The National Institute on Aging Health Disparities Research Framework

Abstract

<p><strong>Objective</strong>: Development of a new framework for the National Institute on Aging (NIA) to assess progress and opportunities toward stimulating and supporting rigorous research to address health disparities.</p><p><strong>Design:</strong> Portfolio review of NIA’s health disparities research portfolio to evaluate NIA’s progress in addressing priority health<br />disparities areas.<br /><strong></strong></p><p><strong>Results:</strong> The NIA Health DisparitiesResearch Framework highlights important factors for health disparities research related to aging, provides an organizing structure for tracking progress, stimulates opportunities to better delineate causal pathways and broadens the scope for malleable targets for intervention, aiding in our efforts to address health disparities in the aging population.<br /><strong></strong></p><p><strong>Conclusions:</strong> The promise of health disparitiesresearch depends largely on scientific rigor that builds on past findings and aggressively pursues new approaches. The NIA Health Disparities Framework provides a landscape for stimulating interdisciplinary<br />approaches, evaluating research productivity and identifying opportunities for innovative health disparities research related to<br />aging. <em>Ethn Dis.</em> 2015;25(3):245-254.</p>

A Scoping Review of Health Disparities in Autism Spectrum Disorder

“…We defined health disparities within the National Institute on Aging health disparities research framework to include health and health system quality disparities related to race, ethnicity, culture, socioeconomic status, environment, geography, sex, or gender identity (Hill et al 2015). Because other reviews have identified health and health system quality disparities related to disability (i.e., between individuals with ASD and controls; Tregnago and Cheak-Zamora 2012; Cashin et al in press), we excluded studies which exclusively focused on disability-related health disparities from our review.…”

“…Health status and life expectancy vary across the population (Hill et al 2015), and emerging evidence suggests that people with autism spectrum disorder (ASD) experience heightened morbidity and early mortality compared to those without ASD (Croen et al 2015; Hirvikoski et al 2016; Cashin et al in press). Well-documented disparities in access to diagnostic and early intervention services for ASD (Ennis-Cole et al 2013; Magaña et al 2013; Mandell et al 2007) suggest that individuals with ASD who are otherwise disadvantaged by society—including those who experience disadvantage related to their race, ethnicity, culture, socioeconomic status, environment, geography, sex, or gender identity—may experience even greater disparities in health status and life expectancy.…”

“…We define health disparities in this paper as the “biological, behavioral, sociocultural, and environmental factors that influence population-level health differences” (Hill et al 2015). Although health disparities are present across the life span, Link and Phelan’s (1995) Fundamental Causes Model of contextual health disparities suggests that health disparities are particularly pertinent to understanding the emergence of adverse health outcomes because health disparities determine the extent to which individuals can potentially avoid risk.…”

“…Although health disparities are present across the life span, Link and Phelan’s (1995) Fundamental Causes Model of contextual health disparities suggests that health disparities are particularly pertinent to understanding the emergence of adverse health outcomes because health disparities determine the extent to which individuals can potentially avoid risk. Recently, Hill and colleagues (2015) developed a health disparities framework (Figure 1; Fundamental Causes Model) whereby fundamental factors that lead to disadvantage—including race, ethnicity, culture, socioeconomic status, environment, geography, sex, and gender identity—should be examined at the environmental, sociocultural, behavioral, and biological level in order to identify malleable targets for intervention to reduce disparities and improve outcomes. In the general population, disadvantage is tightly linked to disparities, including lower life expectancy, worse health outcomes, and poorer health care access (Link and Phelan 1995; Hill et al 2015).…”

“…Recently, Hill and colleagues (2015) developed a health disparities framework (Figure 1; Fundamental Causes Model) whereby fundamental factors that lead to disadvantage—including race, ethnicity, culture, socioeconomic status, environment, geography, sex, and gender identity—should be examined at the environmental, sociocultural, behavioral, and biological level in order to identify malleable targets for intervention to reduce disparities and improve outcomes. In the general population, disadvantage is tightly linked to disparities, including lower life expectancy, worse health outcomes, and poorer health care access (Link and Phelan 1995; Hill et al 2015). Important to the study of health disparities in ASD, health disparities related to disability status (i.e., ASD) may combine with other disadvantaging factors to influence health and health system quality—including high quality care delivery and adequate care access—through causal pathways at the environmental, sociocultural, behavioral, or biological level.…”