RAND-University of Pittsburgh Health Institute

Health Disparities

These disparities pilot grants were designed to provide funding for pilot health services research studies that focus on any aspect of health or health care disparities. In 1999, NIH defined health disparities as follows:

Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.

Many different populations are affected by disparities including racial and ethnic minorities, residents of rural areas, women, children, the elderly, and persons with disabilities. All of these populations were eligible foci for pilot grant projects. In 2000, Public Law 106-525, also known as the Minority Health and Health Disparities Research and Education Act, was enacted which defined health disparity populations in this way:

A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.

We invited research projects that address any aspect of health and health care disparities.

Funding Period

July 15, 2009 - July 15, 2010


University of Pittsburgh Investigator RAND Investigator Title of Project
Annamore Matambanadzo, PhD Kerry Reynolds, PhD Implementing Healthy Eating Strategies: Bringing Knowledge to the Table
Yuting Zhang, PhD William Vogt, PhD Racial and Ethnic Disparities in Responses to the Medicare Part D Coverage Gap among Patients with Cardiac Diseases


Racial and Ethnic Disparities in Responses to the Medicare Part D Coverage Gap among Patients with Cardiac Diseases

A controversial aspect of the Part D benefit design is the coverage gap (“doughnut hole”), which imposes 100% copayments on most drugs for drug spending between $2,400 and $5,451 (2007 figures). Our recent study found, on average, one in four seniors reached the doughnut hole in 2006, and they reduced medication use by 14% per month after entering the doughnut hole. Previous studies show that discontinuation of cardiovascular medication due to lack of drug coverage leads to higher rates of ospitalizations and mortality. Currently no studies examine racial disparities in responses to the Medicare’s coverage gap. We will focus on cardiac patients because cardiovascular medication use is essential to prevent hospitalization, yet cost‐related non‐adherence is a prevailing problem, more severe among minority than white beneficiaries.

We will obtain merged pharmacy and medical claims data for a 5% random sample of 17.6 million Medicare beneficiaries enrolled in fee‐for‐service medical and stand‐alone Part D plans. We will determine racial/ethnic disparities in changes in cardiovascular medication use and subsequent clinical outcomes (mortality, medical care spending and cardiac hospitalization) due to the coverage gap. Should we find different patterns in responses to the coverage gap across racial/ethnic groups, we can recommend policymakers to make alternative resources available to the most severely affected groups. Our findings would also help clinicians anticipate the effects of the coverage gap and initiate cheaper alternative medication if available.

Implementing Healthy Eating Strategies: Bringing Knowledge to the Table

An epidemic of obesity is affecting the population of the United States. Children and adolescents are increasingly likely to experience this serious health issue, placing them at risk for a variety of chronic illnesses including cardiovascular disease and type 2 diabetes. African American children and adolescents, in particular, are at elevated risk for obesity. Previous work indicates that intervening on parents can be an effective method for reducing overweight and obesity among children and adolescents. However, among low-income African American families, it will be necessary to ensure that the intervention is culturally appropriate to fully engage participants. In the proposed study, the research team will determine the feasibility and acceptability of a diet intervention designed to help parents put knowledge into practice in a series of practical, hands-on activities. Intervention sessions will focus on a variety of practical tasks including cooking techniques, food selection, and recipe modification. This pilot implementation will determine the feasibility and acceptability of this program, identify sessions that work especially well and those that require improvement, provide insight into any difficulties with recruitment and retention, and help to identify additional efforts that will be necessary to scale up to a full randomized controlled trial.