Differences in ambulatory care fragmentation by race (original) (raw)
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Ethnicity Disease, 2011
This exploratory study evaluates patterns of care relative to frequency of admission to high quality hospitals and mortality risk for patients with stroke among varying ethnic groups. Methods: Information from 273,532 adult patients with stroke was abstracted from the 2000 and 2006 National Inpatient Sample. Race/ethnicity was categorized as White, African American, Hispanic/Latino, or Asian/Pacific Islander. Hospitals were ranked based on the riskadjusted overall stroke mortality rate and then divided into four groups based on the quartiles of the ranking. Changes in disparities in attending the four groups of hospitals across race/ethnicity from 2000 to 2006 were examined. Disparities in mortality risk among patients in four racial/ethnic groups were also examined. Results: In 2006 as compared to 2000, African American and Hispanic/Latino patients were increasingly likely to be admitted to highquality hospitals. Disparities related to outcomes did not vary in a predictable manner during this period. Relatively low likelihood of admission to high-quality hospitals persisted among Asian/Pacific Islanders. Conclusions: Multiple efforts related to expanded access to care may have contributed to greater likelihood of admission to high-quality hospitals for African American and Hispanic patients, but these efforts do not seem to have affected Asian/Pacific Islander patients. Further research is needed to explore mechanisms for improving outcomes in high-risk populations. Policies should continue to support healthcare quality improvement efforts that have shown positive effects on outcomes of patients of all racial/ethnic groups. Programs that help Asian/ Pacific Islander patients to identify and attend high-quality hospitals should also be encouraged.
Racial/ethnic disparities in access to physician care and medications among US stroke survivors
Neurology, 2010
Background: Mexican Americans and non-Hispanic blacks have higher stroke recurrence rates and lower rates of secondary stroke prevention than non-Hispanic whites. As a potential explanation for this disparity, we assessed racial/ethnic differences in access to physician care and medications in a national sample of US stroke survivors. Methods: Among all 4,864 stroke survivors aged Ն45 years who responded to the National Health Interview Survey years 2000-2006, we compared access to care within the last 12 months by race/ethnicity before and after stratification by age (45-64 years vs Ն65 years). With logistic regression, we adjusted associations between access measures and race/ethnicity for sex, comorbidity, neurologic disability, health status, year, income, and health insurance. Results: Among stroke survivors aged 45-64 years, Mexican Americans, non-Hispanic blacks, and non-Hispanic whites reported similar rates of no generalist physician visit (approximately 15%) and inability to afford medications (approximately 20%). However, among stroke survivors aged Ն65 years, Mexican Americans and blacks, compared with whites, reported greater frequency of no generalist visit (15%, 12%, 8%; p ϭ 0.02) and inability to afford medications (20%, 11%, 6%; p Ͻ 0.001). Mexican Americans and blacks more frequently reported no medical specialist visit (54%, 49%, 40%; p Ͻ 0.001) than did whites and rates did not differ by age. Full covariate adjustment did not fully explain these racial/ethnic differences. Conclusions: Among US stroke survivors at least 65 years old, Mexican Americans and blacks reported worse access to physician care and medications than whites. This reduced access may lead to inadequate risk factor modification and recurrent stroke in these high-risk minority groups.
American journal of epidemiology, 2016
We described the linkage of primary data with administrative claims using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and Medicare. REGARDS study data were linked with Medicare claims by use of Social Security numbers. We compared REGARDS participants by Medicare linkage status, having fee-for-service (FFS) coverage or not, and with a 5% sample of Medicare beneficiaries who had FFS coverage in 2005, overall, by age (45-64 and ≥65 years), and by race. Among REGARDS participants who were ≥65 years of age, 80% had data linked to Medicare on their study-visit date (64% with FFS coverage). No differences except race and sex were present between REGARDS participants without Medicare linkage and those with data linked to Medicare with and without FFS coverage. After the age-sex-race adjustment, comorbid conditions and health-care utilization were similar for those with FFS coverage in the REGARDS study and the 5% sample of Medicare beneficiaries. Among REGAR...
International journal of stroke : official journal of the International Stroke Society, 2016
Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Statistical analyses examined differences in post-acute healthcare utilization, adjusted for pre-stroke utilization, as a function of race (African-American vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver. After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department servic...
Demographic Disparities in Proximity to Certified Stroke Care in the United States
Stroke, 2021
BACKGROUND AND PURPOSE: Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics. METHODS: This cross-sectional study included population data by census tract from the United States Census Bureau's 2014-2018 American Community Survey, stroke hospitals certified by a state or national body and providing intravenous thrombolysis, and geographic data from a public mapping service. Data were retrieved from March to November 2020. Quantile regression analysis was used to compare relationships between road distance to the nearest stroke center for each census tract and tract-level demographics of age, race, ethnicity, medical insurance status, median annual income, and population density. RESULTS: Two thousand three hundred eighty-eight stroke centers and 71 929 census tracts including 316 995 649 individuals were included. Forty-nine thousand nine hundred eighteen (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in nonurban areas than urban areas. Higher representation of individuals with age ≥65 years was associated with increased median distance to a certified stroke center in nonurban areas (0.51 km per 1% increase [99.9% CI, 0.42-0.59]) but not in urban areas (0.00 km [−0.01 to 0.01]). In urban and nonurban tracts, median distance was greater with higher representation of American Indian (urban
BMC Health Services Research, 2012
Background: Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care. Methods: We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors.
Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke
Circulation, 2010
Background— Prior studies suggest differences in stroke care associated with race/ethnicity. We sought to determine whether such differences existed in a population of black, Hispanic, and white patients hospitalized with stroke among hospitals participating in a quality-improvement program. Methods and Results— We analyzed in-hospital mortality and 7 stroke performance measures among 397 257 patients admitted with ischemic stroke to 1181 hospitals participating in the Get With The Guidelines-Stroke program 2003 through 2008. Relative to white patients, black and Hispanic patients were younger and more often had diabetes mellitus and hypertension. After adjustment for both patient- and hospital-level variables, black patients had lower odds relative to white patients of receiving intravenous thrombolysis (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77 to 0.91), deep vein thrombosis prophylaxis (OR, 0.88; 95% CI, 0.83 to 0.92), smoking cessation (OR, 0.85; 95% CI, 0.79 to ...
Stroke; a journal of cerebral circulation, 2014
Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina. Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites. Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65...
Journal of Health Care for the Poor and Underserved, 2011
Individuals with cardiovascular disease (CVD) living in Health Professional Shortage Areas (HPSA) may receive less preventive care than others. The Reasons for Geographic And Racial Differences in Stroke Study (REGARDS) surveyed 30,239 African American (AA) and White individuals older than 45 years of age between 2003-2007. We compared medication use for CVD prevention by HPSA and insurance status, adjusting for sociodemographic factors, health behaviors, and health status. Individuals residing in partial HPSA counties were excluded. Mean age was 649 years, 42% were AA, 55% were women, and 93% had health insurance; 2,545 resided in 340 complete HPSA counties and 17,427 in 1,145 non-HPSA counties. Aspirin, beta-blocker, and ACE-inhibitor use were similar by HPSA and insurance status.
JAMA Network Open
IMPORTANCE Black and Hispanic US residents are disproportionately affected by stroke incidence, and patients with dual eligibility for Medicare and Medicaid may be predisposed to more severe strokes. Little is known about differences in stroke severity for individuals with dual eligibility, Black individuals, and Hispanic individuals, but understanding hospital admission stroke severity is the first important step for focusing strategies to reduce disparities in stroke care and outcomes. OBJECTIVE To examine whether dual eligibility and race and ethnicity are associated with stroke severity in Medicare beneficiaries admitted to acute hospitals with ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study was conducted using Medicare claims data for patients with ischemic stroke admitted to acute hospitals in the