Disparities and Health Equity

The differences in ability to access health care and in health outcomes across the population.

Health Inequity in the United States: A Primer

Issue Brief
Jan. 6, 2020

By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place. In this primer, we provide an overview of these distinctly American problems, and discuss programs and policies that might promote greater health equity in the population. 


Risk Factors and Racial Disparities Related to Low Maternal Birth Satisfaction with Labor Induction: A Prospective, Cohort Study

Dec. 30, 2019

Rebecca F. Hamm, Sindhu K. Srinivas, Lisa D. Levine 

Abstract [from journal]

Background: Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction.

Methods: We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from Jan 2018 to Jun 2018. Women completed


Increasing Adolescent Firearm Homicides and Racial Disparities Following Florida’s ‘Stand Your Ground’ Self-Defence Law

Dec. 20, 2019

Michelle Degli Esposti, Douglas J. Wiebe, Jason Gravel, David K. Humphreys

Abstract [from journal]

Establishing whether specific laws impact rates of firearm homicide in adolescents is critical for identifying opportunities to reduce preventable adolescent death. We evaluated Florida’s Stand Your Ground law, enacted October 2005, using an interrupted time series design from 1999 to 2017. We used segmented quasi-Poisson regression to model underlying trends in quarterly rates of adolescent (15–19 years) firearm homicide in Florida and disaggregated by race (Black/White). We used synthetic and negative controls (firearm suicide) to address time-...

Medicare SNF Payment Policy: What a Difference a Day Makes

Dec. 19, 2019

It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.

Annual Report on Children's Healthcare: Healthcare Access and Utilization by Obesity Status in the United States

James Guevara, MD, MPH
Dec. 13, 2019

Terceira Berdahl, Adam Biener, Marie C. McCormick, James P. Guevara, Lisa Simpson


Research Objective: To examine access to care and utilization patterns across a set of healthcare measures by obesity status and socio-demographic characteristics among children.

Study Design/Population Studied: Nationally representative data from the Medical Expenditure Panel Survey (2010-2015) provides data on obesity status, well-child visits, access to a usual source of care provider, preventive dental visits and prescription medication fills in the past year.


Dissatisfaction with Medical and Surgical Residency Training Is Consistently Higher for Women than for Men

Nov. 11, 2019

C. Jessica Dine, Manqing Liu, David A. Asch, Lisa M. Bellini, Karl Y. Bilimoria, Sanjay V. Desai, Judy A. Shea

Abstract [from journal]

In an attempt to balance service and education, there is a renewed focus on trainee work experiences and job satisfaction. Overall measures of dissatisfaction likely disguise differences across defined subgroups, particularly men and women, known to experience job satisfaction and burnout differently across professions. A previous study showed gender differences in satisfaction during surgical residency training. The objective of this study was to determine gender differences in dissatisfaction with specific aspects of the institutional environment and with...

Comparing Rates of Adverse Events and Medical Errors on Inpatient Psychiatric Units at Veterans Health Administration and Community-Based General Hospitals

Nov. 1, 2019

Sara W. Cullen, Ming Xie, Jentien M. Vermeulen, Steven C. Marcus

Abstract [from journal]

Objective: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes. This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals.

Method: Retrospective medical record reviews assessed the prevalence of


Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients

Marilyn M. Schapira, MD, MPH
Oct. 28, 2019

Marilyn Schapira, Arshia Faghri, Elizabeth Jacobs, Kathlyn Fletcher, Pamela Ganschow, Denise Gil, Alicia Smallwood, Cindy Walker, Joan Neuner

Abstract [from journal]

Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and


Jailers at the Bedside: Ethical Conflicts in Provision of Community Hospital Care for Incarcerated Individuals

Oct. 25, 2019

Emily E. Moin, Dominic A. Sisti

Abstract [from journal]

Incarcerated individuals in the United States are frequently transferred to hospitals in the community setting for specialized medical care beyond the capability of on-site facilities. Despite the widespread prevalence of this practice, hospitals set their own policies for the care of these vulnerable patients, which are often in conflict with broadly accepted principles of medical ethics. This article explores common practices of community hospitals in caring for incarcerated individuals and argues for the need for further research and, ultimately,


Healthcare Utilization for Children in Foster Care

Oct. 14, 2019

Colleen E.Bennett, Joanne N.Wood, Philip V.Scribano

Abstract [from journal]

Objective: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) healthcare utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and, 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.

Methods: Children ≤18 years old with a designation of FC placement and controls matched on age, race/


Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review

Oct. 9, 2019

Stacey Bevan, Jianghong Liu, Kate Wallis, Jennifer Pinto-Martin

Abstract [from journal]

Background: Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the...