Stanford
Prevention Policy Modeling Lab
Research Area

Health Disparities

Health Disparities

Click on a project title to learn more about PPML's work in Health Disparities.

Projects

Past Projects

Reducing Racial/Ethnic Disparities in Syphilis, TB, Hepatitis C and B in the United States

Despite advances in prevention and treatment, significant disparities exist in rates of sexually transmitted infections (STI), tuberculosis (TB), and viral hepatitis in the United States. Multiple causes, many rooted in social determinants of health, increase risks of exposure, reduce access to preventive services such as testing, and delay linkages to care and treatment for underserved populations. Disparities are expressed in worse health outcomes, and reduced prevention effectiveness also may result in higher care and treatment expenditures. This is a cross-cutting project evaluating and quantifying the potential health and economic impacts of addressing the strategies, goals, and indicators, as defined by the STI, Viral Hepatitis, and TB National Strategic Plans to reduce racial and ethnic disparities.

Associated Publication

Racial and Ethnic Disparities in TB Incidence and Outcomes

Although there has been a steady decline in TB incidence and mortality in the United States, disparities have remained constant or increased for some minority groups. Prior PPML work found that U.S.-born non-Hispanic Black, Hispanic, and American Indian/Alaska Native patients had a higher risk of mortality and failure to complete treatment, relative to non-Hispanic White patients. 

This analysis conceptualizes race/ethnicity as a social construct that affects exposure to downstream risk factors, such as socioeconomic status, access to health care, and structural and interpersonal racism. Adjusting for these risk factors in observational analyses could obscure mechanisms through which these racial/ethnic disparities exist. Analyses that reveal the impact of these mechanisms are needed to develop effective intervention strategies to reduce and eliminate observed disparities.

This project uses mediation analysis and quasi-experimental approaches to examine the extent to which downstream risk factors contribute to racial/ethnic disparities in TB incidence and adverse TB outcomes.

The Role of Prenatal Care in Congenital Syphilis Prevention in the United States

Early detection and treatment are core components of congenital syphilis (CS) prevention. The risk of adverse outcomes is lower if a pregnant person with syphilis receives adequate treatment during early pregnancy. Improving antenatal care access and quality has benefits that go vastly beyond the prevention of CS, including: 

  • Reducing disparities in a range of adverse outcomes for pregnant people by race/ethnicity
  • Strengthening healthcare systems 
  • Improving integration of antenatal care with broader reproductive healthcare 

This project models the status quo of antenatal care access and syphilis screening cascade, compared to increased antenatal care access, to understand how to reduce the burden and disparities in CS through improved quality and access to care for pregnant people.

Evaluating Social Determinants of Health-Focused Policy Changes on Health Outcomes and Disparities

Despite advances in prevention and treatment, substantial challenges exist in reducing the incidence, morbidity, mortality, and health inequities associated with HIV, viral hepatitis, sexually transmitted infections, and tuberculosis, as well as negative adolescent mental and physical health outcomes. Many policies and laws that address social determinants of health are expected to have broader effects, and analyses would benefit from including more generalized health outcomes, such as years of life, quality-adjusted life-years (QALY) saved or lost, and economic analyses.

This project aims to analyze the potential health, equity, and economic impact of Braidwood vs. Becerra ruling on preventative services through the Affordable Care Act (ACA). Following the ruling in March 2023, no-cost coverage may no longer be provided for preventative services with an “A” or “B” recommendation from the US Preventative Services Task Force (USPSTF) after March 2010.

To address the impact of this ruling, we evaluate preventative services that would no longer require coverage through the ACA without cost-sharing. This project models the QALYs lost and increased costs, per unit of service, following the potential reduction in no-cost coverage and subsequent decrease in preventative service utilization.

Evaluating the Health and Economic Impacts of Reducing Racial and Insurance Disparities in the Hepatitis B Care Cascade

Globally, HBV is most prevalent in Asia and Sub-Saharan Africa; in the United States, HBV disproportionately affects both native and immigrant Asian and Black populations. This project builds on previous PPML work to evaluate the HBV care cascade using insurance data, which showed that Asian patients and patients with commercial insurance were more likely to receive monitoring and treatment than other patients. This project evaluates the impact of reducing racial and insurance disparities in the HBV care cascade to inform policymakers on the impact of efforts to improve equity.

Modeling the Potential Impact of Interventions to Improve TB Outcomes Among Marginalized Racial/Ethnic Populations

Compared to Non-Hispanic White populations, minority racial-ethnic populations have elevated TB incidence. Mathematical modeling is used to evaluate the potential impact of strengthening TB services in geographic areas with high TB incidence rates and substantial populations of racial-ethnic minorities, with the goal of targeting services to areas with the greatest potential benefit and reducing racial-ethnic disparities in TB incidence.

This project assesses the potential impact of actions to provide expanded LTBI screening and treatment and strengthen prompt and high-quality TB treatment services in geographic areas with documented high TB incidence rates and a high fraction of racial-ethnic minority populations.

Past Project

Racial and Ethnic Disparities in the Burden of Gonorrhea

Gonorrhea infection has a low prevalence in the general population of the United States, but disproportionate effects are seen in subgroups of the population. Increased risk of gonorrhea infection has been found in African American and men who have sex with men (MSM) communities and is associated with low socioeconomic status.

This project explored the consequences of the unequal burden of gonorrhea in the United States. It utilized a Markov cohort model to translate estimated disparities in incidence and prevalence of gonorrhea into estimates of the cost and burden of disease by racial and ethnic groups, with the latter quantified in quality-adjusted life years lost. It also examined the potential health and economic consequences of different intervention strategies on racial and ethnic disparities.

Associated Publication