ArticleSocial science & medicine (1982)2019
Measuring racial segregation in health system networks using the dissimilarity index.
Article in Social science & medicine (1982), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
17 citing papers in PubMed, 25 citations in OpenAlex.
- Spatial Analysis of Flood Risk, Neighborhood Characteristics, and Chronic Health Conditions in North Carolina.GeoHealth · 2026Article
- Referrals and Black-White Coronary Heart Disease Treatment Disparities: A Qualitative Study of Primary Care Physician Perspectives.Journal of general internal medicine · 2025Article
- A Scoping Review of Multilevel Patient-Sharing Network Measures in Health Services Research.Medical care research and review : MCRR · 2025Article
- Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021.Health services research · 2025Article
- Relationship Between Health Care Team Segregation and Receipt of Care by a Cardiologist According to Patient Race in a Midwestern State.Journal of the American Heart Association · 2025Article
- Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases.ESC heart failure · 2025Article
- Relationship between body mass index and residential segregation in large cities of Latin America.BMC public health · 2024Article
- Naming racism as a root cause of inequities in palliative care research: a scoping review.BMC palliative care · 2024Article
- Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- The segregation of physician networks providing care to black and white patients with heart disease: Concepts, measures, and empirical evaluation.Social science & medicine (1982) · 2024Article
- Association of geographical disparities and segregation in regional treatment facilities for Black patients with aneurysmal subarachnoid hemorrhage in the United States.Frontiers in public health · 2024Article
- Within-Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease.Journal of the American Heart Association · 2023Article
- Your neighborhood matters: an ecological social determinant study of the relationship between residential racial segregation and the risk of firearm fatalities.Injury epidemiology · 2023Article
- A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead.Journal of pain and symptom management · 2022Review
- Racial/Ethnic Segregation and Access to COVID-19 Testing: Spatial Distribution of COVID-19 Testing Sites in the Four Largest Highly Segregated Cities in the United States.American journal of public health · 2022Article
- A measure of local uniqueness to identify linchpins in a social network with node attributes.Applied network science · 2021Article
- Health Services Researchers' Use of the Dartmouth Atlas of Health Care: A Literature Review and Network Analysis 1996-2023.Inquiry : a journal of medical care organization, provision and financingReview
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
Racial disparities in the end-of-life treatment of patients are a well observed fact of the U.S. healthcare system. Less is known about how the physicians treating patients at the end-of-life influence the care received. Social networks have been widely used to study interactions with the healthcare system using physician patient-sharing networks. In this paper, we propose an extension of the dissimilarity index (DI), classically used to study geographic racial segregation, to study differences in patient care patterns in the healthcare system. Using the proposed measure, we quantify the unevenness of referrals (sharing) by physicians in a given region by their patients' race and how this relates to the treatments they receive at the end-of-life in a cohort of Medicare fee-for-service patients with Alzheimer's disease and related dementias. We apply the measure nationwide to physician patient-sharing networks, and in a sub-study comparing four regions with similar racial distribution, Washington, DC, Greenville, NC, Columbus, GA, and Meridian, MS. We show that among regions with similar racial distribution, a large dissimilarity index in a region (Washington, DC DI = 0.86 vs. Meridian, MS DI = 0.55), which corresponds to more distinct referral networks for black and white patients by the same physician, is correlated with black patients with Alzheimer's disease and related dementias receiving more aggressive care at the end-of-life (including ICU and ventilator use), and less aggressive quality care (early hospice care).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.