Dataset Information

Do racial and ethnic disparities in health care use vary with health?

ABSTRACT:

Objective

To determine the relationship between health status and the magnitude of black-white and Hispanic-white disparities in the likelihood of having any office-based or hospital outpatient department visits, as well as number of visits.

Data source

2010-2014 Medical Expenditure Panel Survey.

Study design

The probability of having a visit is modeled using a Probit model, and the number of visits using a negative binomial model. We use a nonlinear rank-and-replace method to adjust minority health status to be comparable to that of whites, and predict utilization at different levels of health by fixing an indicator of health status. We compare estimated differences in predicted utilization across racial/ethnic groups for each level of health status to map out the relationship between the racial/ethnic disparity and health status, also stratifying by health insurance coverage.

Extraction methods

We subset to nonelderly adults.

Principal findings

We find that Hispanic-white differences in the probability of having an office-based or hospital outpatient department were widest among adults in excellent health (27 percentage points, 95% CI: [23, 31]) and narrowest when reporting poor or fair health (15 p.p. [13, 17]). Black-white and Hispanic-white differences in the number of visits were wider for adults who report poor or fair health (5.3 visits [4.0, 6.6] and 5.7 [4.3, 7.0], respectively) compared to excellent health (1.7 [1.2, 2.1] and 1.5 [1.1, 2.0], respectively) among adults who are full-year privately insured.

Conclusions

The magnitudes of racial/ethnic disparities vary with level of health.

SUBMITTER: Biener AI

PROVIDER: S-EPMC6338306 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Do racial and ethnic disparities in health care use vary with health?

Biener Adam I AI Zuvekas Samuel H SH

Health services research 20181114 1

<h4>Objective</h4>To determine the relationship between health status and the magnitude of black-white and Hispanic-white disparities in the likelihood of having any office-based or hospital outpatient department visits, as well as number of visits.<h4>Data source</h4>2010-2014 Medical Expenditure Panel Survey.<h4>Study design</h4>The probability of having a visit is modeled using a Probit model, and the number of visits using a negative binomial model. We use a nonlinear rank-and-replace method ...[more]

PMID: 30430571

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Project description:PurposePrevious work has shown that asthma-related emergency department (ED) use is greatest among Black and Latine populations, but it is unknown whether health care use for exacerbations differs across settings (outpatient, ED, inpatient) and correlates with use of routine outpatient services. We aimed to measure disparities by race, ethnicity, and language in pediatric acute asthma care using data from US primary care community health centers.MethodsIn an observational study using electronic health records from community health centers in 18 states, we compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children aged 3 to 17 years on visits for clinic-coded asthma exacerbations (2012-2018). We further evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients. Covariate-adjusted odds ratios (ORs) and rate ratios (RRs) were derived using logistic or negative binomial regression analysis with generalized estimating equations.ResultsAmong 41,276 children with asthma, Spanish-preferring Latine children had higher odds of clinic visits for asthma exacerbation than non-Hispanic White peers (OR = 1.10; 95% CI, 1.02-1.18). Among the subsample of 6,555 children insured under Oregon-Medicaid, non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR = 1.40; 95% CI, 1.04-1.89 and RR = 1.49; 95% CI, 1.09-2.04, respectively). We observed no differences between groups in asthma-related inpatient admissions.ConclusionsThis study is the first to show that patterns of clinic and ED acute-care use differ for non-Hispanic Black and Spanish-preferring Latine children when compared with non-Hispanic White peers. Non-Hispanic Black children had lower use of clinics, whereas Spanish-preferring Latine children had higher use, including for acute exacerbations. These patterns of clinic use were accompanied by higher ED use among Black children. Ensuring adequate care in clinics may be important in mitigating disparities in asthma outcomes.VISUAL ABSTRACT.

Dataset Information

Do racial and ethnic disparities in health care use vary with health?

Objective

Data source

Study design

Extraction methods

Principal findings

Conclusions

Publications

Do racial and ethnic disparities in health care use vary with health?

Similar Datasets

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