Centering Racial and Ethnic Equity in Health Care Throughout Spatial Data Analysis

Abstract

BackgroundThe ongoing COVID-19 pandemic as well as a host of social movements have put a nation-sized spotlight on structural inequality and racial disparities in health throughout America. As health care systems begin to advance health equity by holding plans and payers accounting for racial and socioeconomic disparities in care, quantitative methods are needed that emphasize the distinct linkages between physical locations and racially disparate outcomes.MethodsWe apply a counterfactual model to compare differences in avoidable and potentially avoidable emergency department (ED) admissions among a panel of 8,924 non-Hispanic White, Black, and Hispanic Medicaid participants between 2016 - 2018. The magnitude of disparity estimates is examined in relation to geographic proximity to health care providers, neighborhood socioeconomic contexts, as well as the type of primary care delivery model individuals received. The adjusted rates were assessed by generalized estimating equations (GEE) and average marginal effects models to contrast differences in probability of events in association with race/ethnicity, proximity to care, and treatment through patient-centered medical homes (PCMH). ResultsAttending a patient-centered medical home was associated with a 3.4 percentage point (p <0.001) decrease in Black-White racial disparity and a 1.8 percentage point (p < 0.10) reduction in the overall Black-White disparity for potentially avoidable ED admissions. PCMH attendance was attributed to a 2.6 percentage point (p < 0.10) reduction in Hispanic-White disparities in potentially avoidable admissions, but this difference was not substantial enough to curb the overall Hispanic-White racial disparity in ED admissions. No statistically significant reductions in Black-White or Hispanic-White disparities in avoidable ED admissions were observed. ConclusionMedical homes may be able to curb, but not necessarily eliminate, racial disparities in ED admissions. Counterfactual models of health disparities are in line with recent transitions toward evaluating patient- and value-centered health care reform changes as they are designed to measure health and racial equity. This strategy, or variations of it, are adaptable to other investigations where emphasis on physical locations is considered essential to understanding racial disparities in health outcomes.