received fewer recommended services. Living in a segregated community was associated with more recommended services received, but also problems with seeing a specialist. The relationship of residential segregation to diabetes care varied depending on type of segregation and race/ethnic group assessed. Residential segregation influences the care experience of patients with diabetes in the United States. Our study highlights the importance of investigating how different types of segregation may affect diabetes care received by patients from different race and ethnic groups.
    Medical care 04/2012; 50(8):692-9. · 3.24 Impact Factor
  • Journal of Surgical Research 02/2012; 172(2):189. · 2.02 Impact Factor
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    ABSTRACT: Using data from the 2006 Medical Expenditure Panel Survey and the 2000 Census, the authors explored whether race/ethnic disparities in health care use were associated with residential segregation. They used five measures of health care use: office-based physician visits, outpatient department physician visits, visits to nurses and physician's assistants, visits to other health professionals, and having a usual source of care. For each individual, the authors controlled for age, gender, marital status, insurance status, income, educational attainment, employment status, region, and health status. The authors used the racial-ethnic composition of the zip code to control for residential segregation. The findings suggest that disparities in health care utilization are related to both individuals' racial and ethnic identity and the racial and ethnic composition of their communities. Therefore, efforts to improve access to health care services and to eliminate health care disparities for African Americans and Hispanics should not only focus on individual-level factors but also include community-level factors.
    Medical Care Research and Review 10/2011; 69(2):158-75. · 3.01 Impact Factor
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    ABSTRACT: Much of the current health disparities literature fails to account for the fact that the nation is largely segregated, leaving racial groups exposed to different health risks and with variable access to health services based on where they live. We sought to determine if racial health disparities typically reported in national studies remain the same when black and white Americans live in integrated settings. Focusing on a racially integrated, low-income neighborhood of Southwest Baltimore, Maryland, we found that nationally reported disparities in hypertension, diabetes, obesity among women, and use of health services either vanished or substantially narrowed. The sole exception was smoking: We found that white residents were more likely than black residents to smoke, underscoring the higher rates of ill health in whites in the Baltimore sample than seen in national data. As a result, we concluded that racial differences in social environments explain a meaningful portion of disparities typically found in national data. We further concluded that when social factors are equalized, racial disparities are minimized. Policies aimed solely at health behavior change, biological differences among racial groups, or increased access to health care are limited in their ability to close racial disparities in health. Such policies must address the differing resources of neighborhoods and must aim to improve the underlying conditions of health for all.
    Health Affairs 10/2011; 30(10):1880-7. · 4.64 Impact Factor
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    ABSTRACT: This study aims to evaluate disparities in socioeconomic status and healthcare utilization in hearing-impaired children using a nationally representative sample. Cross-sectional analysis of stacked data from the 1997 to 2003 National Health Interview Survey, a voluntary U.S. household survey of the National Center for Health Statistics. Children were grouped according to three levels of hearing ability based on parental response to perceived hearing status. χ(2) and analysis of variance (ANOVA) models tested the association of individual sociodemographic variables with hearing status. Multivariate regression analyses examined the association of hearing impairment with family income, poverty status, and utilization of routine and specialty health services. The total sample consisted of 76,012 children, of whom 2.6% had some hearing loss and 0.43% had marked hearing loss. Families of hearing-impaired children were more likely to report poorer health status, have Medicaid, live in single-mother households, and live below the poverty level (P < .01). After adjusting for confounders, children with mild and marked hearing impairment were less likely to afford prescription medications (odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.44-2.48 [mild]; OR = 2.72, 95% CI, 1.73-4.29 [marked]) and less likely to have access to mental health services (OR = 3.26, 95% CI, 2.41-4.69 [mild]; OR = 2.62, 95% CI, 1.34-5.12 [marked]) or dental services (OR = 1.65, 95% CI, 1.36-2.02 [mild]; OR = 1.62, 95% CI, 1.09-2.41 [marked]). No difference was identified for access to routine/sick health services. Compared with families of children without hearing loss, families of hearing-impaired children live closer to the poverty level and utilize some medical services with less frequency. Further identification of causal relationships between familial socioeconomic status and childhood hearing loss may help direct policy initiatives designed to mitigate healthcare disparities and improve access to services for hearing-impaired children.
    The Laryngoscope 04/2011; 121(4):860-6. · 1.98 Impact Factor
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    ABSTRACT: The primary hypothesis of this study is that racial/ethnic disparities in health and health care impose costs on numerous aspects of society, both direct health care costs and indirect costs such as loss of productivity. The authors conducted three sets of analysis, assessing: (1) direct medical costs and (2) indirect costs, using data from the Medical Expenditure Panel Survey (2002-2006) to estimate the potential cost savings of eliminating health disparities for racial/ethnic minorities and the productivity loss associated with health inequalities for racial/ethnic minorities, respectively; and (3) costs of premature death, using data from the National Vital Statistics Reports (2003-2006). They estimate that eliminating health disparities for minorities would have reduced direct medical care expenditures by about $230 billion and indirect costs associated with illness and premature death by more than $1 trillion for the years 2003-2006 (in 2008 inflation-adjusted dollars). We should address health disparities because such inequities are inconsistent with the values of our society and addressing them is the right thing to do, but this analysis shows that social justice can also be cost effective.
    International Journal of Health Services 01/2011; 41(2):231-8. · 1.24 Impact Factor

Publication Stats

844 Citations
146.31 Total Impact Points

Institutions

  • 2002–2014
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Health Policy and Management
      Baltimore, MD, United States
  • 2012
    • Johns Hopkins Medicine
      • Department of Health Policy and Management
      Baltimore, MD, United States
  • 2007–2009
    • University of Maryland, College Park
      • Department of African American Studies
      College Park, MD, United States
    • RAND Corporation
      Santa Monica, California, United States
  • 2005–2007
    • The Washington Institute
      Washington, Washington, D.C., United States
    • United States Government Accountability Office
      Washington, Washington, D.C., United States
  • 2003–2007
    • University of Maryland, Baltimore
      • School of Pharmacy
      Baltimore, Maryland, United States
  • 2002–2005
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1997–2004
    • Georgetown University
      Washington, Washington, D.C., United States