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Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non‐Hispanic White survivors into the contributions of individual‐, interpersonal‐, community‐, and societal‐level determinants.We used data from the 2010–2020 Medical Expenditure Panel Survey Household Component (MEPS‐HC). Our primary outcome was whether the person had mental health conditions or not.We employed the Kitagawa–Oaxaca–Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non‐Hispanic Black or Hispanic breast cancer survivors and non‐Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US‐born status (and county of origin).Confidential geographic identifiers are utilized to supplement the MEPS‐HC data with information on community characteristics and local healthcare resources.The prevalence of mental health conditions among non‐Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non‐Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non‐Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community‐ and societal‐level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non‐Hispanic White survivors. However, for foreign‐born Hispanic survivors, the disparity was fully explained by a combination of individual‐ and societal‐level determinants.Our findings, which identify specific individual‐, interpersonal‐, and societal‐ determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health. [ABSTRACT FROM AUTHOR]

Objective: To investigate how county and state‐level estimates of Medicaid enrollment among the total, non‐Hispanic White, non‐Hispanic Black or African American, and Hispanic or Latino/a population are affected by Differential Privacy (DP), where statistical noise is added to the public decennial US census data to protect individual privacy. Data Sources: We obtained population counts from the final version of the US Census Bureau Differential Privacy Demonstration Products from 2010 and combined them with Medicaid enrollment data. Study Design: We compared 2010 county and state‐level population counts released under the traditional disclosure avoidance techniques and the ones produced with the proposed DP procedures. Data Collection/Extraction Methods: Not applicable. Principal Findings: We find the DP method introduces errors up to 10% into counts and proportions of Medicaid participation rate accuracy at the county level, especially for small subpopulations and racial and ethnic minority groups. The effect of DP on Medicaid participation rate accuracy is only small and negligible at the state level. Conclusions: The implementation of DP in the 2020 census can affect the analyses of health disparities and health care access and use among different subpopulations in the United States. The planned implementation of DP in other census‐related surveys such as the American Community Survey can misrepresent Medicaid participation rates for small racial and ethnic minority groups. This can affect Medicaid funding decisions. [ABSTRACT FROM AUTHOR]

Objective: We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality.Data Sources: Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey.Study Design: A cross-sectional study design of nursing homes within U.S. metropolitan areas.Data Collection/extraction Methods: Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau.Principal Findings: Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.Conclusions: Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. [ABSTRACT FROM AUTHOR]

The author discusses the path to achieve health care equity for racial and ethnic underserved communities in the U.S. The author states that the overall quality of care in the country is improving slowly while medical care disparities in racial/ethnic minorities are not decreasing. The author mentions that the Affordable Care Act (ACA) of 2010 holds promise to narrow the disparities by expanding research in health disparities and interventions and implementing ways to advance health care equity.

Objective To review methods of measuring racial/ethnic health care disparities. Study Design Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's ( IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. Empirical Application We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004-2008 Medical Expenditure Panel Survey. Conclusion Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition. [ABSTRACT FROM AUTHOR]

Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status ( SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. [ABSTRACT FROM AUTHOR]

Objective To develop a conceptual framework for investigating the role of racial/ethnic residential segregation on health care disparities. Data Sources and Settings Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011. Study Design The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course. Principal Findings The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified. Conclusions Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions. [ABSTRACT FROM AUTHOR]

Objective To extend recent conceptual and methodological advances in disparities research to include the incorporation of genomic information in analyses of racial/ethnic disparities in health care and health outcomes. Data Sources Published literature on human genetic variation, the role of genetics in disease and response to treatment, and methodological developments in disparities research. Study Design We present a conceptual framework for incorporating genomic information into the Institute of Medicine definition of racial/ethnic disparities in health care, identify key concepts used in disparities research that can be informed by genomics research, and illustrate the incorporation of genomic information into current methods using the example of HER-2 mutations guiding care for breast cancer. Principal Findings Genomic information has not yet been incorporated into disparities research, though it has direct relevance to concepts of race/ethnicity, health status, appropriate care, and socioeconomic status. The HER-2 example demonstrates how available genetic information can be incorporated into current disparities methods to reduce selection bias and measurement error. Advances in health information infrastructure may soon make standardized genetic information more available to health services researchers. Conclusion Genomic information can refine measurement of racial/ethnic disparities in health care and health outcomes and should be included wherever possible in disparities research. [ABSTRACT FROM AUTHOR]

Objective To assess the validity of race/ethnicity in Medicare databases for studies of racial/ethnic disparities. Data Sources The 2010 Medicare Consumer Assessments of Healthcare Providers and Systems ( CAHPS®) survey was linked to Medicare enrollment data and local area characteristics from the 2000 Census. Study Design Race/ethnicity was cross-tabulated for CAHPS and Medicare data. Within each self-reported category, demographic, geographic, health, and health care variables were compared between those that were and were not similarly identified in Medicare data. Data Collection Methods The Medicare CAHPS survey included 343,658 responses from elderly participants (60 percent response rate). Data were weighted for sampling and nonresponse to be representative of the national population of elderly Medicare beneficiaries. Principal Findings Self-reported Hispanics, Asians, Pacific Islanders, and American Indians were underidentified in Medicare enrollment data. Individuals in these groups who were identified in Medicare data tended to be more strongly identified with their group, poorer, and in worse health and to report worse health care experiences than those who were not so identified. Conclusions Self-reported members of racial and ethnic groups other than Whites and Blacks who are identified in Medicare data differ substantially from those who are not so identified. These differences should be considered in assessments of disparities in health and health care among Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

Objective To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act. Data Sources Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001-2003). Study Design We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage. Data Collection Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age. Principal Findings Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups.However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non- Latino whites while Latinos show no measurable disparity. Conclusions Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups. [ABSTRACT FROM AUTHOR]

Objective To examine the effectiveness of current community-based participatory research ( CBPR) clinical trials involving racial and ethnic minorities. Data Source All published peer-reviewed CBPR intervention articles in PubMed and CINAHL databases from January 2003 to May 2010. Study Design We performed a systematic literature review. Data Collection/Extraction Methods Data were extracted on each study's characteristics, community involvement in research, subject recruitment and retention, and intervention effects. Principle Findings We found 19 articles meeting inclusion criteria. Of these, 14 were published from 2007 to 2010. Articles described some measures of community participation in research with great variability. Although CBPR trials examined a wide range of behavioral and clinical outcomes, such trials had very high success rates in recruiting and retaining minority participants and achieving significant intervention effects. Conclusions Significant publication gaps remain between CBPR and other interventional research methods. CBPR may be effective in increasing participation of racial and ethnic minority subjects in research and may be a powerful tool in testing the generalizability of effective interventions among these populations. CBPR holds promise as an approach that may contribute greatly to the study of health care delivery to disadvantaged populations. [ABSTRACT FROM AUTHOR]