Sociodemographic disparities in pediatric pain management

2021 ◽  
pp. 660-670
Author(s):  
Anna Huguet ◽  
Miriam O. Ezenwa
Keyword(s):  
Pain Management ◽  
Ethnic Disparities ◽  
Explanatory Models ◽  
Residential Area ◽  
Insurance Status ◽  
Pediatric Pain ◽  
Sociodemographic Predictors ◽  
Sociodemographic Disparities ◽  
Racial Ethnic ◽  
Clinical Meaningfulness

The purpose of this chapter is to present a narrative review of research studies examining sociodemographic predictors of disparities in pain management in children and adolescents. Findings from this review suggest that there are racial/ethnic disparities in the management of pain, but it is still not clear whether disparities by age, sex, insurance status, and residential area exist owing to the conflicting results and/or the reduced number of studies published. For the studies in which evidence of sociodemographic disparities exist, it is not clear whether the statistically significant sociodemographic disparities were also clinically meaningful, and the goal is to determine predictors of disparities in pain management. Future studies need to focus on determining the clinical meaningfulness of other findings and systematically testing explanatory models for possible sociodemographic disparities in pediatric pain management. Adequately addressing these gaps will help to advance the science of sociodemographic disparities in pediatric pain management.

Sociodemographic disparities in paediatric pain management: relationships and predictors

2013 ◽  
pp. 669-672
Author(s):  
Miriam O. Ezenwa ◽  
Anna Huguet
Keyword(s):  
Pain Management ◽  
Children And Adolescents ◽  
Explanatory Models ◽  
Narrative Review ◽  
Sociodemographic Variables ◽  
Future Studies ◽  
Sociodemographic Predictors ◽  
Sociodemographic Disparities ◽  
Clinical Meaningfulness ◽  
Research Studies

The purpose of this chapter is to present a narrative review of research studies examining sociodemographic predictors of disparities in pain management in children and adolescents. Findings from this review are conflicting. In the majority of the studies, sociodemographic variables were not statistically significant predictors of disparities in pain management. However, some gaps remain. For the studies in which evidence of sociodemographic disparities exist, it is: (1) not clear whether the statistically significant sociodemographic disparities were also clinically meaningful and (2) in all of the studies reviewed, the goal was to determine predictors of disparities in pain management. Future studies need to focus on determining the clinical meaningfulness of other findings and systematically testing explanatory models for possible sociodemographic disparities in paediatric pain management. Adequately addressing these gaps will help to move forward the science of sociodemographic disparities in paediatric pain management.

scholarly journals Racial/Ethnic Disparities in Readmissions in US Hospitals: The Role of Insurance Coverage

2018 ◽  
Vol 55 ◽  
pp. 004695801877418 ◽  
Author(s):  
Jayasree Basu ◽  
Amresh Hanchate ◽  
Arlene Bierman
Keyword(s):  
New York ◽  
Lower Risk ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Ethnic Disparities ◽  
Hospital Performance ◽  
Insurance Status ◽  
Readmission Rates ◽  
Discharge Data ◽  
Racial Ethnic

We examine differences in rates of 30-day readmissions across patients by race/ethnicity and the extent to which these differences were moderated by insurance coverage. We use hospital discharge data of patients in the 18 years and above age group for 5 US states, California, Florida, Missouri, New York, and Tennessee for 2009, the latest year prior to the start of Centers for Medicare & Medicaid Services’ Hospital Compare program of public reporting of hospital performance on 30-day readmissions. We use logistic regression models by state to estimate the association between insurance status, race, and the likelihood of a readmission within 30 days of an index hospital admission for any cause. Overall in 5 states, non-Hispanic blacks had a slightly higher risk of 30-day readmissions relative to non-Hispanic whites, although this pattern varied by state and insurance coverage. We found higher readmission risk for non-Hispanic blacks, compared with non-Hispanic whites, among those covered by Medicare and private insurance, but lower risk among uninsured and similar risk among Medicaid. Hispanics had lower risk of readmissions relative to non-Hispanic whites, and this pattern was common across subgroups with private, Medicaid, and no insurance coverage. Uninsurance was associated with lower risk of readmissions among minorities but higher risk of readmissions among non-Hispanic whites relative to private insurance. The study found that risk of readmissions by racial ethnic groups varies by insurance status, with lower readmission rates among minorities who were uninsured compared with those with private insurance or Medicare, suggesting that lower readmission rates may not always be construed as a good outcome, because it could result from a lack of insurance coverage and poor access to care, particularly among the minorities.

Racial/Ethnic Disparities in Pain Burden and Pain Management in the Context of Opioid Overdose Risk

2019 ◽  
Vol 6 (2) ◽  
pp. 275-289
Author(s):  
Cleo A. Samuel ◽  
Giselle Corbie-Smith ◽  
Samuel Cykert
Keyword(s):  
Pain Management ◽  
Ethnic Disparities ◽  
Opioid Overdose ◽  
Racial Ethnic

Racial-ethnic differences in childhood higher body mass index: insurance status explanatory model

2015 ◽  
Vol 8 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Laurens Holmes ◽  
Sequoia Jackson ◽  
Alexandra LaHurd ◽  
Pat Oceanic ◽  
Kelli Grant ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Race And Ethnicity ◽  
Pediatric Population ◽  
Insurance Coverage ◽  
Ethnic Disparities ◽  
Insurance Status ◽  
Cross Sectional ◽  
Content Type ◽  
Racial Ethnic

Purpose – The purpose of this paper is to examine the prevalence of obesity/overweight using higher body mass index (BMI), assess racial/ethnic variance in overweight/obese prevalence, and to determine whether or not insurance status explains the variance. Design/methodology/approach – A cross-sectional design was used to assess medical records of children in Nemours Healthcare System during 2011. The authors reviewed the records and extracted information on normal BMI, BMI percent, higher BMI, prevalence of overweight/obese and other variables as well as race and ethnicity. χ2 statistic, Fischer's exact and logistic regression model were used to examine the data. Findings – Overall, the prevalence of higher BMI as overweight/obese was comparable to that of the US pediatric population, 33.4 percent. Compared to Caucasian/white, Asians were less likely to have higher BMI, prevalence odd ratio (POR)=0.79, 95 percent CI=0.70-0.90, but Blacks/African Americans (POR=1.22, 95 percent CI=1.18-1.27) and Some other Race were more likely to have higher BMI, POR=1.61, 95 percent CI=1.92-1.71. After controlling for insurance status, the racial disparities in higher BMI persisted; p<0.0001. Research limitations/implications – Racial/ethnic disparities exist in childhood higher BMI, which were not removed after controlling for insurance coverage as a surrogate for socioeconomic status. These findings are indicative of assessing sex, religious, dietary patterns, physical activities level, environmental resources, social media resources; and geographic locale as confounders in race/ethnicity and higher BMI association. Originality/value – Understanding the predisposing factors to obesity/overweight among diverse populations is essential in developing and implementing intervention programs in addressing this epidemic in our nation.

Study finds racial/ethnic disparities in depressive trajectories among middle-aged or older adults

2012 ◽  
Author(s):  
J. Liang ◽  
X. Xu ◽  
A. R. Quinones ◽  
J. M. Bennett ◽  
W. Ye
Keyword(s):  
Older Adults ◽  
Ethnic Disparities ◽  
Middle Aged ◽  
Racial Ethnic

1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1489-P
Author(s):  
SHARON SHAYDAH ◽  
GIUSEPPINA IMPERATORE ◽  
CARLA MERCADO ◽  
KAI M. BULLARD ◽  
STEPHEN R. BENOIT
Keyword(s):  
United States ◽  
Ethnic Disparities ◽  
Diabetic Coma ◽  
Racial Ethnic

scholarly journals Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer

2017 ◽  
Vol 35 (1) ◽  
pp. 86-95 ◽  
Author(s):  
Albert J. Farias ◽  
Xianglin L. Du
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ethnic Disparities ◽  
Medication Possession Ratio ◽  
Adjuvant Endocrine Therapy ◽  
Hormone Receptor Positive ◽  
Medication Costs ◽  
Poverty Status ◽  
Racial Ethnic ◽  
Out Of Pocket Costs

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

scholarly journals Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Chirag Vyas ◽  
Charles Reynolds ◽  
David Mischoulon ◽  
Grace Chang ◽  
Olivia Okereke
Keyword(s):  
Native American ◽  
Ethnic Differences ◽  
Ethnic Disparities ◽  
Late Life ◽  
Geographic Region ◽  
Omega 3 ◽  
Late Life Depression ◽  
Item Level ◽  
Racial Ethnic ◽  
Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

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