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Activity Number: 597
Type: Topic Contributed
Date/Time: Wednesday, August 12, 2015 : 2:00 PM to 3:50 PM
Sponsor: Social Statistics Section
Abstract #317035
Title: Improving the Understanding of Racial/Ethnic Disparity in Health Care Through a Within-Geographic-Unit Analysis
Author(s): Guofen Yan*
Companies: University of Virginia School of Medicine
Keywords: Hierarchical logistic regression ; county-level estimates ; county-specific estimates ; county random-effects ; end-stage renal disease (ESRD) ; pre-ESRD care
Abstract:

Racial/ethnic disparities have long been noted in multiple aspects of health care access and outcomes. Assessment of racial disparities using patient-level models often cannot adequately adjust for confounding by geographic differences in health care utilization in which racial minorities tend to live in areas with lower utilization. This confounding can be largely addressed by examining the difference between patients of racial/ethnic subgroups living in the same geographic-area unit. We perform within-county analyses using two-stage hierarchical models to produce model-based estimates of the within-county racial disparity in access to health care for each of the counties in the study sample. We examine the racial disparity in the receipt of nephrologist care among the national population approaching end-stage renal disease (ESRD). The results indicate that the racial disparity in pre-ESRD nephrologist care existed in most US counties. We also discuss implications of the results in the contexts of causal inference and potential policy interventions, such as whether efforts to improve pre-ESRD care should be implemented nationally rather than regionally.


Authors who are presenting talks have a * after their name.

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