Professor Russell Kirby takes aim at health disparities with pair of published studies

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With an aim to help close health disparities, Dr. Russell Kirby, USF Distinguished Professor and Marrell Endowed Chair in Community and Family Health in the College of Public Health, co-authored two studies, both of which are published in the September issue of the American Journal of Public Health.

“They’re completely different projects,” Kirby said.

“The Association Between Race/Ethnicity and Major Birth Defects in the United States, 1999-2007” examined 27 major birth defects and their prevalence relative to numerous racial and ethnic groups and subgroups.

Russell Kirby, PhD, MS

Russell Kirby, PhD, MS

The study, which its authors say is the largest of its kind ever undertaken, collected data from 12 U.S. birth-defects surveillance systems to analyze about 13.5 million live births, representing approximately one in three live births in the United States over that time period.

The paper is about identifying and clarifying a problem in order to deal with it, Kirby said.

“It links up with the major public health interest in better understanding disparities,” he said, “and once we understand the disparities, then we can look for approaches that can reduce them. Nobody knows what to study until we demonstrate that there’s something to study.”

Accordingly, like the first paper, the second one, “Role of Health Insurance on the Survival of Infants With Congenital Heart Defects,” seeks mainly to serve the purpose of identification. It grew from a study that was funded by the National March of Dimes and again put the whys and wherefores of health disparities under a microscope.

“We identified babies with selected birth defects and then linked their birth-defect records with their hospitalization data from the Agency for Health Care Administration,” Kirby said. “So, potentially up to the age of 10, we had all the inpatient hospitalizations, ER visits and outpatient visits. This particular study, then, is looking at the pattern of hospitalizations and what kind of insurance coverage each child had.

“The big-picture question of why this study was done is that we’ve known for a long time that there are differences in survival with congenital heart defects by maternal race and ethnicity. We wondered, is it possibly something related to socio-economic factors?

“Of course, in administrative health data,” he explained, “it’s very hard to get direct measures of socio-economic factors, so we used the insurance status as a variable. It turns out we were able to reduce the disparity by controlling for insurance. The disparity was still there, but it was narrower.”

Kirby said it isn’t unheard of to publish two articles in the same issue of the same journal. In fact, he said, he’s done it before, but in a journal with a narrower, more specific focus, rather than in a journal with the broader, more general focus and readership of AJPH.

“It’s a bit unusual,” he admitted with a humble shrug, then quickly turned the discussion to the collaborative effort involved with both studies and numerous others in the works.

“We support the Florida Department of Health and its Florida Birth Defects Registry,” he said. “We have a number of grants and contracts with them for various activities, and we provide a lot of statistical analysis and database support and do a lot of special studies for them. So, this is only one of a number of papers that we have coming out that look at various issues with birth defects.

“I’d be remiss if I didn’t point out the National Birth Defects Prevention Network,” he continued. “Most of the members of the network are people who work in the various state birth-defects programs, and the primary activity we do is collecting data to establish the prevalence of various conditions.

“But we don’t call the network the National Birth Defects Surveillance Network, because we aren’t collecting this data just to collect data,” he said, ever mindful of the group’s mission. “We collect the data so we can use it to improve public health by reducing the prevalence of these conditions and improving the outcomes for the babies who have them. That’s why it’s called the National Birth Defects Prevention Network.”

Story by David Brothers, USF College of Public Health