Socioeconomic Diversity in Integrated Healthcare Delivery Systems

Background

Persons of lower socioeconomic status (SES) are at higher risk for death from a wide variety of causes including cancer and pneumonia. However, there is currently conflicting evidence on SES health disparities due in part to a paucity of SES in the United States. Area-based SES measures (ABSM) can be obtained by linking subject addresses to the SES structure for specified areas as defined by the US Census Bureau. ABSMs are a relatively inexpensive way to obtain SES information. The Cancer Research Network (CRN) has the capability to further link ABSMs to claims data on large numbers of patients over lengthy periods of follow-up for intervention studies aimed at eliminating health disparities.

##Objective

A major goal of this proposed project is to demonstrate the functionality of the virtual data warehouse (VDW) for studies using ABSMs and determine which ABSM indicators provide consistent differences in health care utilization in the CRN.

##Specific Aims

The specific aims for this project are to determine among enrollees of 3 CRN sites:

1. The distribution of area-level SES characteristics

2. Differences in cancer screening rates by area-level SES

3. Differences in pneumococcal vaccination rates by area-level SES.

##Methods

We will use the CRN VDW to establish a large cohort of men and women aged 50 years or older, enrolled in one of 3 CRN sites between 2000 and 2001. This project will use diagnoses and procedure codes in the VDW utilization data to track participants over a 7-year period (2000-2006). Within this cohort, we will assess the distribution of various ABSM indicators based on the 2000 census SES structure and determine differences in rates of cancer screening and pneumococcal vaccination by SES. We will determine which ABSM indicators provide consistent differences in health care utilization.

##Significance

Reducing death from cancer is a key US public health objective towards the goal of eliminating health disparities by 2010. This project will determine the potential of using SES information derived from the Census Bureau linked to patient addresses to identify and target vulnerable population for enhanced delivery of services.

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