Examining Health Disparities: Dahai Yue's Research at the University of Maryland
Introduction
Health disparities, particularly those related to socioeconomic status and race, represent a persistent challenge in the United States. Significant gaps exist in life expectancy, with wealthy individuals living longer than their less affluent counterparts, and racial minorities often facing shorter lifespans than White individuals. Dahai Yue, a health policy and management professor and director of the School of Public Health’s Center on Aging at the University of Maryland, is leading research to understand the root causes of these disparities and identify potential solutions.
Unveiling the Childhood Origins of Health Disparities
With support from a $3.5 million grant, Yue and his research team are embarking on an extensive study focusing on the impact of childhood experiences and environments on mortality disparities. The team will gather, link, and analyze health and mortality data from publicly available censuses from 1890 to 1940, the National Death Index, and family tree information from the Family Search database. This involves examining the life and death records of approximately 20 million people, including a large and representative sample of Black people and White people, to explore how specific childhood experiences correlate with longevity.
A central aim of this research is to establish the causal relationship between childhood origins of health and health disparities. Researchers will measure two key factors - quality of education and the infectious disease environment in childhood - against the age and cause of death of each person. This approach seeks to determine how these early-life factors contribute to the observed differences in health outcomes later in life.
The Significance of Education and Environment
The study places particular emphasis on the quality of education and the infectious disease environment during childhood. These factors are hypothesized to have lasting effects on an individual's health trajectory. Access to quality education can influence socioeconomic opportunities, health behaviors, and overall well-being, while exposure to infectious diseases in childhood can have long-term impacts on the immune system and chronic disease risk.
By analyzing historical data, the researchers aim to quantify the extent to which these childhood factors contribute to disparities in mortality. This involves linking educational attainment and exposure to infectious diseases with subsequent health outcomes, such as chronic diseases and mortality rates. The findings from this analysis could provide valuable insights into the mechanisms through which early-life experiences shape health disparities.
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Bariatric Surgery Outcomes and Neighborhood Socioeconomic Status
Yue's research extends to examining the impact of socioeconomic factors on healthcare access and outcomes. One study focused on bariatric surgery, a highly effective treatment for severe obesity, where socioeconomic disparities in access and outcomes persist. The study examined whether neighborhood socioeconomic status (nSES), measured by the Distressed Communities Index (DCI), is independently associated with prolonged hospital stays and higher readmission rates after bariatric surgery. It also evaluated the interaction between race/ethnicity and nSES, to assess disparities in post-surgical outcomes.
The retrospective cohort study used Maryland State Inpatient Databases (SID) from 2018 to 2020, including 10,784 adult patients who underwent bariatric surgery. The primary explanatory variable was nSES, operationalized using DCI quintiles, linked to patient ZIP codes. The primary outcomes were hospital length of stay and readmission rates.
The study found that while length of stay did not differ significantly by DCI Quintiles, readmission risk was higher in distressed neighborhoods, though not statistically significant. No interaction was observed between nSES and race/ethnicity. These findings suggest the need to enhance post-discharge care for socioeconomically vulnerable populations undergoing bariatric surgery.
Homelessness and Healthcare Utilization
Another area of Yue's research focuses on the healthcare utilization patterns of individuals experiencing homelessness. A study examined the differential associations of homelessness with emergency department visits and hospitalizations by race, ethnicity, and gender. The study used a sample of Medicaid beneficiaries in California in 2017 and 2018, identifying beneficiaries experiencing homelessness (BEH) and those who did not (NBEH).
The study found that homelessness was significantly associated with more ED visits, a higher likelihood of frequent ED visits, and more ED visits due to mental health conditions and substance use disorders. Experiencing homelessness was also significantly associated with more hospitalizations, a higher likelihood of frequent hospitalizations, and a longer length of stay. Furthermore, the study identified distinct utilization patterns by race, ethnicity, and gender, highlighting the complex interplay of factors contributing to healthcare disparities among the homeless population.
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The Role of Enabling Services
Yue's research also explores the impact of enabling services on healthcare access and outcomes. Enabling services, such as case management, transportation assistance, and language interpretation, are designed to help individuals overcome barriers to accessing healthcare. A study examined the effects of enabling services on access to care, preventive services, and satisfaction among health center patients.
The study found that enabling services improved access to care, increased the use of preventive services, and enhanced patient satisfaction. These findings underscore the importance of providing comprehensive support services to address the social determinants of health and improve health equity.
Medicaid Expansion and Racial/Ethnic Disparities
The effects of Medicaid expansion on healthcare access across different racial and ethnic groups have also been examined in Yue's body of work. A study investigated the racial/ethnic differential effects of Medicaid expansion on health care access. The study found that Medicaid expansion had varying impacts on healthcare access for different racial and ethnic groups, highlighting the need for targeted interventions to address persistent disparities.
Increased Schooling and Reduced Hospitalization
Yue's research has also explored the long-term health benefits of education. One study examined the relationship between increased schooling and reduced hospitalization later in life. Using data from the United States, the study found that individuals with higher levels of education were less likely to be hospitalized in later life. This finding suggests that investments in education can have significant long-term health benefits.
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