Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map

Continued racial/ethnic health disparities were recently described as "the most serious and shameful health care issue of our time." Although the 2014 US Affordable Care Act-mandated national insurance coverage expansion has led to significant improvements in health care coverage and acces...

Full description

Saved in:

Bibliographic Details
Published in:	American journal of public health (1971) 2018-03, Vol.108 (3), p.e1-e11
Main Authors:	Peterson, Kim, Anderson, Johanna, Boundy, Erin, Ferguson, Lauren, McCleery, Ellen, Waldrip, Kallie
Format:	Article
Language:	eng
Subjects:	Access African Continental Ancestry Group - statistics & numerical data AJPH Research Brain Cancer Clinical trials Colon Colon cancer Colorectal cancer Continental Population Groups Criteria Cultural differences Delivery of Health Care Diabetes Diabetes mellitus Ethnic factors European Continental Ancestry Group - statistics & numerical data Fairness Head injuries Health care Health care policy Health disparities Health services Health Services Accessibility Healthcare Disparities - statistics & numerical data Hispanic Americans Hispanic Americans - statistics & numerical data HIV HIV/AIDS Hospital administration Human immunodeficiency virus Humans Hypertension Insurance coverage Internal validity Kidney diseases Life expectancy Life span Lung cancer Management Minority & ethnic groups Minority groups Mortality Multiculturalism & pluralism National insurance Native North Americans Other Chronic Disease Other Race/Ethnicity Patient Protection & Affordable Care Act 2010-US Population Population (statistical) Population studies Private sector Prostate cancer Public health Race Racial differences Racial inequality Random effects Rectum Reviews Statistical significance Stroke Surgery Synthesis Traumatic brain injury United States United States Department of Veterans Affairs Veterans White people
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Continued racial/ethnic health disparities were recently described as "the most serious and shameful health care issue of our time." Although the 2014 US Affordable Care Act-mandated national insurance coverage expansion has led to significant improvements in health care coverage and access, its effects on life expectancy are not yet known. The Veterans Health Administration (VHA), the largest US integrated health care system, has a sustained commitment to health equity that addresses all 3 stages of health disparities research: detection, understanding determinants, and reduction or elimination. Despite this, racial disparities still exist in the VHA across a wide range of clinical areas and service types. To inform the health equity research agenda, we synthesized evidence on racial/ethnic mortality disparities in the VHA. Our research librarian searched MEDLINE and Cochrane Central Registry of Controlled Trials from October 2006 through February 2017 using terms for racial groups and disparities. We included studies if they compared mortality between any racial/ethnic minority and nonminority veteran groups or between different minority groups in the VHA (PROSPERO# CRD42015015974). We made study selection decisions on the basis of prespecified eligibility criteria. They were first made by 1 reviewer and checked by a second and disagreements were resolved by consensus (sequential review). Two reviewers sequentially abstracted data on prespecified population, outcome, setting, and study design characteristics. Two reviewers sequentially graded the strength of evidence using prespecified criteria on the basis of 5 key domains: study limitations (study design and internal validity), consistency, directness, precision of the evidence, and reporting biases. We synthesized the evidence qualitatively by grouping studies first by racial/ethnic minority group and then by clinical area. For areas with multiple studies in the same population and outcome, we pooled their reported hazard ratios (HRs) using random effects models (StatsDirect version 2.8.0; StatsDirect Ltd., Altrincham, England). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: odds ratio or HR of mortality for racial/ethnic minority group versus Whites, clinical area, strength of evidence, statistical significance, and racial group. From 2840 citations, we included 25 studies. Studies were large (n ≥ 10 000) and involved nationally representative co
ISSN:	0090-0036 1541-0048