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Kaiser’s Monthly Update on Health Disparities

Kaiser’s Disparities Research Roundup

This Kaiser Disparities Research Roundup is a regularly updated summary of new research on health care disparities. It includes selected academic research and policy papers that focus on a broad range of disparities in health care, including disparities in health insurance coverage, access to care, utilization of care, quality of care, and health status.

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This Kaiser Disparities Research Roundup is a regularly updated summary of new research on health care disparities. It includes selected academic research and policy papers that focus on a broad range of disparities in health care, including disparities in health insurance coverage, access to care, utilization of care, quality of care, and health status.

1. Differences In Patient-Reported Experiences Of Care By Race And Acculturation Status

2. Racial Disparity In U.S. Diagnoses Of Acquired Immune Deficiency Syndrome, 2000-2009

3. Quality And Equity Of Primary Care With Patient-Centered Medical Homes: Results From A National Survey

4. Healthcare Utilization Among Hispanic Immigrants With Diabetes: Investigating The Effect Of U.S. Documentation Status

5. Racial/Ethnic Disparities In Health And Health Care Among U.S. Adolescents

6. Factors That Mediate Racial/Ethnic Disparities In U.S. Fetal Death Rates

7. Decomposing The Gap In Satisfaction With Provider Communication Between English- And Spanish-Speaking Hispanic Patients

8. Health Care Access And Utilization Among U.S.-Born And Foreign-Born Asian Americans

9. Racial Disparities In Economic And Clinical Outcomes Of Pregnancy Among Medicaid Recipients

1. Differences In Patient-Reported Experiences Of Care By Race And Acculturation Status

Using data from the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey Adult Primary Care instrument, this study found that race and acculturation status were significantly associated with experiences of care, including patient ratings of their provider and perceptions of shared decision making and helpfulness. Consistent with previous research, unacculturated Hispanics had the poorest self-rated health scores, gave significantly higher provider ratings, and had more interest in shared decision making than other groups. The authors conclude that race and acculturation may play a role in physician-patient relationships and overall health care delivery.
(Hasnain M, Schwartz A, Girotti J, et al. Differences in patient-reported experiences of care by race and acculturation status. Journal of Immigrant and Minority Health. 2012 Nov; DOI: 10.1007/s10903-012-9728-x).

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2. Racial Disparity In U.S. Diagnoses Of Acquired Immune Deficiency Syndrome, 2000-2009

Using data from the national HIV surveillance records, this study, analyzed trends in racial/ethnic disparities in rates of AIDS diagnoses in all 50 states and the District of Columbia. The analysis found that between 2000 and 2009, disparities in the rate of AIDS diagnoses decreased between all racial/ethnic groups except those between black and white men aged 13-24, for whom disparities increased. The findings indicate progress in reducing overall racial/ethnic disparities in AIDS diagnoses in the last decade but highlight widening black-white disparities among young men nationwide.
(An Q, Prejean J, Hall I. Racial disparity in U.S. diagnoses of acquired immune deficiency syndrome, 2000-2009. American Journal of Preventive Medicine. 2012 Oct; 43(5): 461-466).

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3. Quality And Equity Of Primary Care With Patient-Centered Medical Homes: Results From A National Survey

This study analyzed the impact of patient-centered medical homes on reducing disparities in the quality of pediatric primary care, using data from the National Survey for Children’s Health. The study found that having a patient-centered medical home (PCMH) was associated with a significant reduction in unmet health needs across racial and ethnic groups. However, it did not alter the disparity between groups for other measures of quality of care. The authors suggest that PCMHs should prioritize obtaining racial and ethnic data on patients and incorporating patient experience data into program evaluations.
(Aysola J, Bitton A, Zaslavsky A, et al. Quality and equity of primary care with patient-centered medical homes: results from a national survey. Medical Care. 2012 Oct; DOI: 10.1097/MLR.0b013e318270bb0d).

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4. Healthcare Utilization Among Hispanic Immigrants With Diabetes: Investigating The Effect Of U.S. Documentation Status

This study examined differences in the use of health care between documented and undocumented Hispanic immigrants with diabetes using data from the 2007 Hispanic Healthcare Survey. The analysis found that, among Hispanics wi
th diabetes, undocumented immigrants were less likely to have seen a health care provider in the previous six months, report having a usual source of care, and have health insurance compared to documented immigrants. These findings build on existing research by detailing new differences by documentation status. The authors suggest additional research using primary data collection and quantitative analyses be conducted to further understand the causal factors that influence Hispanic immigrants’ decisions to seek medical care.
(Do E, Matsuyama RK. Healthcare utilization among Hispanic immigrants with diabetes: investigating the effect of U.S. documentation status. Journal of Immigrant Minority Health. 2012 Oct; DOI: 10.1007/s10903-012-9729-9).

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5. Racial/Ethnic Disparities In Health And Health Care Among U.S. Adolescents

This study examined racial and ethnic disparities in health status, access to care, and use of services among U.S. adolescents using data from the 2003 National Survey of Children’s Health. The analysis found lower rates of coverage and care and poorer health status among racial and ethnic minority groups compared to whites and particularly significant disparities for specific groups. For example, American Indians/Alaska Natives had the largest number of disparities at age 18, Latinos had the highest uninsured rate, and African Americans had the largest number of health status disparities. The study found several unique disparities among adolescents that have not previously been identified in children’s health, which may have implications for future research, practice, and policy.
(Lau M, Lin H, Flores G. Racial/ethnic disparities in health and health care among U.S. adolescents. Health Services Research. 2012 Oct; 47(5): 2031—2059).

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6. Factors That Mediate Racial/Ethnic Disparities In U.S. Fetal Death Rates

This study examined the impact of socioeconomic status, maternal health, complications during pregnancy, and fetal health status on racial disparities in fetal death. Using hospital delivery data from three states between 1993 and 2005, the researchers found that these factors influenced fetal death disparities, but the role of the factors varied across groups. The authors conclude that additional research is needed to understand the role of mediating factors and suggest that those amenable to intervention should be the focus of immediate efforts to reduce fetal death disparities.
(Lorch SA, Kroelinger CD, Ahlberg C, Barfield WD. Factors that mediate racial/ethnic disparities in U.S. fetal death rates. American Journal of Public Health. 2012 Oct; 102(10): 1902—1910).

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7. Decomposing The Gap In Satisfaction With Provider Communication Between English- And Spanish-Speaking Hispanic Patients

This study quantified and sought to understand disparities in patient satisfaction between English- and Spanish- speaking Hispanic patients using data from the Medical Expenditure Panel Survey. The analysis found that, relative to Spanish-speakers, English-speaking Hispanics were more likely to be satisfied with provider communication and that acculturation, health insurance, and education all contributed to this difference. The findings point to the importance of understanding the heterogeneity of the Hispanic population to create widespread improvements in clinical interactions.
(Villani J, Mortensen K. Decomposing the gap in satisfaction with provider communication between English- and Spanish-speaking Hispanic patients. Journal of Immigrant Minority Health. 2012 Oct; DOI: 10.1007/s10903-012-9733-0).

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8. Health Care Access And Utilization Among U.S.-Born And Foreign-Born Asian Americans

This study examined disparities in health care access and utilization between U.S.-born and foreign-born Asian Americans using data from the National Health Interview Survey. The study found that, overall, foreign-born Asians had less access to care and lower utilization compared to their U.S.-born peers, with some variation by country of birth. These findings highlight key barriers to care for Asian immigrants, including socioeconomic status, language, and culture.
(Ye J, Mack D, Fry-Johnson Y, et al. Health care access and utilization among U.S.-born and foreign-born Asian Americans. Journal of Immigrant Minority Health. 2012 Oct; DOI: 10.1007/s10903-011-9543-9).

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9. Racial Disparities In Economic And Clinical Outcomes Of Pregnancy Among Medicaid Recipients

To explore racial and ethnic disparities in pregnancy outcomes among Medicaid enrollees, this study analyzed Medicaid Analytic eXtract data from 2005 to 2007 in 14 southern states. The study found that, among Medicaid enrollees, African-American women were more likely than non-Hispanic white and Hispanic women to have longer hospital stays and pregnancy complications. Hispanic women had the lowest rate of adverse pregnancy outcomes. The study estimated that eliminating disparities in adverse pregnancy events could save between $114 and $214 million annually in Medicaid costs in the 14 states studied.
(Zhang S, Cardarelli K, Shim R, et al. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and Child Health Journal. 2012 Oct; DOI: 10.1007/s10995-012-1162-0).

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