Magnitude Of Disparity Research Articles

A76 Inequalities in the distribution of primary care providers: Comparing healthcare disparity among urban and rural Floridian

Abstract Background Many economics, sociology, and urban planning researchers have assessed regional inequalities, especially for those populations affected by socioeconomic factors such as low income and unemployment status. Inequalities regarding health and its providers have been documented in the last few decades. In 2010, the Department of Human and Health Service (DHHS) launched the Healthy People 2020 movement with goals to eliminate health inequality/disparity and to encourage healthy development. According to the DHHS, health disparity is defined as “a particular type of health difference that is closely linked with physical distance to service, social, economic, and/or environmental disadvantage”. Health disparity that results from the limited access to healthcare facilities is believed to be associated with the unequal distribution of resources and opportunities such as healthcare service, physical activity facilities, and healthy food. However, empirical studies are insufficient for understanding the extent and magnitude of health disparities in the United States. This study seeks to use the inequality of distribution of healthcare providers as a measure for spatial health disparities in urban and rural areas (AIM1) while also monitoring socioeconomic characteristics of the populations in said areas (AIM2). Methods For the first aim, this study will calculate the population per physician ratio for each urban and rural census tract boundary in Florida. The Gini coefficient and Lorenz curve are used to measure the sufficiency or the insufficiency of physician distribution for each urban and rural Florida. These measures are designed to analyze inequality of income or wealth, but they also have been used to study the distribution of health resources such as physician distribution. Second, this study will use Hot Spot Analysis in Geographic Information System (GIS) to calculate the Getis-Ord GI statistic to identify patterns of disadvantaged socioeconomic populations. Cluster areas with high or low densities of certain socioeconomic characteristics, hot spots, will be determined. Results Preliminary results present that primary care physicians in both urban and rural areas of Florida were unevenly distributed. The Gini coefficient for the distribution of primary care physicians in urban Florida was 0.49 (SD=0.0001), while that of the rural Florida was 0.38 (SD=0.01). Conclusions The inequality in the distribution of primary care physicians was higher in urban areas compared with that of the rural Florida. For this purpose, the availability (number) of physicians could be adjusted depending on socioeconomic factors.

Disparities in dental care associated with disability and race and ethnicity

BackgroundBoth racial and ethnic and disability-related disparities in dental care exist, yet little is known about the cumulative effect of these 2 characteristics. The purpose of this study was to determine how the combination of disability and race and ethnicity is associated with dental examinations, delays in receiving needed care, and inability to obtain needed care among noninstitutionalized working-age adults in the United States. MethodsThe authors conducted cross-sectional analyses of Medical Expenditure Panel Survey data pooled across the years 2002 to 2012, yielding a sample of 208,548. Multivariable logistic regression analyses were used to examine the association of disability (including physical, sensory, and cognitive limitations) and race and ethnicity with each of the dependent variables. ResultsCompared with non-Hispanic whites, other racial and ethnic groups were less likely to receive annual dental examinations. There were significant disparities for people with disabilities in receipt of examinations, delays in obtaining needed care, and being unable to obtain needed care. The combination of disability status and membership in an underserved racial or ethnic group was associated with a greater magnitude of disparity in all 3 areas, especially for American Indian, Alaska Native, and multiracial people with disabilities. ConclusionsCommunity-dwelling adults with disabilities in underserved racial and ethnic groups have higher levels of delayed and unmet needs for dental care and lower receipt of routine dental examinations. Practical ImplicationsAs the United States population ages and grows more diverse, the population of people with disabilities in underserved racial and ethnic groups will expand. Dentists need to be aware of, and be prepared to address, the needs of these people.

Abstract P201: Rural/Urban Differences in the Prevalence of Stroke Risk Factors

Introduction: Despite previously reported higher stroke (and heart disease) mortality in rural areas, there are few data on the presence or magnitude of rural-urban disparities in the prevalence of stroke risk factors. Methods: Participants (n = 28,242) of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were categorized into the 6-level ordinal National Center for Health Statistics Urban-Rural Classification Scheme. The prevalence of 6 traditional risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy and heart disease) and estimated 10-year risk of stroke (indexed by the Framingham Stroke Risk Function score) was assessed across the rural-urban scale in models adjustment for demographic factors (age, race, sex, and state of residence) and after further adjustment for community-level socioeconomic status disadvantage. Results: Hypertension, diabetes and heart disease were all more prevalent in rural regions (p < 0.05); with respective odds 1.25-times (95% CI: 1.11 - 1.42), 1.15-times (95% CI: 0.99 - 1.33), and 1.19-times (95% CI: 1.02 - 1.39) greater in the most rural as compared to the most urban regions (see Table). The estimated 10-year risk of stroke was also greater in rural areas; however, the estimated magnitude of increased stroke risk was relatively small. Adjustment for neighborhood-level socioeconomic status disadvantage attenuated some, but not all, of these relationships (for example, hypertension OR: 1.25 to 1.21, diabetes OR: 1.15 to 1.00, heart disease OR: 1.19 to 1.10). Discussion: These data suggest that while some of the increased stroke mortality in rural areas may be due to an increased burden of stroke risk factors in rural areas, the contribution of risk factors is quite inconsistent across the rural-urban spectrum. This association was attenuated by the adjustment for socioeconomic status, which suggests that some of the higher stroke risk in rural counties may be due to their lower level of socioeconomic status.

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers.

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17-19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.

Abstract 84: Where Should Interventions be Focused to Reduce the Black-white Disparity in Stroke Mortality? Insights From the Reasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Introduction: The study of racial disparities in stroke mortality should guide interventions to reduce these disparities. A higher mortality in blacks than whites could result from a higher incidence of stroke in blacks, a higher case-fatality of stroke in blacks, or both. Interventions focusing on primary prevention are needed if incidence is a major contributor to disparities, while interventions addressing treatment are a priority if case-fatality is a major contributor. Hypothesis: Higher stroke mortality in REGARDS will be attributable to higher incidence, higher case fatality, or both. Methods: 29,681 black and white participants aged 45+ were followed for stroke over 7 years. Fatal stroke (stroke mortality) was defined as a stroke event with death within 30-days, incident stroke included all stroke events (regardless of death), and case-fatality as the proportion of stroke events with death within 30-days. Black-white differences in stroke mortality and stroke incidence were assessed using proportional hazards models, and case-fatality using logistic regression (with adjustment for age and sex). Results: There were 954 incident events with 242 deaths within 30-days. We showed higher stroke mortality in blacks, with a black-white disparity in fatal stroke at young ages (at age 45, HR = 4.35; 95% CI: 1.94-9.76), but a declining magnitude of the disparity at older ages (at age 85, HR = 0.87; 95% CI: 0.56 - 1.35). The pattern was similar for incident stroke, although the magnitude of the black-white disparity was smaller (at age 45: HR = 2.40; 95% CI: 1.72 - 3.33; at age 85: HR = 0.95; 95% CI: 0.76 - 1.19). There was no evidence of a black-white disparity in case-fatality rate (OR = 1.26; 95% CI: 0.93 - 1.71). Conclusion: In a nationwide cohort, we found that the black-white disparity in stroke mortality was primarily attributable to a racial disparity in stroke incidence, not case fatality. Thus, interventions designed to reduce the black-white disparity in stroke mortality require a primary prevention focus aimed at reducing the disparity in stroke incidence. While effective interventions to improve stroke outcomes are needed, these data suggest that improving treatment after the initial event will not reduce black-white disparities in stroke mortality.

Optimizing Data Management with Disparities in Data Value

ABSTRACT When there is a disparity in the value of different data records and fields, there is a need for an optimization of data resources. Not all data necessarily contribute the same value. It depends on the usage of the data, as well as a variety of other factors. This paper presents models for optimizing data management in the presence of a disparity between the values contributed by different data. We expound on what disparity of data value represents and illustrate models to derive a numerical measure of such disparity. We then use real-world data from a large data resource used to manage alumni relations, and demonstrate our optimization methods and results. We then discuss the tradeoffs involved between value and cost, and the implications for data management, both in this real-world context and in general. KEYWORDS: Disparity, Data Value, Data Management, Optimization INTRODUCTION Organizations make large investments in technology to manage data, a critical organizational resource. In making these investments organizations have to carefully evaluate the information systems and technology that are used to manage the data. Typically, such evaluations are primarily based on technical requirements such as storage capacities and processing speeds and on functional requirements such as presentation formats (e.g., dashboards and visualization) and business needs such as speed of delivery and search capabilities. In this paper, we suggest that evaluating data management systems must consider yet another perspective, economic aspects. In no way minimizing the importance of technical and functional aspects, we suggest that the design and management of data resources ought to also consider the cost-benefit tradeoffs associated with managing data resources. To emphasize this perspective we argue that all data should not be treated as contributing equally to the benefit derived from using a data resource and that some records in a dataset may contribute more to benefit than others. We refer to this as disparity in the value derived from the data (or value disparity). We believe that understanding value disparity and the associated value/cost tradeoffs, has important implications for data management. Not only can it impact how we use data, it can also impact the design and management of data resources and associated information systems. We examine value disparity in a large data resource used to manage alumni relations. Using this as a context, we first evaluate value disparity and show that it is significantly large in this data resource. We then describe the current data acquisition and management policies, discuss the relationship between the policies and the value disparity identified, and in this context, highlight related implications for data management including how the data resource may be optimized considering an economic perspective. The rest of the paper is organized as follows. First we describe the research relevant to value/cost tradeoffs in data management to define the scope of our research. We then develop our models for assessing the magnitude of value disparity. We further illustrate the application of our models using sizable samples from the data resource for managing alumni relations. We finally discuss the implications of understanding value disparity for data management and conclude with a discussion on the limitations of our research. BACKGROUND Managing data efficiently and effectively helps organizations realize the business value of the data. Data contributes to business value in multiple different ways. Data supports managing operational activities such as tracking supply chain activities (Gattiker & Goodhue, 2004) and customer relationships (Roberts and Berger, 1999). Data also helps organizations gain competitive advantage through analytics (Davenport, 2006) and decision support (March & Hevner, 2007, Ramakrishnan et al. …

Territorial Inequalities and Economic Growth in Romania. A Multi-factor Approach

Territorial inequalities represent a long-running subject in regional economics and many statistical methods aiming to provide relevant data and information on the magnitude and evolution of disparities have been developed over time. It is a topic of interest in Romania as well, given that the development gaps among counties continuously increased since the transition to market economy, despite many strategies explicitly targeting them. In this context, the paper introduces a new synthetic index of territorial inequalities that includes three variables: GDP/capita, labour productivity and life expectancy in order to capture various aspects of economic and social spatial disparities. This methodological approach offers a better and more complex image on territorial development gaps, compared to the analyses using individual indicators. We further assessed the impact of territorial disparities (as measured by this synthetic index) on the economic development in Romania over 1995-2012, by means of an economic growth model. We found a cointegrating relationship between GDP and the synthetic index of territorial inequalities, suggesting that the regional development in Romania is systematically unbalanced and the disparities have had the tendency to widen with economic growth.

Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.

BackgroundThis paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants.MethodsUsing cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups.ResultsWe observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months.Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping.ConclusionBy examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0393-z) contains supplementary material, which is available to authorized users.

Abstract A26: Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention

Abstract While traditional settings such as physician offices and community health agencies have had measurable success in delivering behavioral health interventions, they are less successful in recruiting underserved African American participants. Inner-city African American women, faced with multiple risk factors contributing to persistent health disparities, require a source of reliable health information in a setting that is easily accessible and credible to them. Salon-based health education programs are becoming increasingly popular for reaching African American females because they engage trusted members of the community (salon owners and hair stylists) in a location that represents care and reflects the tradition of sharing information through oral communication. We partnered with neighborhood hair salons to promote messages about persistent cervical cancer disparities and low rates of human papillomavirus (HPV) vaccination in the African American community. Study goals were to: (1) recruit eight beauty salons in low-income Philadelphia neighborhoods to serve as health education sites; (2) train hair stylist to be able to discuss cervical cancer disparities and HPV infection with their customers, and (3) increase knowledge and awareness about HPV, as well as intentions to vaccinate, among customers at each salon. Study inclusion criteria for customers consisted of being a young woman ages 18 to 26 or the caregiver of a young female ages 9 to 17. Stylists were trained by members of the research team to be able to briefly discuss cervical cancer and HPV with their customers during regular salon hours. Additionally, professional health educators were trained more substantially on the health topics and were placed in the salons to supplement the work of the stylists and provide a more in-depth educational experience for the customers. Survey data related to knowledge and attitudes about HPV and HPV vaccination were collected from customers immediately before and after the health education, and approximately one month later. Salon stylists and owners were interviewed post-intervention to assess their experiences with participating in the intervention. Two hundred and forty women from 10 salons were enrolled in the study. Roughly 60% of participants were caregivers while 40% were young women. Knowledge about cervical cancer and HPV infection increased significantly in both groups from baseline to endpoint and remained high at the one-month follow-up assessment. At follow-up, 68% of participants said that they had had a discussion with a friend or family member about what they learned, and 57% planned to talk to their doctor or their daughter's doctor about HPV vaccination. Sixty-two percent of caregivers reported that it was important that their daughter be vaccinated against HPV in the future. There were no significant differences between the caregivers and the young women on outcome measures of knowledge, attitudes, or intentions to vaccinate. During the post-intervention interviews with the stylists, many indicated that they enjoyed having discussions about health in the salon and that salons should continue to serve as venues of education for women in the African American community. The majority of stylists indicated that neither they, nor their customers, were aware of the magnitude of cervical cancer disparities among African American women nor the availability of the HPV vaccine as a method of protection for young women. Results of the study indicate that such community-based interventions are both feasible and effective in reaching populations not traditionally included in health education interventions. Citation Format: Amy Leader, Pamela Weddington, Ralph DiClemente, Gina Wingood, Alicia Jackson, Ivan Juzang. Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A26. doi:10.1158/1538-7755.DISP13-A26

UTILIZING THE CANADIAN COMMUNITY HEALTH SURVEY TO INVESTIGATE CARDIOVASCULAR RISK AND DISEASE AMONG PEOPLE WITH MENTAL HEALTH DISORDERS

Previous research has demonstrated that cardiovascular morbidity is elevated among persons with mental health disorders (MHDs) compared to people without MHDs; however, there is no reliable estimate of the burden of disease across Canada. A thorough examination of cardiovascular disease (CVD) among Canadians with MHDs is needed, not only to contribute findings to the international dialogue, but also to estimate the magnitude of this heath disparity and inform approaches to prevention and treatment.

Examining Program Quality Disparities Between Urban and Rural Kindergartens in China: Evidence From Zhejiang

In recent years, the Chinese government has initiated a national plan to universalize quality kindergartens for all age-eligible Chinese children. Kindergarten is the main form of early childhood education and care (ECEC) service across China. However, the government faces two thorny issues on the journey toward realizing educational equity for some of the nation’s most vulnerable children. The first issue is the critical shortage of kindergarten programs. The second issue is a widening gap in quality between rural and urban kindergarten programs. Therefore, this study examines the quality of 91 kindergarten programs across different locations and funding sources in Zhejiang Province based on a stratified random selection method to gain insights into the aspects and magnitude of quality disparities in programs serving children from the richest and most powerful urban residents to the most disadvantaged village families. Program quality was rated utilizing eight subscales of the Chinese Early Childhood Programs Rating Scale, modified from Harms, Clifford, and Cryer’s (2005) Early Childhood Environment Rating Scale. Finally, recommendations for future studies and policy formation are provided to enhance and perhaps hasten the process of universalizing quality kindergartens in the increasingly market-based context of modern China.

Magnitude of perceived depth of multiple stereo transparent surfaces.

According to the geometric relational expression of binocular stereopsis, for a given viewing distance the magnitude of the perceived depth of objects would be the same, as long as the disparity magnitudes were the same. However, we found that this is not necessarily the case for random-dot stereograms that depict parallel, overlapping, transparent stereoscopic surfaces (POTS). The data from five experiments indicated that (1) the magnitude of perceived depth between the two outer surfaces of a three- or a four-POTS configuration can be smaller than that for an identical pair of stereo surfaces of a two-POTS configuration for the range of disparities that we used (5.2-19.4 arcmin); (2) this phenomenon can be observed irrespective of the total dot density of a POTS configuration, at least for the range that we used (1.1-3.3 dots/deg(2)); and (3) the magnitude of perceived depth between the two outer surfaces of a POTS configuration can be reduced as the total number of stereo surfaces is increased, up to four surfaces. We explained these results in terms of a higher-order process or processes, with an output representing perceived depth magnitude, which is weakened when the number of its surfaces is increased.

Socioeconomic disparities in mortality after diffuse large B-cell lymphoma in the modern treatment era

AbstractDespite advances in treatment, including the introduction of rituximab, survival after diffuse large B-cell lymphoma (DLBCL) remains heterogeneous. However, no studies have considered the association between neighborhood socioeconomic status (SES) and race/ethnicity on DLBCL mortality before (1988-2000) and after (2001-2009) the introduction of rituximab. We studied all 33 032 DLBCL patients diagnosed between 1988-2009 in California for vital status through December 31, 2010. Patients diagnosed from 2001 to 2009 vs 1988 to 2000 had significantly decreased overall and DLBCL-specific mortality. However, those living in lower SES neighborhoods had 34% (95% confidence interval [CI], 27%-40%) and 24% (95% CI, 16%-32%) higher mortality rate from all causes and lymphoma, respectively, than patients in higher SES neighborhoods. The magnitude of mortality disparities by neighborhood SES was more marked in younger (<65 years) than in older patients (≥65 years), in married than nonmarried patients, and after 2000. We concluded that patients living in low SES neighborhoods had substantially worse survival after DLBCL, and this disparity was striking in younger (ie, not eligible for Medicare-aged) patients, married patients, and after the introduction of rituximab. These disparities suggest there are barriers, including inadequate insurance coverage with additional financial burden, to effective treatment among socioeconomically disadvantaged patients.

How Well do Prices Converge in Anticipation of Capital Control Liberalization? Evidence from a Chinese Reform

This paper analyzes the effects of a pilot program that enables cross-market investment between Hong Kong and Shanghai's stock exchanges. Among the companies that are concurrently listed in both markets, the announcement of the program causes the price disparity between shares in both markets to reduce by an average of 16.6 percent within the same day of announcement. The price convergence is directly proportional to the magnitude of preexisting price disparity. Despite the large institutional differences between both markets, the prices converge symmetrically via initial share price increases in the market that traded the stock at a relative discount. The results suggest that capital control plays an important role in explaining the disparity of equity prices between markets.

Breast and Cervical Cancer Screening Disparities Associated with Disability Severity

BackgroundPrior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability. MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations. FindingsWomen both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors. ConclusionsWomen with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.

Government Quality and Spatial Inequality: A Cross-Country Analysis

This paper examines the relationship between government quality and spatial inequality across forty-six countries over the period 1996–2006. The results of the analysis point to the existence of a negative and significant association between government quality and the magnitude of regional disparities. Countries with better quality of government register lower levels of spatial inequality. This finding is robust to the inclusion in the analysis of additional explanatory variables that may affect both regional disparities and governance outcomes. The observed link between government quality and spatial inequality is confirmed by various robustness tests.

Race/Ethnicity, Educational Attainment, and Foregone Health Care in the United States in the 2007–2009 Recession

This study assessed possible associations between recessions and changes in the magnitude of social disparities in foregone health care, building on previous studies that have linked recessions to lowered health care use. Data from the 2006 to 2010 waves of the National Health Interview Study were used to examine levels of foregone medical, dental and mental health care and prescribed medications. Differences by race/ethnicity and education were compared before the Great Recession of 2007 to 2009, during the early recession, and later in the recession and in its immediate wake. Foregone care rose for working-aged adults overall in the 2 recessionary periods compared with the pre-recession. For multiple types of pre-recession care, foregoing care was more common for African Americans and Hispanics and less common for Asian Americans than for Whites. Less-educated individuals were more likely to forego all types of care pre-recession. Most disparities in foregone care were stable during the recession, though the African American-White gap in foregone medical care increased, as did the Hispanic-White gap and education gap in foregone dental care. Our findings support the fundamental cause hypothesis, as even during a recession in which more advantaged groups may have had unusually high risk of losing financial assets and employer-provided health insurance, they maintained their relative advantage in access to health care. Attention to the macroeconomic context of social disparities in health care use is warranted.

Temporal channels and disparity representations in stereoscopic depth perception

Stereoscopic depth perception is supported by a combination of correlation-based and match-based representations of binocular disparity. It also relies on both transient and sustained temporal channels of the visual system. Previous studies suggest that the relative contribution of the correlation-based representation (over the match-based representation) and the transient channel (over the sustained channel) to depth perception increases with the disparity magnitude. The mechanisms of the correlation-based and match-based representations may receive preferential inputs from the transient and sustained channels, respectively. We examined near/far discrimination by observers using random-dot stereograms refreshed at various rates. The relative contribution of the two representations was inferred by changing the fraction of dots that were contrast reversed between the two eyes. Both representations contributed to depth discrimination over the tested range of refresh rates. As the rate increased, the correlation-based representation increased its contribution to near/far discrimination. Another experiment revealed that the match-based representation was constructed by exploiting the variability in correlation-based disparity signals. Thus, the relative weight of the transient over sustained channel differs between the two representations. The correlation-based representation dominates depth perception with dynamic inputs. The match-based representation, which may be a nonlinear refinement of the correlation-based representation, exerts more influence on depth perception with slower inputs.

Does Economic Globalization affect Regional Inequality? A Cross-country Analysis

Summary This paper investigates the relationship between economic globalization and regional inequality in a panel of 47 countries over the period 1990–2007, using a measure of globalization that distinguishes the different dimensions of economic integration. The results show that there is a positive and statistically significant association between economic globalization and the magnitude of regional disparities. Countries with a greater degree of economic integration with the rest of the world tend to register higher levels of regional inequality. This finding is robust to the inclusion of additional explanatory variables and to the choice of the specific measure used to quantify the relevance of spatial inequality within the sample countries. Our analysis also reveals that the spatial impact of economic globalization is greater in low- and middle-income countries, whose levels of regional disparities are on average significantly higher than in high-income countries.

Interaction Between Age and Race Alters Predicted Survival in Colorectal Cancer

Racial disparities in colorectal cancer persist. Late stage at presentation and lack of stage-specific treatment may be contributing factors. We sought to evaluate the magnitude of disparity remaining after accounting for gender, stage, and treatment using predicted survival models. We used institutional tumor registries from a public health system (two hospitals) and a not-for-profit health system (nine hospitals) from 1995 to 2011. Demographics, stage at diagnosis, treatment, and survival were recorded. Hazard ratios (HRs) and predicted HRs were determined by Cox regression and postestimation analyses. There were 6,990 patients: 55.7% white, 23.6% African American, 15.1% Hispanic, and 5.6% Asian/other. Predictors of survival were surgery (HR 0.57, 95% confidence interval [CI] 0.46-0.70), chemotherapy (HR 0.7, 95% CI 0.62-0.79), female gender (HR 0.87, 95% CI 0.83-0.90), age (HR 1.04, 95% CI 1.03-1.05), and African American race (HR 3.6, 95% CI 1.5-8.4). Balancing for stage, gender, and treatment reduced the predicted HRs for African Americans by 28% and Hispanics by 17%. In this model, African American and Hispanics still had the worst predicted HRs at younger ages, but whites had the worst predicted HR after age 75. Gender, stage, and treatment partially accounted for worsened survival in African Americans and Hispanics at all ages. At younger ages, race-related disparities remained which may reflect tumor biology or other unknown factors. Once gender, stage, and treatment are balanced at older ages, the increased mortality observed in whites may be due to factors such as comorbidities. Further system- and patient-level study is needed to investigate reasons for colorectal cancer survival disparities.