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. 2009 Feb;66(1):23-48.
doi: 10.1177/1077558708323607. Epub 2008 Sep 16.

Measuring trends in racial/ ethnic health care disparities

Benjamin Lê Cook  1 , Thomas G McGuire, Samuel H Zuvekas
Affiliations

Measuring trends in racial/ ethnic health care disparities

Benjamin Lê Cook et al. Med Care Res Rev. 2009 Feb.

Abstract

Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black-White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic-White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.

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Figures

Figure 1
Figure 1. The Institute of Medicine’s Definition of Racial/Ethnic Health Care Disparities
Source: Institute of Medicine (2002).
Figure 2
Figure 2. Three Definitions of Racial Disparities
Note: Bars on the right of figure represent differences included in racial disparities definitions according to the AHRQ in the National Healthcare Disparities Reports, the IOM, and the RDE method used in other health services literature. SES+ = socioeconomic status (SES) variables plus two variables that are highly correlated with SES: health insurance type and region of country; AHRQ = Agency for Healthcare Research and Quality; IOM = Institute of Medicine; RDE = residual direct effect.
Figure 3
Figure 3. Unadjusted Black-White (BW) and Hispanic-White (HW) Differences in Total Medical Expenditures (US$2005)
Figure 4
Figure 4. Unadjusted Black-White (BW) and Hispanic-White (HW) Difference in Any Outpatient or Office-Based Visit
Figure 5
Figure 5. Assessing the Effect of SES Changes on Change in Medical Expenditure Disparities: 1996/1997 to 2004/2005
Note: HS = health status; SES = socioeconomic status.
See this image and copyright information in PMC

References

    1. Agency for Healthcare Research and Quality . National healthcare disparities report, 2003. Author; Rockville, MD: 2003.
    1. Agency for Healthcare Research and Quality . National healthcare disparities report, 2004. Author; Rockville, MD: 2004.
    1. Agency for Healthcare Research and Quality . MEPS HC-036: 1996-2004 pooled estimation file. Author; Rockville, MD: 2005a.
    1. Agency for Healthcare Research and Quality . National healthcare disparities report, 2005. Author; Rockville, MD: 2005b.
    1. Agency for Healthcare Research and Quality . MEPS HC-036BRR: 1996-2004 replicates for calculating variances file. Author; Rockville, MD: 2006a.

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