Browsing by Subject "Disparities"

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A capabilities approach to understanding health disparities
(2018-08) Thurman, Whitney Annetta; Harrison, Tracie C., 1968-; Garcia, Alexandra; Sage, William M; Stuifbergen, Alexa K; Umberson, Debra; Walker, Veronica
Health disparities are pervasive in the U.S., and three of the greatest risk factors for poor health outcomes are race, rural residence, and disability. Individuals in these groups frequently experience poor health outcomes and social disadvantages. Such disadvantages contradict ethical principles such as respect for equal moral worth of all and social values such as non-discrimination. The purpose of this dissertation was to explore race, disability, rural culture, and disparities experienced by these groups using a social justice lens. Specifically, this dissertation relies upon a social constructionist perspective situated within Sen’s capabilities approach to examine the cultural and social systems that influence the meaning and experience of health, well-being, and disability. The dissertation is comprised of three separate manuscripts; each presents findings from a distinct investigation. The first is an issue brief that answers the research question: how does the capabilities approach compare with the WHO’s International Classification of Functioning, Disability, and Health (ICF) in terms of these models’ ability to accommodate the diverse experiences and needs of people with disabilities? The second presents results from a critical analysis of literature related to racial disparities in healthcare utilization and outcomes among veterans in the Veterans’ Healthcare Administration (VHA). This investigation answers the research question: what are the structural determinants that influence disparities in health between African-American veterans and their non-Hispanic white counterparts with osteoarthritis? The third presents findings from a grounded theory study investigating well-being among working-age adults with disabilities living in rural counties in Texas. This investigation of 12 rural-dwelling adults with disabilities answers the research questions: how do working-age adults with disabilities who live in rural Texas define and pursue well-being, and how does the rural environment influence both their definition of and their ability to pursue well-being? The findings from this dissertation underscore the critical notion that individuals are inextricable from their social worlds. It is argued that without a holistic assessment of an individual’s sociocultural and economic circumstances, healthcare providers may inadvertently perpetuate disparities by providing culturally inappropriate care and/or prescribing physically or economically unattainable interventions. Implications for nursing practice, policy, and the delivery of long-term services and supports in rural areas are discussed.
A cohort perspective of U.S. adult mortality
(2011-05) Masters, Ryan Kelly; Hummer, Robert A.; Hayward, Mark D.; Powers, Daniel A.; Umberson, Debra J.; Krueger, Patrick M.
This dissertation advances a cohort perspective to analyze trends in racial and educational disparities in U.S. adult mortality. The project is organized around three themes. First, I emphasize that recent temporal changes in U.S. adult mortality risk are rooted in cohort forces. Unfortunately, much of the mortality literature has failed to account for the fact that the sociohistorical conditions of U.S. cohorts have changed dramatically, and these changes have tremendous implications for population health and mortality trends. My work clearly shows the pitfalls of omitting these cohort effects from analyses of U.S. adult mortality risk. Second, I illustrate that because exposure to social and health conditions have changed over time, resources in adulthood are growing increasingly important in shaping U.S. adult mortality risk. In this regard, my findings also highlight growing disparities in U.S. mortality across race/ethnic gender groups. Third, I advance a cohort theory of U.S. mortality, drawing from both “fundamental cause” theory and a life course perspective of mortality but couching them in a cohort framework to highlight the importance of historical changes in U.S. social and health contexts in both childhood and adulthood. This cohort perspective is then used to analyze three central topics in the U.S. mortality literature: the black-white crossover in older-adult mortality, the growing educational gap in U.S. adult mortality, and the origins and persistence of black-white inequalities in U.S. adult mortality. I estimate hierarchical age-period-cohort cross-classified random effects models using National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to simultaneously analyze age, period, and cohort patterns of U.S. adult mortality rates. I find (1) the black-white crossover is a cohort-specific phenomenon, (2) educational disparities in U.S. adult mortality rates are growing across birth cohorts, not time periods, and (3) racial disparities in U.S. adult mortality rates stem from cumulative racial stratification across both cohorts and the life course. Such findings have direct consequences for both mortality theories and policy recommendations. Only by considering the disparate sociohistorical conditions that U.S. cohorts have endured across their life courses can we fully understand and address current and future health disparities in the United States.
Educational differentials in U.S. adult mortality : trends and causes
(2014-12) Sasson, Isaac; Weinreb, Alexander; Hayward, Mark D; Hummer, Robert A; Powers, Daniel A; Tuljapurkar, Shripad; Umberson, Debra J
As life expectancy at birth in the United States approaches eighty years of age, educational differentials in adult mortality are greater than ever. One of the key sociological insights of our time is that these two processes are fundamentally interrelated. As society gains greater social capacity to control health and disease socioeconomic status (SES) becomes increasingly important for shaping healthy social environments and lifestyles, which reduce the risk of mortality. Of all SES indicators, educational attainment is perhaps the single most important predictor of mortality in the United States. Not only do low-educated Americans have shorter lifespans compared to their college-educated counterparts, on average, but they have recently suffered absolute declines in life expectancy. However, debates surrounding the extent, causes, and even validity of those trends continue. This dissertation makes several unique contributions to our understanding of lifespan inequality by educational attainment in the United States. First, using vital statistics data, it documents trends in life expectancy and lifespan variation—a unique dimension of lifespan inequality—by educational attainment for black and white Americans of both genders from 1990 to 2010. Second, it decomposes those trends by age and cause of death in order to understand the proximate causes of the educational disparity in adult mortality. Third, it evaluates the extent to which changes in the composition of education groups account for the rising education-mortality gradient. The findings reveal that the gap in life expectancy at age 25 between the low educated (having fewer than twelve years of schooling) and the college educated has doubled among men and more than tripled among women over the study period; that life expectancy declined among low-educated white men and women (by 0.6 and 3.1 years, respectively); and that much of these trends is attributed to an increase in premature deaths from smoking-related diseases and external causes. While both sides of the selection-causation debate have merit, changes in group composition do not fully account for the increase in mortality among low-educated Americans, for whom economic circumstances have worsened. Overall, the association between educational attainment and adult mortality is pervasive, enduring, and increasing in magnitude.
IRB Research Proposal: Understanding barriers to substance abuse treatment
(2016) Pinedo, Miguel
This two-year pilot study aimed to 1) to gain greater understanding of barriers to specialty substance abuse treatment among Whites, African Americans, and Latinos with lifetime substance abuse disorders; 2) to compare and contrast barriers to specialty substance abuse treatment by race/ethnicity and gender among participants with lifetime AUD; and 3) using findings from Aims 1 & 2, to develop a new quantitative scale to assess barriers to specialty substance abuse treatment
Qualitative interview guide: Understanding barriers to substance abuse treatment
(2016) Pinedo, Miguel
This two-year pilot study aimed to 1) to gain greater understanding of barriers to specialty substance abuse treatment among Whites, African Americans, and Latinos with lifetime substance abuse disorders; 2) to compare and contrast barriers to specialty substance abuse treatment by race/ethnicity and gender among participants with lifetime AUD; and 3) using findings from Aims 1 & 2, to develop a new quantitative scale to assess barriers to specialty substance abuse treatment.
Racial/ethnic disparities between Hispanic and Non-Hispanic White women with breast cancer
(2022-12-02) Thaliffdeen, Ryan Safraz; Rascati, Karen L.
Background: Across the United States, Hispanic (H) patients with breast cancer (BCa) have displayed similar to better outcomes than Non-Hispanic White (NHW) BCa patients. However in Texas specifically, some data suggest that H BCa patients may have worse outcomes compared to their NHW counterparts. Objective: To compare clinical characteristics, healthcare resource utilization (HCRU), and outcomes amongst H and NHW BCa patients. Methods: This retrospective cohort study used existing electronic health record (EHR) data from a Texas-based integrated delivery network (2018–2022). Patients were indexed on first BCa diagnosis date and grouped based on race-ethnicity combination (NHW, Any Race/H). A tumor registry was used to supplement EHR data, with variables such as genotype and receipt of treatment type. Baseline characteristics, healthcare visit frequency, proportions of patients with hospitalizations or emergency department (ED) visits at 1-year and 3-years post-diagnosis, and time to HCRU were compared between groups. Results: A total of 741 patients were included in the final study population (N=109, H; N=632, NHW). Analysis of baseline characteristics showed significant differences between mean age at diagnosis (SD) (p<0.0001), H=56.9(SD=14.8) versus NHW=63.1(SD=12.8); primary insurance type (p<0.0001), H=32.0% Medicare and 17.5% Medicaid versus NHW=43.7% Medicare and 4.6% Medicaid; and patients who received chemotherapy (p=0.0426), H=51.4% versus NHW=41.0%. There were no significant differences in the proportion of patients with ≥1 hospitalization at 1-year (p=0.2755), H=15.6% versus NHW=11.9%, and 3-years (p=0.7903), H=33.0% versus NHW=34.3%, post-diagnosis. Mean total number of visits per patient (p=0.9361), H=91.9(SD=59.9) versus NHW=92.2(SD=63.3), as well as subtypes such as mean number of telemedicine visits per patient (p=0.0556), H=2.7(SD=4.1) versus NHW=3.6(SD=5.2), were also not significantly different, regardless of visit subtype. Additionally, likelihood of hospital admission (HR: 1.3, 95% CI: 0.8–2.1, ref: H) and ED visit (HR: 1.1, 95% CI: 0.7–1.6, ref: H) were not significantly different. Finally, there were no significant differences in mortality (p=0.1160), H=2.8% versus NHW=6.7%. Conclusion: Although there were some differences in baseline characteristics between H and NHW BCa patients, no significant differences were found with respect to frequency of healthcare visits and time to HCRU.
Telephone interview guide: Understanding barriers to substance abuse treatment
(2016) Pinedo, Miguel
This two-year pilot study aimed to 1) to gain greater understanding of barriers to specialty substance abuse treatment among Whites, African Americans, and Latinos with lifetime substance abuse disorders; 2) to compare and contrast barriers to specialty substance abuse treatment by race/ethnicity and gender among participants with lifetime AUD; and 3) using findings from Aims 1 & 2, to develop a new quantitative scale to assess barriers to specialty substance abuse treatment
Telephone interview guide: Understanding barriers to substance abuse treatment (Spanish version)
(2016) Pinedo, Miguel
This two-year pilot study aimed to 1) to gain greater understanding of barriers to specialty substance abuse treatment among Whites, African Americans, and Latinos with lifetime substance abuse disorders; 2) to compare and contrast barriers to specialty substance abuse treatment by race/ethnicity and gender among participants with lifetime AUD; and 3) using findings from Aims 1 & 2, to develop a new quantitative scale to assess barriers to specialty substance abuse treatment
The impact of race and ethnicity on healthcare utilization, medication utilization, and obesity-related clinical measurements in an employee-based insured population
(2022-04-27) Nguyen, Cindy Trang; Rascati, Karen L.
Objective: To evaluate an association between race/ethnicity on healthcare and medication utilization, as well as obesity-related clinical measures across weight categories in patients who are overweight or obese within an employee-based commercial insurance plan. Methods: This retrospective cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients that were 18 years or older at index, BMI ≥ 25 or greater at index, had continuous health plan enrollment throughout the study period, and did not die during the study period were included in the study. Patients were divided into 4 race/ethnicity groups and categorized by obesity classification. The primary outcome of this analysis was healthcare utilization as measured by inpatient, outpatient, and emergency department visits. Kruskal-Wallis tests and chi-square tests were employed to analyze overall differences in continuous and categorical data, respectively. Results: Among 6,051 patients, 4,384 patients were White, 892 were Black, 439 were Hispanic or Latino, and 336 were categorized as Other. Additionally, 2,386 patients were overweight at index, followed by 1,914 obese class I patients, 928 obese class II patients, and 823 obese class III patients. The composite outcome of outpatient visits, inpatient visits, and emergency department visits were significantly different across race/ethnicity groups for all patients (p<0.0001) and obesity classifications including overweight (p=0.002), obese class I (p<0.0001), and obese class II (p=0.0087). Within obese class III, there were no significant differences in race for outpatient visits (p=0.6757), presence of at least one emergency department visit (p=0.3104), and composite outcome of all visits (p=0.5274). Conclusion: Despite patients being on an employee-based commercial insurance plan with continued coverage, differences in healthcare utilization, medication utilization, obesity-related clinical measures, and bariatric surgery utilization were present. However, patients with class III obesity demonstrated no significant differences in healthcare utilization, medication utilization, and frequency of clinical measures among race categories. These results suggest that worsening obesity severity is associated with increased healthcare utilization of patients despite racial or ethnic classification, providing real-world evidence for the management of overweight and obese patients, especially in relation to racial and ethnic minorities who are low utilizers of weight loss therapies.
The relationships between age, gender, and race and rate of immune recovery and life expectancy among patients living with HIV
(2016-08) Nduaguba, Sabina Onyinye; Wilson, James P.; Ford, Kentya C.; Lawson, Kenneth A
Despite medical advancement transforming HIV disease from a death sentence to a chronic illness, not all patients living with HIV (PLWH) experience the best health outcomes. The purpose of this study was to identify disparities (age, gender, and ethnicity) in health outcomes among patients living with HIV who reside in Texas. HIV surveillance data from the Texas Department of State Health Services was used to identify patients diagnosed with HIV between 1996 and 2013. This cohort was divided into 4 subcohorts according to year of HIV diagnosis; 1996-1997, 1998-2006, 2007-2010, and 2011-2013. The primary outcomes were rate of immune recovery, AIDS diagnosis, and death. Hierarchical linear models and survival analyses were used to assess the relationships between age, gender, and ethnicity and rate of immune recovery and AIDS diagnosis and death. A total of 70,996 patients were included in the study; 7,206, 36,286, 15,628, and 11,876 in the 1996-1997, 1998-2006, 2007-2010, and 2011-2013 subcohorts respectively. The results showed that age, gender, and ethnicity were not statistically associated with rate of immune recovery (p>0.01) but tended towards lower rate of immune recovery with increasing age and in males and Hispanics. Age was associated with clinical progression to AIDS and death (p<0.01) in all 4 subcohorts. Male gender was associated with clinical progression to AIDS in all subcohorts except the 2011-2013 subcohort but there was no relationship between gender and death in the 4 subcohorts. Compared to Hispanics, the risk of an AIDS diagnosis was lower in Blacks across all 4 subcohorts. After controlling for covariates, the relationship was lost in the 1996-1997 and 2011-2013 subcohorts. There was no clear difference in the risk of an AIDS diagnosis between Blacks and Whites. Compared to Whites and Hispanics, Blacks had higher risk of death in the 1996-1997 and 1998-2006 subcohorts. However, there was no relationship between ethnicity and death in the 2007-2010 and 2011-2013 subcohorts after controlling for covariates. In conclusion, the results of the survival analyses suggests some clinical relevance of differential rates of immune recovery, which presents an opportunity for early intervention before long-term outcomes like AIDS diagnosis and death occur.