Health Disparities

Summary

Documenting the extent and understanding the causes of disparities in accessing and receiving cancer-related health services is a major cross-cutting theme of research supported by the Health Services and Economics Branch (HSEB). We study health disparities by race/ethnicity and the socioeconomic status of individuals and by the socioeconomic characteristics of the community environment.

Studies and Initiatives

• The monograph, "Methods for Measuring Cancer Disparities: A Review Using Data Relevant to Healthy People 2010 Cancer-Related Objectives", was written under contract by the Applied Research Program and provides an empirical analysis of methods appropriate for the measurement of cancer disparities. This report raises some conceptual issues and reviews different methodological approaches germane to measuring progress toward the goal of eliminating cancer-related health disparities, and to assist in monitoring progress toward the Healthy People 2010 cancer objectives.
• HSEB completed a systematic review of the research literature on health disparities in cancer treatment by race/ethnicity.
  Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 2002 Mar 6;94(5):334-57. Review. [View Abstract]
• The NCI-sponsored Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) project, a prospective study of 10,000 patients with newly diagnosed lung or colorectal cancers, is designed to examine disparities in the receipt of state-of-the-science cancer care and factors that contribute to disparities in outcomes, and to identify ways to lessen those disparities.
• The Applied Research Program is using the 2003 California Health Interview Survey (CHIS) to develop a means for assessing the cross-cultural equivalence of survey questions. This project uses a questionnaire evaluation technique called behavior coding, which involves assigning codes to survey questions that appear to present difficulties to either the interviewer (e.g., misreading the item) or the respondent (e.g., asking for clarification or providing uncertain answers). The project will extend the use of this technique to the multi-cultural domain by behavior coding CHIS interviews across three language groups (English, Spanish, and either Chinese or Korean). Investigators will determine which survey questions appear to present problems in particular languages, indicating where the translated version should be reviewed and modified. The project will provide valuable information concerning the means by which this practice should be carried out in other surveys that include multiple languages.

Tools and Data Sources

The California Health Interview Survey Cancer Control Module, co-sponsored by NCI, is designed to allow the collection of detailed information on the use of cancer screening services by racial/ethnic groups not well covered by other surveys, including Hispanics, Asians, Pacific-Islanders, and African-Americans.

Workshops

In September 2008, a workshop entitled Methodological and Conceptual Issues in Conducting Research on Racial/Ethnic Discrimination in Healthcare Delivery, sponsored by several institutes of the National Institutes of Health, was held in Bethesda, MD.

Funding Opportunities

Several Funding Opportunities support research in this area. For example, studies supported by the Cancer Surveillance Using Health Claims-Based Data System program announcement include studies of disparities in the receipt in cancer care based on demographic and socio-economic characteristics.

The Program Announcement The Effect of Racial and Ethnic Discrimination/Bias on Health Care Delivery (PA-07-206 (R01), PA 06-306 (R21), and PA 06-348 (R03)), supports research to:

1. improve the measurement of racial/ethnic discrimination in health care delivery systems through improved instrumentation, data collection, and statistical/analytical techniques;
2. enhance understanding of the influence of racial/ethnic discrimination in health care delivery and its association with disparities in disease incidence, treatment, and outcomes among disadvantaged racial/ethnic minority groups; and
3. reduce the prevalence of racial/ethnic health disparities through the development of interventions to reduce the influence of racial/ethnic discrimination in health care delivery systems in the United States.

Related Publications

Publications: Health Disparities includes articles on studies that have examined cancer-related health disparities by race/ethnicity and socioeconomic status.