When Does A Difference Become A Disparity? Conceptualizing Racial And Ethnic Disparities In Health

Hebert, Paul L.; Sisk, Jane E.; Howell, Elizabeth A.

doi:10.1377/hlthaff.27.2.374

Cited by 126 publications

(105 citation statements)

References 15 publications

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“…Together these data suggest that the differences in outcomes we observed between short and taller adults are a disparity, which the World Health Organization defines as a "differences in health that are not only unnecessary and avoidable, but in addition, are considered unfair and unjust." (14,15) Although shorter height has been previously shown to be associated with a higher rate of death among pediatric lung transplant candidates (9), there has been little formal examination of the impact of candidate height on outcomes before and after lung transplantation. Registry reports from the International Society for Heart and Lung Transplantation do not examine waiting list outcomes, and therefore have not identified short stature as a risk factor for poor outcomes (16).…”

Section: Discussionmentioning

confidence: 99%

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

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Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates.Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes.Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results:The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (,162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation.Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.

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Section: Discussionmentioning

confidence: 99%

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

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“…However, the government and other vital stakeholders can create policies and programs to reduce poverty and/or environmental degradation. Health disparity occurs in the contexts of unjust deprivations-whether conscious or unconscious-that result in significant health outcomes amongst various racial/ethnic groups [12].…”

Section: What Is Health Disparity?mentioning

confidence: 99%

Money as Health: A Study of Health Status Disparities among African Americans of Flint, Michigan

Amadi¹

2017

JPCPY

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Choice theory has been used as an effective approach in the assessment and treatment of human behavior. It is particularly deployed in cases involving the clinical care of patients who may have chronic co-morbid conditions [1,2]. Although choice theory explores how the personal choices of patients impact their health outcome, there are certain contexts in which health status cannot be simply attributed to maladaptive behaviors [1]. This claim may seem counterintuitive to the basic tenets of the behavioral health enterprise, but a case can be made regarding how a patient's social economic status may predispose him/her to unwanted or unwarranted cycle of poor health status. In this article, the author examines the issue of poverty as a significant predictor of health status. By carefully reviewing relevant literature on the social economic status of African American residents of Flint, Michigan, publically available data suggests a correlation between poverty and the health status of this minority population. Given that a patient's economic means determine where he/she may reside, it is not enough to attribute related health disparities to the question of personal choices. The victims of the lead poisoning in Flint did not choose their health status. They were simply relegated to a potentially hazardous environment, which had direct implications for their health status.

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“…A potential reason for gender disparities in cardiovascular testing is providers' gender stereotyping and bias 11, 13, 14, 15, 16. Gender stereotyping is the process by which people make assumptions about others' characteristics based on their gender, along specific trait dimensions 17.…”

Section: Introductionmentioning

confidence: 99%

Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

Daugherty

Blair

Havranek

et al. 2017

JAHA

110

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BackgroundPhysicians' gender bias may contribute to gender disparities in cardiovascular testing. We used the Implicit Association Test to examine the association of implicit gender biases with decisions to use cardiovascular tests.Methods and ResultsIn 2014, cardiologists completed Implicit Association Tests and a clinical vignette with patient gender randomly assigned. The Implicit Association Tests measured implicit gender bias for the characteristics of strength and risk taking. The vignette represented an intermediate likelihood of coronary artery disease regardless of patient gender: chest pain (part 1) followed by an abnormal exercise treadmill test (part 2). Cardiologists rated the likelihood of coronary artery disease and the usefulness of stress testing and angiography for the assigned patient. Of the 503 respondents (9.3% of eligible; 87% male, median age of 45 years, 58% in private practice), the majority associated strength or risk taking implicitly with male more than female patients. The estimated likelihood of coronary artery disease for both parts of the vignette was similar by patient gender. The utility of secondary stress testing after an abnormal exercise treadmill test was rated as “high” more often for female than male patients (32.8% versus 24.3%, P=0.04); this difference did not vary with implicit bias. Angiography was more consistently rated as having “high” utility for male versus female patients (part 1: 19.7% versus 9.8%; part 2: 73.7% versus 64.3%; P<0.05 for both); this difference was larger for cardiologists with higher implicit gender bias on risk taking (P=0.01).ConclusionsCardiologists have varying degrees of implicit gender bias. This bias explained some, but not all, of the gender variability in simulated clinical decision‐making for suspected coronary artery disease.

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When Does A Difference Become A Disparity? Conceptualizing Racial And Ethnic Disparities In Health

Cited by 126 publications

References 15 publications

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Money as Health: A Study of Health Status Disparities among African Americans of Flint, Michigan

Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

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