For the purposes of the paper, disease-specific disparities are defined as disparities affecting individuals with a specific combination of chronic conditions. For example, using CMS administrative data Shaya and colleagues (2009) found that African American patients with both COPD and asthma had fewer outpatient visits, hospitalizations and used fewer medical services overall compared to white patients with the same disease combination. Likewise, a study of patients with chronic kidney disease and hypertension found that African American men had poorly controlled hypertension compared to African American women and white patients (Duru et al. 2009). A potential gender disparity was also noted by Kramer and colleagues after investigating patients with type II diabetes and coronary heart disease; men were found to be more thoroughly treated compared to women (Kramer et al. 2012).
Research that is conducted to investigate disparities in patients with specific chronic disease combinations is plentiful. Numerous studies have looked at patients with co-morbid conditions and have evaluated whether differences exist across different patient groups as in the Shaya study described above. Typically, however, one type of disparity (i.e. gender or race/ethnicity) is studied in a two-condition combination for one type of measure (i.e. utilization, cost, prevalence). Researchers have not “dissected” particular disease combinations to explore all the potential disparities that may exist. As a result, it is challenging to identify overall patterns across the individual studies. Reviewing the literature on the myriad studies of unique combinations of MCC was beyond the scope of the project.