I apologize for the late post!
Part 1:
1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., Matthias, R. (2008). Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale. Social Science & Medicine; paper is attached
2. What was the definition of the construct?
The construct is the impact of SES inequalities on adolescent health, and that this is very challenge to measure and study because it is difficult to define adolescent SES independent of parent/guardian SES.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
As this was developed a long time ago, there are several studies published discussing how the questionnaire has been used in various populations, and how results of the questionnaire have correlated with different health outcomes for adolescents.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
Because this questionnaire was developed several years ago, there have been studies using the questionnaire to demonstrate reliability. More than one study has been conducted to answer the same question – such as use of the questionnaire to measure adolescent SES and how this correlates with adolescents self-reported health, consumption of soft drinks and high-sugar foods, frequency of tooth brushing, etc. The relationship of the questionnaire responses (and indirect measure of SES) with these outcomes were consistent across studies.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
As this tool is being used internationally across cultures, if external validity had not been carefully evaluated, this could have resulted in improper assumptions or conclusions about SES. For future research applications, if the questionnaire had been described as appropriate for all populations of children/adolescents and was then used in a new group and SES was improperly measured with the questionnaire, this may either create a false relationship between SES and the outcome of interest, or fail to detect an important relationship between SES and an adolescent health outcome.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Gutin, L., Yao, F., Dodge, JL., Grab, J., Mehta, N. (2019). Comparison of Liver Transplant Wait-List Outcomes Among Patients With Hepatocellular Carcinoma With Public vs Private Medical Insurance. JAMA Network Open; paper is attached
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
The construct is SES inequalities, as measured by type of insurance – private (ie Kaiser) vs public health insurance, have an effect on liver transplant waitlist outcomes – transplant, mortality, waitlist drop out. The outcome is that of the patients listed for liver transplant with hepatocellular carcinoma (liver cancer).
3. What is the evidence for the validity and reliability of the measures?
None
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
There is evidence showing that measurements of SES have a relationship with liver transplant outcomes for patients – geographic location and distance to transplant center, education level, employment and income, etc. – and for this paper, they are specifically looking at how type of insurance impacts transplant list outcomes. The comparison group is patients with private insurance, particularly Kaiser, as UCSF (study location) has a close relationship with Kaiser. The transition from Kaiser facilities to UCSF transplant listing is well-established. When patients are referred to UCSF transplant clinic from Kaiser (and as they continue to follow with both UCSF and Kaiser), they have nearly always had every recommended study completed, documentation is clear, and the Kaiser EHR is available through Epic. When patients are sent from (and followed by) other clinics/healthcare systems, independent of their type of insurance, their pre-transplant work up is often incomplete, documentation is sparse, records have to be requested and faxed over. I think private vs public insurance theoretically makes sense as a comparison when interested in the effect of SES, but I also think that in this particular setting, there may be more contributing to the differences in outcomes specifically because of the clinical relationship between Kaiser GI/hepatology and UCSF transplant.
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
The disparities are reported in hazard ratios. Kaiser insurance is used as a reference, and the hazard ratio for public insurance is statistically significant, 1.93. Other private insurance is also included as a variable, and the hazard ratio when using Kaiser as a reference is 1.42, but the p-value is 0.07. They present univariable analysis, and then multivariable analysis, which includes insurance type (Kaiser vs private, Kaiser vs public), AFP level (tumor biomarker), and MELD score.
Part 3:
1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.
Commented on Jerrine Morris’ post