262600 Considerations of survey design and co-morbidity when analyzing health utilization surveys for disparities: An example of racial disparities in treating fibroid tumors

Sunday, October 28, 2012

Justin Dickerson, MBA , Department of Health Policy & Management, Texas A&M Health Science Center, School of Rural Public Health, College Station, TX
Matthew Lee Smith, PhD, MPH, CHES , Department of Health Promotion and Behavior, The University of Georgia, College of Public Health, Athens, GA
Jane N. Bolin, PhD, JD, RN , Health Policy & Management, Texas A&M HSC School of Rural Public Health, College Station, TX
Objectives – To examine whether survey design (i.e., weighted or un-weighted data) and co-morbidity variables are important aspects to consider when analyzing health utilization surveys for instances of disparities, specifically with regard to racial disparities in treating fibroid tumors in women.

Methods – Patients with fibroid tumor(s) were selected from the 2008 National Hospital Discharge Survey (n = 483). Logistic regression was used to estimate odds ratios to describe relationships between socio-economic variables and whether a hysterectomy procedure was performed. Model estimates were adjusted based on the introduction of survey weights and co-morbidity variables.

Results – Using un-weighted survey data, being African-American was associated with lower likelihood of hysterectomy (OR = 0.55 – 0.57, 95% CI = 0.32 – 0.96, p = 0.018 – 0.034). Using un-weighted data and adjusting for co-morbidities, being African-American was associated with lower likelihood of hysterectomy (OR = 0.55 – 0.57, 95% 95% CI = 0.33 – 0.94, p = 0.023 – 0.029). When using survey weights, no association was found between being African-American and having a hysterectomy.

Conclusion – Findings of racial differences in treatment of fibroid tumors are sensitive to survey design and co-morbidity adjustments. This suggests careful consideration is needed on behalf of disparity researchers to select statistical weighting and associated implications for finding interpretation.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health or related research

Learning Objectives:
Describe the potential problems in using health utilization surveys to study health disparities, including racial disparities in women's health issues. Learners will be able to identify appropriate strategies for health survey utilization analysis during the planning stages of their research.

Keywords: Women's Health, Methodology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the research for this study as principal investigator. I have also published several peer-reviewed journal articles on methodological topics in the area of health promotion, and presented such research at national meetings such as APHA.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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