State insurance mandates for in vitro fertilization are not associated with improving racial and ethnic disparities in utilization and treatment outcomes

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Racial and ethnic disparities in health care delivery can lead to inadequate peripartum pain management and associated adverse maternal outcomes. An epidural blood patch (EBP) is the definitive treatment for moderate to severe postdural puncture headache (PDPH), a potentially debilitating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States. In this retrospective observational study, we used the National Inpatient Sample, a nationally representative database of discharge records for inpatient admissions in the United States, from 2016 to 2020. We analyzed delivery hospitalizations of women of childbearing age (15-49 years) diagnosed with PDPH. Adjusting for maternal and hospitalization characteristics as confounders, we used a multilevel mixed-effects logistic regression model to compare the rates of EBP utilization by race and ethnicity. Secondarily, among hospitalizations with an EBP, we examined the association between race and ethnicity and the timing of the EBP procedure. We analyzed 49,300 delivery hospitalizations with a diagnosis of PDPH. An EBP was performed in 24,075 (48.8%; 95% confidence interval [CI], 47.8%-49.9%) of these hospitalizations. EBP was performed in 52.7% (95% CI, 51.3%-54.1%) of White non-Hispanic patients with PDPH. Compared to White non-Hispanic patients, Black non-Hispanic (adjusted odds ratio [aOR] = 0.69; 99% CI, 0.56-0.84), Hispanic (aOR = 0.80, 99% CI, 0.68-0.95), and Asian or Pacific Islander patients (aOR = 0.74, 99% CI, 0.58-0.96) were less likely to receive an EBP. The median (interquartile range [IQR]) time to perform an EBP was 2 (1-3) days after admission, with 90% of EBP procedures completed within 4 days of admission. There was no significant association between race and ethnicity and the timing of EBP placement. In this nationwide analysis of delivery hospitalizations from 2016 to 2020 in the United States with a diagnosis of PDPH, we identified racial and ethnic disparities in the utilization of EBP. Minoritized patients identified as Black non-Hispanic, Hispanic, or Asian or Pacific Islander were less likely to receive an EBP for the treatment of PDPH compared to White non-Hispanic patients. Suboptimal treatment of PDPH may be associated with adverse long-term outcomes such as postpartum depression, posttraumatic stress disorder, and chronic headaches. Racial and ethnic disparities in EBP utilization should be further investigated to ensure equitable health care delivery.

Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high morbidity and mortality. Mechanical circulatory support (MCS) devices are critical in management, but racial and ethnic disparities in MCS utilization remain understudied. Research Question: Do disparities exist in the utilization of MCS and healthcare resources among racial and ethnic groups with AMI-CS in the United States? Methods: We extracted data from the National Inpatient Sample database from 2018 to 2020. We included patients aged ≥18 years with AMI and CS listed as primary or secondary diagnosis, identified using ICD-10-CM (AMI: I21.0–I21.4; CS: R57.0). Racial/ethnic groups analyzed included White, Black, Hispanic, and Asian or Pacific Islander. The primary outcome was in-hospital mortality. Secondary outcomes included MCS utilization, hospital length of stay (LOS), total hospital charges, acute kidney injury (AKI)/hemodialysis, and sepsis. Multivariable logistic and linear regression models were used to assess associations between race/ethnicity and in-hospital outcomes, adjusting for potential covariates. Results: Among 89,125 hospitalizations for AMI-CS, Hispanic individuals had lower odds of in-hospital mortality compared to White individuals (OR 0.86; 95% CI, 0.76–0.96), while no significant differences were observed for other racial and ethnic groups. The odds of receiving MCS were higher among Asian or Pacific Islander (OR 1.35; 95% CI, 1.14–1.60) and Hispanic individuals (OR 1.15; 95% CI, 1.01–1.30) relative to White individuals. Compared to White individuals, Hispanic individuals had longer hospital stays (β = 1.3 days; 95% CI, 0.78–1.7), whereas Black individuals had shorter stays (β = –0.50 days; 95% CI, –0.91 - –0.10). The odds of AKI or hemodialysis were higher in Hispanic (OR 1.26; 95% CI, 1.12–1.42), Black (OR 1.59; 95% CI, 1.40–1.79), and Asian or Pacific Islander individuals (OR 1.39; 95% CI, 1.18–1.64) compared to White individuals. Hispanic individuals also had higher odds of developing sepsis (OR 1.18; 95% CI, 1.04–1.34). Additionally, total hospital charges were significantly greater for Hispanic ($53,770; 95% CI, $39,307–$68,233) and Asian or Pacific Islander individuals ($33,737; 95% CI, $8,954–$58,520) compared to White individuals. Conclusion: Racial and ethnic disparities in MCS use and clinical outcomes persist among patients with AMI and CS, highlighting the need for targeted strategies to improve AMI care.

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

PurposeThe purpose of this study was to examine ethnic disparities in the utilization of digital healthcare services (DHS) in Israel and explore the characteristics and factors influencing DHS use among the Arab minority and Jewish majority populations.MethodsA cross-sectional correlational design was employed to collect data from 606 Israeli participants, 445 Jews, and 161 Arabs. Participants completed a digital questionnaire that assessed DHS utilization, digital health literacy, attitudes towards DHS, and demographic variables.ResultsThe findings reveal significant disparities in DHS utilization and attitudes between these ethnic groups, with Jewish participants demonstrating higher rates of utilization and positive attitudes toward DHS. The study also explores the predictive role of digital health literacy and attitudes in DHS use while considering ethnicity as a potential moderator. Significant predicting factors related to DHS utilization among Jews include positive attitudes and high health literacy. Among the Arabs, only attitudes towards DHS significantly predict the extent of DHS use. Digital health literacy affects the extent of use through attitudes at the two groups of the moderator significantly, but it is stronger among the Arab group.ConclusionTo improve healthcare outcomes and reduce disparities, efforts should focus on ensuring equitable access to DHS for the Arab minority population. Targeted interventions, including digital literacy education, removing technology access barriers, offering services in Arabic, and collaborating with community organizations, can help bridge the gap and promote equal utilization of DHS.

ObjectiveTo estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization.Data SourceLongitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization.Study DesignWe apply an intent‐to‐treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children.Principal FindingsThe implementation of MMC reduced monthly professional visits by a smaller degree for non‐whites than whites (3.8 percentage points vs. 6.2 percentage points), thereby helping to equalize the initial racial/ethnic disparity in utilization. The Passport MMC program in the Louisville‐centered region statistically significantly reduced disparities for professional visits (closing the gap by 8.0 percentage points), while the Kentucky Health Select MMC program in the Lexington‐centered region did not. No substantive impact on disparities was found for either outpatient or inpatient utilization in either program.ConclusionsWe find evidence that MMC has the possibility to reduce racial/ethnic disparities in professional utilization. More work is needed to determine which managed care program characteristics drive this result.

Racial and ethnic disparity in shoulder surgery: a systematic review

Racial and ethnic disparities in utilization of total knee arthroplasty among older women

Racial and Ethnic Disparities in Utilization and In-Hospital Outcomes of CardioMEMS Implantation for Heart Failure: A Nationwide Inpatient Sample Analysis (2016-2022).

Race/ethnic disparities in the utilization of treatment for drug dependent inmates in U.S. State correctional facilities

Allogeneic hematopoietic stem cell transplant (allo-HSCT) is increasingly being used in the United States (US) and across the world as a curative therapeutic option for patients with certain high-risk hematologic malignancies and non-malignant diseases. However, racial and ethnic disparities in utilization of the procedure and in outcome following transplant remain major problems. Racial and ethnic minority patients are consistently under-represented in the proportion of patients who undergo allo-HSCT in the US. The transplant outcomes in these patients are also inferior. The interrelated driving forces responsible for the differences in the utilization and transplant outcome of the medical intervention are socioeconomic status, complexity of the procedure, geographical barriers, and the results of differences in the genetics and comorbidities across different races. Bridging the disparity gaps is important not only to provide equity and inclusion in the utilization of this potentially life-saving procedure but also in ensuring that minority groups are well represented for research studies about allo-HSCT. This is required to determine interventions that may be more efficacious in particular racial and ethnic groups. Various strategies at the Federal, State, and Program levels have been designed to bridge the disparity gaps with varying successes. In this review paper, we will examine the disparities and discuss the strategies currently available to address the utilization and outcome gaps between patients of different races in the US.

Racial and ethnic disparities in utilization of chiropractic services have been described at the state level, but little is known about such local disparities. We analyzed Medicare data for the year 2008 to evaluate by ZIP code for utilization of chiropractic services among older adults in Los Angeles County, California. We evaluated for availability and use of chiropractic services by racial/ethnic category, quantified geographic variations by coefficient of variation, and mapped utilization by selected racial/ethnic categories. Among 7502 beneficiaries who used chiropractic services, 72% were white, 12% Asian, 1% black, 1% Hispanic, and 14% other/unknown. Variation in the number of beneficiaries per ZIP code who used chiropractic services was highest among Hispanics, blacks, and Asians. We found evidence of racial disparities in use of chiropractic services at the local level in Los Angeles County. Older blacks and Hispanics in Los Angeles County may be underserved with regard to chiropractic care.

e16165 Background: Esophageal cancer is a highly lethal malignancy with significant racial and ethnic disparities in clinical outcomes and healthcare utilization. Cardiovascular and cerebrovascular events, including myocardial infarction (MI), arrhythmias, and sudden cardiac arrest, add to the disease burden. This study uses the National Inpatient Sample (NIS) from 2016–2021 to investigate racial disparities in MACCE outcomes, mortality, and healthcare resource utilization among hospitalized esophageal cancer patients. Methods: A retrospective cohort analysis was performed using the NIS database to identify adult esophageal cancer patients. Demographic and clinical characteristics, including race, socioeconomic status, and comorbidities, were compared across racial groups. Primary outcomes included in-hospital mortality, MI, sudden cardiac arrest, stroke, and arrhythmia. Healthcare utilization metrics, including length of stay (LOS) and total charges, were also analyzed. Multivariable logistic regression models adjusted for potential confounders were used to assess racial disparities in these outcomes. Results: Among 229,963 esophageal cancer patients, the racial distribution included White (80.5%), Black (10.0%), Hispanic (6.2%), Asian or Pacific Islander (2.4%), Native American (0.5%), and Other (2.2%). Black (OR 1.148, p = 0.014) and Asian or Pacific Islander (OR 1.228, p = 0.038) patients had significantly higher odds of mortality compared to White patients. Black patients had a lower risk of MI (OR 0.72, p = 0.008) but were significantly more likely to experience sudden cardiac arrest (OR 2.206, p < 0.001). Hispanic (OR 1.398, p = 0.021) and Other racial groups (OR 1.688, p = 0.025) also had increased odds of sudden cardiac arrest. Atrial fibrillation was significantly less common in Black (OR 0.627, p < 0.001), Hispanic (OR 0.52, p < 0.001), and Asian or Pacific Islander (OR 0.476, p < 0.001) patients. Length of stay was significantly longer for Black (8.25 days), Hispanic (7.34 days), and Other (7.71 days) racial groups compared to White patients (6.79 days, p < 0.001). Hospital charges were highest among Hispanic ($107,531) and Asian or Pacific Islander ($109,164.6) patients compared to White patients ($84,753.53, p < 0.001). Conclusions: This study identifies significant racial disparities in esophageal cancer outcomes, with Black and Asian patients experiencing higher mortality and Black patients demonstrating an increased risk of sudden cardiac arrest. Differences in length of stay and hospital charges underscore healthcare inequities. These findings emphasize the need for targeted interventions to reduce cardiovascular risks and improve equitable healthcare access and outcomes for racial and ethnic minority populations with esophageal cancer.

Introduction: Gender-affirming surgery (GAS) is a critical step for many transgender individuals seeking alignment between their physical appearance and gender identity. However, disparities in access to GAS across racial and ethnic groups remain inadequately addressed. This study aims to examine racial and ethnic disparities in access to top and bottom gender-affirming surgeries. Methods: A retrospective cohort analysis was conducted using the TriNetX database (2014-2024). Patients aged 18+ with a diagnosis of gender dysphoria who completed at least 6 months of hormone therapy were included. Patients were identified using ICD-10 and CPT codes and stratified by race and ethnicity: African American, Asian, Native Hawaiian, American Indian, Hispanic, and White. Propensity score matching adjusted for demographic and clinical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare the likelihood of undergoing top or bottom surgery at 6 months and 1-year posteligibility. A P value <.05 was considered significant. Results: At 6 months posteligibility, African American patients had significantly lower odds of undergoing top (OR = 0.876, P = .0480) and bottom surgeries (OR = 0.399, P = .0111) compared to White patients. Hispanic patients also had lower odds for top (OR = 0.873, P = 0.0014) and bottom surgeries (OR = 0.872, P = 0.0314). In contrast, Asian patients had higher odds of receiving top (OR = 1.267, P = .0079) and bottom surgeries (OR = 1.333, P = 0.0007). These disparities remained evident at the 1-year mark, with African American and Hispanic patients continuing to experience reduced surgical access relative to White patients. Conclusion: Significant racial and ethnic disparities persist in GAS access. Targeted interventions are needed to promote equitable surgical care for transgender individuals.

Racial Disparities Among Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement.