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).
Fox ER et al. Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults: The Jackson Heart Study Cohort. JAMA Cardiology, 2016; 1(1): 15-25.
PMID: 27437649. PMCID: PMC5115626. DOI: 10.1001/jamacardio.2015.0300
2.What was the definition of the construct?
The authors validated the Framingham Risk Score (FHS) and the American College of Cardiology/American Heart Association (ACC/AHA) CVD risk algorithm in black adults. They created 6 models that included cardiovascular risk factors, biochemical measures, and the ankle brachial index. The goal was to see if by adding these additional data points, if they could achieve better ability to classify cardiovascular risk for black patients than the FHS and ACC/AHA models were able to do.
3.How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The authors used external validation of the model. They validated their models using two separate study groups that consisted of black adults. They then applied the model to their study group, the JHS patient population. I think their method of external validation is the appropriate way to validate their measure and I would have recommended the same approach. The authors report that the validation for the prediction model was based on guidelines from the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) Statement.
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?
The authors generated 6 models using cardiovascular risk factors, biochemical measures, and ankle brachial index measurements. They then compared each of these models to the FHS and ACC/AHA models. They found that their model 6 was no different from the FHS and the ACC/AHA.
5.Describe the implications of a lack of measurement validity or reliability for future research applications.
The authors performed this study because of a gap in the literature where it was unclear if the current measures of cardiovascular risk (the FHS and the ACC/AHA models) were applicable to black patients. If they had not performed this study, it would still be unknown if those models were appropriate for use in black patients. Because of the high risk of cardiovascular disease in black patients, this is a critically important question to address. By using a non-validated model, all data gathered cannot be interpreted properly.
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)
Mullen MT et al. Disparities in Accessibility of Certified Primary Stroke Centers. Stroke, 2014: 45(11): 3381-3388.
***THIS ARTICLE IS TOO LARGE TO BE UPLOADED***
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 authors investigated population level access (< or = 60 minutes from a primary stroke center) to primary stroke centers. They report using “validated models of prehospital time” including the Network Analyst Function in SDRI ArcMap 10.1 to calculate the road distance.
The dimensions of inequalities measured were race, ethnicity, sex, census region, and geographic location. Outcomes measured are access to a primary stroke center in less than or equal to 60 minutes.
3.What is the evidence for the validity and reliability of the measures?
The authors state that the measures (including road distance, time spent on scene by EMS, etc) have been validated previously, but details are not addressed in the current publication.
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?
This is a cross-sectional population level study. The reference categories vary based on the research question. For race: white v. non-white. For ethnicity: Hispanic vs. non-Hispanic. For gender: male v. female. For census region: the South v. Midwest v. Northeast v. West. There is not a single reference category for this study because the authors are investigating multiple questions of the cross-sectional data. In this case, I understand why the authors set up the study in this way however, it does not establish a clear control and study group.
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 disparity is measured based on proportion of the population with access to primary stroke centers. The authors report percent of each group (based on the breakdown described in #4 above) with access to these centers. This is an absolute measure and only that is provided. I would like to see both absolute and relative measures given.