Report Identifies Strategies for Measuring, Interpreting Racial and Ethnic Disparities in Health Care

A report published recently by the Urban Institute aimed to quantify and interpret measures of disparities in health care, one of the most important yet challenging prospects in the pursuit of equitable care.

Racial and ethnic disparities have been a longstanding issue in the US health care system, but efforts to eliminate these inequities are limited by lack of research and evidence-based practices. Authors of the report note that a key limitation of many studies on health care disparities is the absence of a clear definition on the issue, as well as a framework for analysis, which can result in estimates that are ill defined and subject to misinterpretation.

The definition on health disparities provided by the Institute of Medicine (IOM) was used for the analysis, which indicates that racial and ethnic differences in health care access and use for reasons outside of clinical need and patient preferences are considered unjustifiable and thus constitute a disparity.

“Under this definition, differences due to age, sex, health status, and patient preferences are considered acceptable or just,” they explained. “Though this is not the only valid definition, it provides a clear example of how to explicitly define a disparity and use a conceptual framework that defines just and unjust drivers of differences to guide interpretation.”

The report provided 5 recommendations for producing and interpreting estimates of racial and ethnic disparities in health care:

• Include a clear and explicit definition of the health care disparity of interest and a corresponding method that applies the definition to estimate the magnitude and/or drivers of the disparity
• Provide a conceptual framework that considers or incorporates the role of systemic racism as an unjust driver of group differences to guide the interpretation of study results
• Discuss the data limitations in applying a given definition of disparity, including the measurement of race and ethnicity
• Estimate a model with a comprehensive set of covariates consistent with the conceptual framework and use the appropriate components of the estimated model to calculate the magnitude of the disparity as defined
• Investigate models that move beyond documenting disparities to analyzing contributing factors

Authors additionally provided several empirical examples using data from the National Health Interview Survey to further illustrate the value of these recommendations. Key findings from their empirical analyses showed that disparity estimates can vary widely when using different disparity definitions, indicating that clearly defining the disparity with a supporting conceptual framework—rather than defining it implicitly based on the included covariates in a regression model—is critical for interpretation.

Furthermore, estimates of a single disparity definition, such as that from the IOM, and its component parts vary modestly across estimation approaches. However, they said that their examples indicate that an approach using a more comprehensive model with a rich set of covariates is less likely to understate the IOM disparity.

Lastly, if the data demonstrate a differential effect of socioeconomic status or other covariates on outcomes by racial group, estimates of the disparity and the drivers of disparity may be improved by estimating separate models by race, they said.

“Clear, high-quality measures of racial and ethnic disparities in health care use, with explicit definitions and interpretations, are critical to understanding disparities and exploring their causal factors,” said the authors.

“Well-defined and interpretable estimates are necessary to produce more actionable information to address disparities, guide and evaluate interventions to reduce and eliminate disparities in health care use, and set and prioritize equity policy agendas for policymakers and the public.”

The report was funded by the Robert Wood Johnson Foundation.

Reference

Clemans-Cope L, Garrett B, McMorrow S. How should we measure and interpret racial and ethnic disparities in health care? Urban.org. Published on January 11, 2023. https://urbn.is/3wxCKiL