Racial and ethnic disparities in prescription coverage and medication use

This study compared drug coverage and prescription drug use by race and Hispanic ethnicity for Medicare beneficiaries with three chronic conditions: diabetes, hypertension, or heart disease. We found that among beneficiaries without any drug coverage black persons and Hispanics used 10 to 40 percent fewer medications, on average, than white persons with the same illness, and spent up to 60 percent less in total drug costs. Having drug coverage somewhat lessened these differences although the effect was consistent with only M + C prescription benefits. Substantially lower medication use remained for dually eligible black beneficiaries and Hispanics with employer-sponsored drug benefits

"The Business Case for Racial Equity" Quantifies the Cost of Racism in the U.S.

Altarum Institute and the W.K. Kellogg Foundation (WKKF) released a report detailing the economic impact of racism, and the benefits of advancing racial equity as the demography of our nation continues to evolve

The Business Case for Racial Equity, 2013

Striving for racial equity -- a world where race is no longer a factor in the distribution of opportunity -- is a matter of social justice. But moving toward racial equity can generate significant economic returns as well. When people face barriers to achieving their full potential, the loss of talent, creativity, energy, and productivity is a burden not only for those disadvantaged, but for communities, businesses, governments, and the economy as a whole. Initial research on the magnitude of this burden in the United States (U.S.), as highlighted in this brief, reveals impacts in the trillions of dollars in lost earnings, avoidable public expenditures, and lost economic output

Study Protocol of a Randomized Controlled Trial Evaluating the Prime Time Sister Circles (PTSC) Program\u27s Impact on Hypertension among Midlife African American Women

Background The Prime-Time Sister Circles® (PTSC) program is a multifaceted, community-based peer support intervention targeting African American women who are 40 to 75 years of age. It aims to reduce hypertension disparities observed among African American women by promoting adherence to antihypertensive therapies, including lifestyle modification and therapeutic regimens. Methods The PTSC randomized controlled trial will evaluate the effectiveness of the PTSC Program on improved blood pressure control, healthcare utilization attributed to cardiovascular events, and healthcare costs. The study began in 2016 and will end in 2022. African American women who are 40–75 years old, have been diagnosed with hypertension, reside in Washington, D.C. or Baltimore, Maryland, and receive their care from Unity Health Care, a federally qualified health center in Washington, D.C., or Baltimore Medical System, a federally qualified health center in Baltimore, Maryland, are eligible to participate. Those randomized to the intervention group participate in the PTSC Program, which spans 13 weeks and comprises facilitator-led discussions, didactic training about hypertension management, and peer-based problem-solving concerning CVD risk factors and their amelioration. Blood pressure, weight, body mass index, waist circumference, self-reported adherence, physical activity, dietary practices, stress, and healthcare utilization data are collected at baseline, 13 weeks (end of the intervention), 9 months (months post-intervention), and 15 months (one year after the intervention). Healthcare costs will be computed at the end of the study. The study’s design is reported in the present manuscript, wherein we employed the SPIRIT checklist to guide its construction. Discussion Disparities in hypertension prevalence and management observed among mid-life African American women exist as a result of a confluence of structural determinants of health. Consequently, there is a need to develop, implement, and evaluate culturally appropriate and relevant interventions that are tailored to their lived experiences. The PTSC Trial aims to assess the impact of the program on participants’ cardiovascular, psychosocial, and cost outcomes. Its results have implications for advancing the science of designing and implementing culturally relevant interventions for African American women. Trial registration Unique identifier: NCT04371614. Retrospectively registered on April 30, 2020

Examining Causes of Racial Disparities in General Surgical Mortality: Hospital Quality Versus Patient Risk

BACKGROUND: Racial disparities in general surgical outcomes are known to exist but not well understood. OBJECTIVES: To determine if black-white disparities in general surgery mortality for Medicare patients are attributable to poorer health status among blacks on admission or differences in the quality of care provided by the admitting hospitals. RESEARCH DESIGN: Matched cohort study using Tapered Multivariate Matching. SUBJECTS: All black elderly Medicare general surgical patients (N=18,861) and white-matched controls within the same 6 states or within the same 838 hospitals. MEASURES: Thirty-day mortality (primary); others include in-hospital mortality, failure-to-rescue, complications, length of stay, and readmissions. RESULTS: Matching on age, sex, year, state, and the exact same procedure, blacks had higher 30-day mortality (4.0% vs. 3.5%, P\u3c0.01), in-hospital mortality (3.9% vs. 2.9%, P\u3c0.0001), in-hospital complications (64.3% vs. 56.8% P\u3c0.0001), and failure-to-rescue rates (6.1% vs. 5.1% P\u3c0.001), longer length of stay (7.2 vs. 5.8 d, P\u3c0.0001), and more 30-day readmissions (15.0% vs. 12.5%, P\u3c0.0001). Adding preoperative risk factors to the above match, there was no significant difference in mortality or failure-to-rescue, and all other outcome differences were small. Blacks matched to whites in the same hospital displayed no significant differences in mortality, failure-to-rescue, or readmissions. CONCLUSIONS: Black and white Medicare patients undergoing the same procedures with closely matched risk factors displayed similar mortality, suggesting that racial disparities in general surgical mortality are not because of differences in hospital quality. To reduce the observed disparities in surgical outcomes, the poorer health of blacks on presentation for surgery must be addressed

Hospital characteristics associated with highly automated and usable clinical information systems in Texas, United States

<p>Abstract</p> <p>Background</p> <p>A hospital's clinical information system may require a specific environment in which to flourish. This environment is not yet well defined. We examined whether specific hospital characteristics are associated with highly automated and usable clinical information systems.</p> <p>Methods</p> <p>This was a cross-sectional survey of 125 urban hospitals in Texas, United States using the Clinical Information Technology Assessment Tool (CITAT), which measures a hospital's level of automation based on physician interactions with the information system. Physician responses were used to calculate a series of CITAT scores: automation and usability scores, four automation sub-domain scores, and an overall clinical information technology (CIT) score. A multivariable regression analysis was used to examine the relation between hospital characteristics and CITAT scores.</p> <p>Results</p> <p>We received a sufficient number of physician responses at 69 hospitals (55% response rate). Teaching hospitals, hospitals with higher IT operating expenses (>$1 million annually), IT capital expenses (>$75,000 annually) and hospitals with larger IT staff (≥ 10 full-time staff) had higher automation scores than hospitals that did not meet these criteria (p < 0.05 in all cases). These findings held after adjustment for bed size, total margin, and ownership (p < 0.05 in all cases). There were few significant associations between the hospital characteristics tested in this study and usability scores.</p> <p>Conclusion</p> <p>Academic affiliation and larger IT operating, capital, and staff budgets are associated with more highly automated clinical information systems.</p

Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community

BACKGROUND: Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. OBJECTIVE: To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. DESIGN: A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. PARTICIPANTS: Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. MEASUREMENTS: An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. RESULTS: For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR] = 1.8, 2.6; OR = 2.2, 3.3, respectively; all P < .05). Results were similar for perceived discrimination occurring in the past year. CONCLUSIONS: Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization

Estimating the economic burden of racial health inequalities in the United States.

The primary hypothesis of this study is that racial/ethnic disparities in health and health care impose costs on numerous aspects of society, both direct health care costs and indirect costs such as loss of productivity. The authors conducted three sets of analysis, assessing: (1) direct medical costs and (2) indirect costs, using data from the Medical Expenditure Panel Survey (2002-2006) to estimate the potential cost savings of eliminating health disparities for racial/ethnic minorities and the productivity loss associated with health inequalities for racial/ethnic minorities, respectively; and (3) costs of premature death, using data from the National Vital Statistics Reports (2003-2006). They estimate that eliminating health disparities for minorities would have reduced direct medical care expenditures by about $230 billion and indirect costs associated with illness and premature death by more than$1 trillion for the years 2003-2006 (in 2008 inflation-adjusted dollars). We should address health disparities because such inequities are inconsistent with the values of our society and addressing them is the right thing to do, but this analysis shows that social justice can also be cost effective

THE ECONOMIC BURDEN OF HEALTH INEQUALITIES IN THE UNITED STATES

We estimated the economic burden of health disparities in the United States using three measures: (1) direct medical costs of health inequalities, (2) indirect costs of health inequalities, and (3) costs of premature death. Our analysis found: • Between 2003 and 2006 thecombined costs of health inequalitiesand premature death in the United States were $1.24 trillion. • Eliminating health disparities for minorities would havereduced direct medicalcareexpenditures by$229.4 billion for the years 2003-2006. • Between 2003 and 2006, 30.6% of direct medicalcareexpenditures for African Americans, Asians,and Hispanics were excess costs due to health inequalities. • Eliminating health inequalities for minorities would havereduced indirectcostsassociated with illnessand premature death by morethan onetrillion dollars between 2003 and 2006