Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996

Weinick, Robin M.; Zuvekas, Samuel H.; Cohen, Joel W.

doi:10.1177/107755800773743592

Cited by 136 publications

(169 citation statements)

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“…Therefore, the current study overrepresents non-Hispanic whites not only compared with the US population, but also compared with rheumatology practice. These findings are characteristic of survey research and medical care, since minorities are less likely to seek specialist care (27)(28)(29)(30) and to participate in studies (31)(32)(33)(34). It should also be noted that fewer persons in our cohort than in the US population did not complete high school (11.7% versus 15.9%).…”

Section: Discussionmentioning

confidence: 65%

Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy

Wolfe¹,

Michaud²,

Anderson³

et al. 2004

Arthritis & Rheumatism

390

189

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Objective. According to the Centers for Disease Control and Prevention, the 1999 and 2000 incidence rates for tuberculosis (TB) in the US population were 6.4 and 5.8, respectively, per 100,000 persons. Recently, reports of TB following infliximab administration have raised questions regarding the rate of TB in patients with rheumatoid arthritis (RA) generally and in those treated with infliximab in clinical practice. We undertook this study to determine the baseline rate of TB in RA prior to the introduction of infliximab and to determine the rate of TB among those currently receiving infliximab.Methods. We surveyed patients with questionnaires, followed by detailed validation from medical records and physician reports. In study 1, we evaluated 10,782 RA patients in 1998-1999 prior to the widespread use of infliximab. In study 2, we evaluated 6,460 infliximab-treated patients in 2000-2002.Results. In study 1, the lifetime rate of TB was 696 per 100,000 patients (95% confidence interval [95% CI] 547-872). Of these cases, 76.8% occurred prior to the onset of RA. During the period of prospective followup, 1 case of TB developed during 16,173 patient-years of followup, yielding a rate of 6.2 cases (95% CI 1.6-34.4) per 100,000 patients. In study 2, the TB incidence rate among infliximab-treated patients was 52.5 cases (95% CI 14.3-134.4) per 100,000 patient-years of exposure. Three of the 4 cases occurred in patients with a history of TB exposure, and no cases occurred in persons with recent TB skin tests or prophylaxis. Conclusion.The rate of TB is not increased in RA patients generally. Among infliximab-treated patients, the rate is 52.5 cases (95% CI 14.3-134.4) per 100,000 patient-years of exposure. A thorough medical history regarding TB, as well as tuberculin testing and radiographic examination (if indicated), should be an essential component of anti-tumor necrosis factor therapy.

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Section: Discussionmentioning

confidence: 65%

Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy

Wolfe¹,

Michaud²,

Anderson³

et al. 2004

Arthritis & Rheumatism

390

189

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“…34,35 Racial/ethnic disparities in health and medical care have been associated with health insurance, 36,37 sociodemographic factors, 38,39 and elements of the health care system such as accessibility and use of a medical home or usual source of care (USC). 14,[40][41][42][43] Little is known about the potential for a change in disparities after providing health Many minority children enroll in SCHIP, providing a unique opportunity to assess changes in disparities among vulnerable children who might otherwise be uninsured. Preexisting racial/ethnic disparities have been described among SCHIP enrollees.…”

mentioning

confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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ABSTRACT. Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.Methods. Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured >12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/ most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care. R acial/ethnic disparities in health care delivery are associated with adverse hea...

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“…African Americans, Hispanics, and Asian Americans experience greater barriers to receiving primary care (Shi, 1999) and are less likely to have a usual source of care than Whites (Weinick, Zuvekas, & Cohen, 2000). Racial and ethnic minority group members are likewise less likely than Whites to have health insurance, have fewer choices of where 238 R. H. Keefe to receive care, and are more likely to receive care in hospital emergency rooms (Collins, Hall, & Neuhaus, 1999).…”

Section: Abstract Health Disparities Public Health Social Work Minomentioning

confidence: 99%

Health Disparities: A Primer for Public Health Social Workers

Keefe

2010

Social Work in Public Health

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Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996

Cited by 136 publications

References 0 publications

Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy

Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Health Disparities: A Primer for Public Health Social Workers

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