Health Care Disparities


The presence of racial and socioeconomic disparties in access to and quality of health care continues to be among the most important public health issues in the United States.  Population level data lends itself well to the study of disparities in health care outcomes because large sample sizes are available for analysis, affording more statistical power than prospective studies which tend to involve a smaller number of participants, particularly participants in racial or socioeconomic minority groups.  Below are ongoing or completed projects undertaken by center investigators that focus on disparities in health care.

Ongoing Projects

Understanding Racial Disparities in Surgical Outcomes

Funded by the National Institute on Aging
Principal Investigator: Jeffrey H. Silber, MD, PhD

Many studies have documented important racial disparities in surgical outcomes, but their etiologies are not clear. While we generally find better surgical outcomes (lower mortality) at teaching hospitals and a higher rate of minority patients at these hospitals, the survival benefit at teaching hospitals does not seem to equally apply to white and black patients. This study is exploring why we observe disparities in three common surgical specialties with respect to procedure time, a classic measure of surgical practice. 

Studying Socioeconomic Disparities in Cancer Survival with Tapered Matching

Funded by the National Institute on Minority Health and Health Disparities
Principal Investigator: Jeffrey H. Silber, MD, PhD

The overall goal of this study is to better understand why breast and colon cancer patients with lower SES in the Medicare system have worse survival and to suggest potential remedies to improve these disparities.  This is a retrospective observational study that utilizes secondary data in the SEER-Medicare database for over 250,000 elderly breast and colon cancer patients diagnosed between 1992 and 2010.

Recently Completed Projects

Describing and Understanding Racial Disparities

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Jeffrey H. Silber, MD, PhD

This project explores “Tapered Multivariate Matching,” a new theory and conceptual framework for examining racial disparities and quality of care. The aims of the study are to apply the tapered multivariate matching framework to breast and colorectal cancer using the national Medicare-SEER database to identify specific aspects of patient care that lead to quality differences by race and to demonstrate how tapered multivariate matching results can be conveyed in a clear and understandable report to policy analysts and the public.

Race, Treatment and Endometrial Cancer Survival

Funded by:  National Cancer Institute
Principal Investigator:  Katrina Armstrong, MD, MSCE; CHOP Site Principal Investigator:  Jeffrey H. Silber, MD, PhD

Between 1992 and 1998, five-year survival for African-American women with endometrial cancer was 58.9 percent, compared to 85.8 percent for Caucasian women. Prior studies have identified several factors that contribute to this disparity, including later stage at diagnosis and higher tumor grade. However, significant differences in survival between African-American women persist even after adjusting for these factors.  This project explored the contribution of differences in treatment to the higher mortality among African-American women.