Ethnic Disparities In Utilization Research Articles (Page 1)

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.

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 and ethnic disparities in utilization of functional neurosurgical procedures have been extensivelydocumented. However, few studies have focused on the differences between Hispanic and non-Hispanic White populations in regions with high representation of both groups. Given the large Hispanic population within our hospital's catchment area, we aimed to compare the utilization of functional neurosurgery between the Hispanic and White populations in our practice. We conducted a retrospective review of patients undergoing functional neurosurgery procedures from2017 to 2024 at the University of Arizona in Tucson. Rates of epilepsy, pain, and movement disorder procedureswerecompared by ethnicity, focusing on Hispanic vs non-Hispanic White populations. Correlations with age, American Society of Anesthesiologists class, income, insurance status, distance from the treatment center, and complications were examined. A total of 750 procedures were performed among 702 patients. Deep brain stimulation accounted for 27.73% of procedures, spinal cord stimulation for 35.87%, epilepsy surgery for 22.53%, and intrathecal pump placement for 13.7%. Amongthe included patients, 43.3% were treated for chronic pain, 22.5% for epilepsy, 18.1% for Parkinson's disease, 4.8%foressential tremor, 2.3% for spasticity, 0.9% for dystonia, and 8.0% for other/unknown diagnoses. Regarding ethnicity,74.3% of our cohort identified as non-Hispanic White, 18.1% as Hispanic, and 7.6% as other or unknown ethnicity.Hispanic patients were significantly underrepresented relative to Southern Arizona demographics (χ2 [1, n= 693]= 280.38, p< 0.0001, ϕ=0.64). This disparity was consistent and significant across all procedure types. Significant differencesinfive-year median inflation-adjusted household income were observed between Hispanic and White non-Hispanicgroups (Welch t-test [n= 693]= 5.79, p< 0.0001, Cohen d= 0.53). Cluster analysis revealed four distinct clusters based on multiple predictors, and multinomial regression identified several significant predictors of undergoing each procedure type. Functional procedures are underutilized among Hispanic patients in Southern Arizona, with disparities associated with age, income, and distance from the treatment center.

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

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.

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.

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.

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

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

Racial and Ethnic Disparities in Utilization of Minimally-Invasive Hysterectomy

8760 Racial and Ethnic Disparities in Utilization of Laparoscopic Myomectomy

Objective We sought to identify racial/ethnic patterns of health care utilization for asthma among asthmatic children (ages 0-18) and address unequal access to optimal asthma management as a determinant of asthma disparities. Methods We used children Medi-Cal (California’s Medicaid program) enrollees, including African American, Asian, Hispanic, and White children in Los Angeles and retrieved individual hospital utilization records of 69,118 asthmatic children (2013-2018). We applied Hierarchical Generalized Linear Models (HGMLs) to identify the patterns of health care utilization at the individual level, controlling for demographic and neighborhood characteristics. Results African American children show a higher ratio of ED to outpatient visits (OR = 1.32, 95% CI 1.08-1.62) and hospitalizations to outpatient visits (OR = 1.50, 95% CI 1.30-1.73). They also had a high ratio of ED visits (OR = 1.36, 95% CI 1.10-1.68) and hospitalizations (OR = 1.47, 95% CI 1.26-1.71) relative to PCP visits. A ratio of ED visits and hospitalizations decreased if a ratio of controller medications to total medications was greater than 0.5, but increased if children were male, under 11 years old, or living in low-income neighborhoods (Median household income < 25th percentile, $45,629) with high poverty rates (>20%). Conclusions African American male children from disadvantaged neighborhoods are at the highest risk for higher utilization of hospital-based care for asthma. Our findings also indicate a lower ratio of controller medications contributed to increases in ED visits and hospitalizations, suggesting suboptimal management of asthma and a lack of intervention treatment through medications among minority children.

Racial and Ethnic Disparities in Utilization of Tonsillectomy among Medicaid-Insured Children

Background: Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. Methods: A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. Results: Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13–3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16–3.40). Conclusions: Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.

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

Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products. Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables. There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites. The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites. Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities.

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 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.

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

We sought to understand the role of Latino acculturation in dental care utilization in Iowa children. We used logistic regression to evaluate factors associated with having a previous-year dental check-up with 2005 Iowa Child and Family Household Health Survey data. We constructed models to examine the association with race/ethnicity and used chosen interview language to measure Latino acculturation. After we controlled for several factors, having a regular dental care source, having a dental need, dental insurance status, family income, children's dental health rating, children's age, and brushing habits were associated with having a previous-year dental check-up. Race/ethnicity was indirectly associated with use of dental services through other related factors with significant differences for less-acculturated Latinos. Policymakers and health planners should implement strategies to address individual, community, and system factors affecting racial/ethnic minorities. A regular source of dental care for Latino children that will enhance their access to services should be ensured. Ignoring the needs of the fastest growing segment of children with the poorest oral health and the least access to care will lead to future increase of oral diseases in this population.