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Institute of Medicine Definition of Racial Disparities

Posted on December 5, 2011

Benjamin Cook discusses the definition of racial disparity put forward by the Institute of Medicine.

 

So that is where the Institute of Medicine came in, and they said we need to be more rigorous about how we define a disparity. And so they had a panel of experts come around, and they discussed, and there's quite some controversy even within that IOM panel. And in "Unequal Treatment" -- the 2002 publication that IOM put out -- they came out with the definition that said a disparity is all differences, except those due to clinical appropriateness and need and patient preferences.

So for that... that's sort of a different statement than either the unadjusted that the HRQ [Health Care, Research, and Quality] is using for their disparities reports and a different statement from what we typically do, which is run a regression and put everything on the right-hand side. That's something in between.

That's saying we want to make whites and African Americans and Latinos look the same on clinical appropriateness and need and preferences but not other things. And that's quite a bold statement in some ways. It's saying that we're now going to consider a disparity, a racial and ethnic disparity, as something that relates to income.

And so I think there's a lot of people who would agree that race and socioeconomic status are very intertwined. Well, the full adjustment models, those regression models, they really, they sort of exclude that. They say we just want that isolated race experience. But the IOM definition says if there are differences due to income, and African Americans or Latinos or Asians are more likely to be in those lower income groups, then that's going to contribute somehow to the disparity. That's going to contribute to the disparity estimation.

So that sort of middle ground where you're not adjusting for socioeconomic status, but you are adjusting for clinical appropriateness and need and patient preferences is sort of the new thing about the Institute of Medicine definition.

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Excerpted from an interview with the researcher conducted at the 2011 NHSN Conference held in Miami, FL.

Institute of Medicine. (2002, March). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

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