Racial segregation and disparities in health care delivery: conceptual model and empirical assessment

Mary S Vaughan Sarrazin; Mary E Campbell; Kelly K Richardson; Gary E Rosenthal

doi:10.1111/j.1475-6773.2009.00977.x

Back

Racial segregation and disparities in health care delivery: conceptual model and empirical assessment

Journal article

Open access

Peer reviewed

Racial segregation and disparities in health care delivery: conceptual model and empirical assessment

Mary S Vaughan Sarrazin, Mary E Campbell, Kelly K Richardson and Gary E Rosenthal

Health services research, Vol.44(4), pp.1424-1444

08/2009

DOI: 10.1111/j.1475-6773.2009.00977.x

PMCID: PMC2739036

PMID: 19467026

Files and links (1)

url

https://doi.org/10.1111/j.1475-6773.2009.00977.xView

Published (Version of record) Open Access

Abstract

This study examines two dimensions of racial segregation across hospitals, using a disease for which substantial disparities have been documented. Black (n=32,289) and white (n=244,042) patients 67 years and older admitted for acute myocardial infarction during 2004-2005 in 105 hospital markets were identified from Medicare data. Two measures of segregation were calculated: Dissimilarity (i.e., dissimilar distribution by race across hospitals), and Isolation (i.e., racial isolation within hospitals). For each measure, markets were categorized as having low, medium, or high segregation. The relationship of hospital segregation to residential segregation and other market characteristics was evaluated. Cox proportional hazards regression was used to evaluate disparities in the use of revascularization within 90 days by segregation level. Agreement of segregation category based on Dissimilarity and Isolation was poor (kappa=0.12), and the relationship of disparities in revascularization to segregation differed by measure. The hazard of revascularization for black relative to white patients was lowest (i.e., greatest disparity) in markets with low Dissimilarity, but it was unrelated to Isolation. Significant racial segregation across hospitals exists in many U.S. markets, although the magnitude and relationship to disparities depends on definition. Dissimilar distribution of race across hospitals may reflect divergent cultural preferences, social norms, and patient assessments of provider cultural competence, which ultimately impact utilization.

United States

Models, Theoretical

Healthcare Disparities - statistics & numerical data

Medicare

Humans

Proportional Hazards Models

Quality of Health Care - statistics & numerical data

Hospitalization - statistics & numerical data

European Continental Ancestry Group - statistics & numerical data

Prejudice

African Continental Ancestry Group - statistics & numerical data

Myocardial Infarction - therapy

Process Assessment (Health Care)

Aged

Details

Title: Subtitle: Racial segregation and disparities in health care delivery: conceptual model and empirical assessment
Creators: Mary S Vaughan Sarrazin - Center for Research in Innovative Implementation Strategies for Practice (CRIISP), Iowa City VA Medical Center, Iowa City, Iowa 52246, USA. Mary-vaughan-sarrazin@uiowa.edu
Mary E Campbell
Kelly K Richardson
Gary E Rosenthal
Resource Type: Journal article
Publication Details: Health services research, Vol.44(4), pp.1424-1444
Publisher: United States
DOI: 10.1111/j.1475-6773.2009.00977.x
PMID: 19467026
PMCID: PMC2739036
ISSN: 0017-9124
eISSN: 1475-6773
Grant note: R03 AG027286 / NIA NIH HHS R03 AG027286-02 / NIA NIH HHS NIA R03 AG027286 / NIA NIH HHS
Language: English
Date published: 08/2009
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984064189002771

Metrics

39 Record Views

58 Times Cited - Web of Science

See more details