Public health students examine racial disparities in health care

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Doctoral students Dr. Arturo Rebollón and Shawna Green of the USF College of Public Health have contributed to research examining differences in stroke hospitalization charges by race, age and income prior to the implementation of the Patient Protection and Affordable Care Act (ACA).

Their findings, “Comoribity-Adjusted Stroke Hospitalization Charge Disparities: Baseline Estimates for Comparative Assessments of Health Policy Provisions,” is published in the Annals of Public Health and Research.

Using the 2008 Healthcare Cost and Utilization Project (HCUP), they found black patients with cerebral infarction—commonly known as strokes—and cerebrovascular disease, had higher rates of comorbid diabetes, hypertension, hospital charges and overall length of hospital stays compared to white patients.


“This paper highlights racial disparities, specifically, and also the socioeconomic challenges that contribute to and exacerbate so much of the chronic disease burden we spend our time researching in public health,” said doctoral student Shawna Green, who helped write overall results and edit the paper with the team. She is working toward earning her degree from the Department of Community and Family Health.

Rebollón, a doctoral student in the Department of Global Health based in Panama, collaborated with hypothesis testing and data analysis of the study.

He said working on this project allowed him to apply class-acquired knowledge to the research, an experience he encourages other students to get involved with during their training as students.

“We live in a complex time for the health system,” Rebollón said. “There are intentions to replace the Affordable Care Act, but it’s difficult to understand the real implications, especially to high-risk and underserved populations. This study provides a baseline evaluation to compare the efficacy of ACA interventions. We are all aware that ACA is not perfect, there is plenty of room to improve and this study provides necessary evidence.”

Rebollón said they stratified data by age groups, race and socioeconomic status, finding that older, poor African American patients had the worst health outcomes and spent more money on health care when compared to white patients.

These increased costs reduce access to health services, thus worsening overall health status, Rebollón said.

According to Green, the findings also indicate an area that needs more attention.

“Any time disparities are discovered, the results have the potential to greatly impact public health,” she said. “Lower income minority populations are less likely to access quality health care and, in the long run, this is making people sicker and suffer more than their white peers. This is unacceptable, and as we suggested, programs that fund health care, for these groups especially, should make prevention of chronic disease a priority.”

Former assistant professor in the Department of Health Policy and Management at COPH, Dr. Dawood Sultan, served as first author of the research. Sultan is currently serving as an associate professor of sociology at Hampton University in Hampton, Va. Alumna Deanna Ryder of the Department of Health Policy and Management also contributed to the research.

The researchers of the paper conclude that prevention programs and better management of diabetes and hypertension may reduce hospitalization charges among older African Americans and decrease current disparities.

“Evidence shows that ‘one-size fits all’ interventions do not work,” Rebollón said. “We must use evidence-based interventions, social marketing and community involvement on large scale to start preventing disease. It will be expensive at first, but will save us billions of dollars in the long run.


Dawood HS, Arthur RW, Meg MC, Ryder D, Shawna MG, et al. (2017) Comorbidity-Adjusted Stroke Hospitalization Charge Disparities: Baseline Estimates for Comparative Assessments of Health Policy Provisions. Ann Public Health Res 4(1): 1053.


Story by Anna Mayor, USF College of Public Health