Health Disparities Research

Transcription

1 Health Disparities Research Larissa Avilés-Santa, MD, MPH, FACP, FACE Medical Officer National Heart, Lung, and Blood Institute Introduction to Principles and Practice of Clinical Research National Institutes of Health Clinical Center March 15, 2016

2 Disclaimer The views expressed in this presentation do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. There are no conflicts of interest to disclose.

3 Objectives Definitions Factors or Areas of Study Research Examples

4 May 31, 1992 March 4, 2001

5

6 Environmental Health Perspectives 2006; 114:

7 Environmental Health Perspectives 2006; 114:

8 What does the term disparities mean? Why is it important to study them?

9 Disparity versus Difference Element of injustice, inequity, disadvantage Are all differences disparities?

10 Equality versus Equity Equal utilization of services = the standard Equal need Equal preferences Equal benefit Assurance of access to necessary and highquality care? Rathore SS, Krumholz HM, Annals of Internal Medicine 2004; 141:

11 Equity in Health Care The clinical need is the primary determinant of equal opportunities for utilization of health care resources. Rathore SS, Krumholz HM, Annals of Internal Medicine 2004; 141:

12 Equity

13 Disparities in Health or Disparities in Health Care?

14 Why is it important to study health disparities? To ensure that we are: Reducing and eliminating health disparities wherever we find them Implementing and delivering the best health care practices for our patients

15 Disparities in Health or Disparities in Health Care as Research Questions

16 Myers HF, J Behavioral Medicine 2009; 32: 9-19

17

18 Psychosocial and sociocultural factors Language Beliefs Practices Social networks and support Identity Sex/Gender Race/Ethnicity Birth place Migration history Language Access to Health Care & Utilization

19 234,769 Medicare patients with acute myocardial infarction 26,575 eligible for reperfusion NEJM 2000; 342:

20

21 Identity Sex/Gender Race/Ethnicity Birth place Migration history Language Health Status Health Outcomes Biological Factors Age Genetics Fetal development Prenatal care Maternal health Early development Comorbities Nutrition Pathology/Pathophysiology

22 National Vital Statistics Report, October 2012

23 JAMA 2015; 313:

24 JAMA 2015; 313:

25 Stages III or IV Poorly differentiated or undifferentiated Tumor size 5cm ER- Watlington AT et al, Cancer 2007; 109:

26

27 Zhang Y, Baik SH: J Gen Intern Med 2013; 29:

28 Zhang Y, Baik SH: J Gen Intern Med 2013; 29:

29 Identity Sex/Gender Race/Ethnicity Birth place Migration history Language Stress/Stressors Gender-related Age-related Race/ethnicity-related Personal/family wellbeing and health Personal/family safety Financial Community characteristics Geography Health Status Health Outcomes Biological Factors Age Genetics Fetal development Prenatal care Maternal health Early development Comorbities Nutrition Pathology/Pathophysiology

30 Dumont DM et al, Maternal Child Health J 2014; 18: Isaksson J et al, J Psychiatric Res 2015; 71: Latendresse G et al, Nursing Res 2015; 64:

31 Religion Spirituality Hope Resilience Psychosocial and sociocultural factors Language Beliefs Practices Social networks and support Identity Sex/Gender Race/Ethnicity Birth place Migration history Language Cognitive Processing Comprehension Decision making Education Health Behaviors Stress/Stressors Gender-related Age-related Race/ethnicity-related Personal/family wellbeing and health Personal/family safety Financial Community characteristics Geography Health Status Health Outcomes Biological Factors Age Genetics Fetal development Prenatal care Maternal health Early development Comorbities Nutrition Pathology/Pathophysiology

32 Sarasa-Renedo A et al, Drug and Alcohol Dependence 2015; 153:

33 Compton S et al, Res Soc Adm Pharm 2010; 6:

34 Health Status Health Outcomes Access to Health Care & Utilization

35 J Fam Plann Reprod Health Care 2014; 0: 1-7 Acta Obstet Gynecol Scand 2003; 82: BMC Public Health 2014; 14: 523

36 Stages III or IV Poorly differentiated or undifferentiated Tumor size 5cm ER- Watlington AT et al, Cancer 2007; 109:

37 Health Status Health Outcomes Access to Health Care & Utilization Health system factors

38 Problem within the System: penalties Solutions: proactive; non-traditional Prieto-Centurión et al, Ann Am Thorac Soc 2013; 10:

39 Weinstein LC et al, CA Cancer J Clin 2015;

40 Durkin MS et al, Autism Res 2015; 8:

41 Brown T et al, Preventive Med Reports 2015; 2:

42 Brown T et al: Preventive Med Reports 2015; 2:

43 Piron M, et al: Transfusion 2008; 48: Corral JE et al: J Gastrointest Cancer 2015; 46: Guillard TR, Osei K: J Racial and Ethnic Disparities 2016; 3:

44

45 Gilbert and Rey, Journal of Urban Health; NY Academy of Medicine Linton JM et al, Pediatr Clin North Am 2016; 63: McClaren ZM et al, BMC Health Services Res 2014; 14: 541-

46

47

48 Why is it important that we continue doing research in health disparities?

49 Why is it important to study health disparities? To ensure that we are: Reducing and eliminating health disparities wherever we find them Implementing and delivering the best health care practices for our patients

50 Why to do research in health or health care disparities? Documentation Explanation Strategies towards reduction or elimination Smith WR et al, Annals of Internal Medicine 2007; 147:

51 Documentation Newly recognized factor? Revisiting a covariate? New population?

52 Explanation Mechanism of disease? Clinical outcomes? Change in policy?

53 Strategies towards reduction or elimination Interventions Reframing and reevaluation Biological factors? Clinical outcomes? Utilization of health services? Policy? Socioeconomic factors? Environmental factors?

54

55

56 Larissa Avilés-Santa, MD, MPH