James P. Scanlan, Attorney at Law

Journal Comments

The numbering of the items below is that according to which they are maintained on the Measuring Health Disparities page of jpscanlan.com. 

A number of the items listed below were initially published online on the websites of The Lancet or Journal Review. Several years ago the Lancet ceased to maintain online response and more recently Journal Review closed its site entirely. The comments from that had been posted on those sites have been, or will be, posted on this site.

142.   The monitoring of health inequalities has never been sound.  BMJ Nov. 9, 2012 (responding to Marmot M. Goldblatt P.  Importance of monitoring health inequalities. BMJ 2013;347:f6576): http://www.bmj.com/content/347/bmj.f6576/rr/671152

141.  General reductions in adverse health outcomes tend to increase rather than reduce relative differences in rates of experiencing those outcomes.  Health Affairs Oct. 28, 2013 (responding to  Qasim M, Andrews RM.  Despite Overall Improvement In Surgical Outcomes Since 2000, Income-Related Disparities Persist.  Health Affairs.  2013;32(10):1773-1780): http://content.healthaffairs.org/content/32/10/1773/reply#healthaff_el_476813

140. There are important differences between disparities in survival and disparities in mortality.  BMC Cancer Oct. 16, 2013 (responding to Yu XQ. Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer 2009, 9:364: doi:10.1186/1471-2407-9-364): http://www.biomedcentral.com/1471-2407/9/364/comments#1563696

139. Need for researchers to acknowledge alternative methods.  Health Affairs.  Apr. 1, 2013 (responding to Trivedi AN, Grebla RC, Wright SM, Washington DL.  Despite improved quality of care in the veterans affairs health system, racial disparity persists for important clinical outcomes.  Health Affairs, 30, No. 4 (2011):707-715): http://content.healthaffairs.org/content/30/4/707.full/reply#healthaff_el_476354

138. Efforts to quantify the magnitude of inequalities must consider more carefully the implications of the patterns by which measures tend to be affected by the prevalence of an outcome. BMC Public Health March 10, 2013 (responding to Scholes S., Bajekal M, Hande L, et al.  Persistent socioeconomic  inequalities in cardiovascular risk factors in England over 1994-20000.  A time-trend analysis of repeated cross-sectional data.  BMC Public Health 2012, 12:129 doi:10.1186/1471-2458-12-129): http://www.biomedcentral.com/1471-2458/12/129/comments#1358696

137.  Goodbye to the rate ratio.  BMJ Feb. 25, 2013 (responding to Hingorani AD, van der Windt DA, Riley RD, et al.  Prognosis research strategy (PROGRESS) 4: Stratified medicine research. BMJ2013;346:e5793): http://www.BMJ.com/content/346/BMJ.e5793/rr/632884

136.  Researchers must address whether other methods yield different conclusions. Health Aff (Millwood) Feb. 5, 2013 (responding to Sommers BD, Buchmueller T, Decker SL, et al.  The Affordable Care Acts has led to significant gains in health insurance and access to care for young adults.  2011;32(1):920-930): http://content.healthaffairs.org/content/32/1/165.abstract?sid=7a17deef-f029-4dc6-895f-2b4f41398fc0#responses

135.   The need for new thinking about how to measure disparities.  BMJ Feb. 4, 2013 (responding to Epstein K.  Persistent health disparities in the US signal for new thinking.  BMJ 2012;345:e6204 doi: 10.1136/BMJ.e620): http://www.BMJ.com/content/345/BMJ.e6204/rr/628910

134.  How Measures are Affected by the Prevalence of an Outcome (responding to Clemans-Cope L, Kenney GM, Buettgens M, et al.  The Affordable Care Acts coverage expansions will reduce differences in insurance rates by race and ethnicity.  Health Aff (Millwood) 2012;31(5):920-930): http://content.healthaffairs.org/content/31/5/920.abstract/reply#healthaff_el_476249

133.  Discussions of relative and absolute differences cannot ignore that there are two relative differences.  BMJ Nov. 8, 2012 (responding to King NB, Harper S, Young ME.  Use of relative and absolute effect measure in reporting health inequalities: structured review. BMJ 2012;345:e544 doi: 10.1136/bmj.e5774): http://www.bmj.com/content/345/bmj.e5774/rr/613496

132. Clarity in the reporting of health equity issues requires addressing measurement issues. PLoS Medicine Nov. 3, 2012 ( responding to The PLOS Medicine Editors (2012) Bringing Clarity to the Reporting of Health Equity. PLoS Med 9(10): e1001334. doi:10.1371/journal.pmed.1001334): http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=57571&root=57571

131.  Recognizing contrasting patterns of gender differences in mortality and gender differences in survival. PLoS Medicine Sept, 26, 2012 (responding to Cornell M. Schomaker M, Garone db, et al.  Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: A Multicentre cohort study.  PLoS Med 9(9): e1001304): doi:10.1371/journal.pmed.1001304:

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=54807&root=54807

130. Study of effects of increasing coverage on inequalities in use of insecticide–treated bed nets illustrates implications of choices of measure of inequality.  PLoS Medicine, July 5, 2012  (responding to Noor AM, Amin AA, Akhwale WS, Snow RW (2007) Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children. PLoS Med 4(8): e255. doi:10.1371/journal.pmed.0040255):

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=51561&root=51561

129. Assumption of constant relative risk reductions across different baseline rates is unsound. CMAJ Mar. 12, 2012 (responding to Barratt A, Wyer PC, McGinn T, et al. Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ 2004;171(4):353-358):                                                                                           

http://www.cmaj.ca/content/171/4/353.short/reply#cmaj_el_690714

128.  Study of changes in the effect of marital status on cancer outcomes overlooks the way standard measures of association tend to be affected by the overall prevalence of an outcome. BMC Public Health March 5, 2012 (responding to Kravdal H, Syse A.  Changes over time in the effect of marital status on cancer survival.  BMC Public Health 2011;11:804 (doi:10.1186/1471-2458-804): http://www.biomedcentral.com/1471-2458/11/804/comments#730697

127. Studies of effects of health conditions on self-rated health must consider the ways standard measures of health disparities tend to be affected by the prevalence of an outcome.  BMJ Public Health Feb. 14, 2012 (responding to Delpierre C, Kelly-Irving M, Munch-Petersen M., et al.  SRH and HRQ: does social position impact differently on their with health status.  BMC Public Health 2012, 12,19: doi:10.1186/1471-2458-12-19): http://www.biomedcentral.com/1471-2458/12/19/comments#732698

126. Flaws in tools for measuring healthcare disparities can exacerbate those disparities (responding to Blustein J, Weissman JS, Ryan AM.  Analysis raised question of whether pay-for-performance in Medicaid can efficiently reduce racial and ethnic disparities.  Health Aff (Millwood) 2011;30(6):1165-1175): http://content.healthaffairs.org/content/30/6/1165/reply

125. Understanding contrasting patterns of relative differences in survival and relative differences in mortality.  Emerging Themes in Epidemiology. Jan. 12, 2011 (responding to Hockey R, Tooth l, Dobson A.  Relative survival: a useful tool to assess generalisability in longitudinal studies of health in older persons.  Emerging Themes in Epidemiology 2011, 8,3): http://www.ete-online.com/content/8/1/3/comments

124.  Estimation of treatment effects across a range of baseline rates should not be based on assumptions of either constant relative risks or constant odds ratios.  Emerging Themes in Epidemiology Jan. 12, 2012 (responding to Wang H, Boissel JP, Nony P.  Revisiting the relationship between baseline risk and risk under treatment.  Emerging Themes in Epidemiology 2009;6:1): http://www.ete-online.com/content/6/1/1/comments

123.  Efforts to appraise changes in inequalities in poor health over the life course must consider the implications of general increases in poor health as the population ages.  BMC Public Health Jan. 12, 2012 (responding to Benzeval M, Green MJ, Leyland AH.  Do social inequalities in health widen or converge with age.  Longitudinal evidence from three cohorts in the West of Scotland.  BMC Public Health 2011, 11:947: doi:10.1186/1471-2458-11-947): http://www.biomedcentral.com/1471-2458/11/947/comments

122.  The inevitability of interaction. BMJ Dec. 19, 2011 (responding to Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ 2003;326:219): http://www.bmj.com/content/326/7382/219?tab=responses

121.  Nomogram for calculating number needed to treat is based on an unsound premise.  BMJ Dec. 8, 2011 (responding to Chatellier G, Zapletal E, Lemaitre D, et al. The number needed to treat: a clinically useful nomogram in its proper context. BMJ 1996;312:426-429): http://www.bmj.com/content/312/7028/426?tab=responses

120.  The crucial priority for research on equity and health is the development of a sound method of measurement.  PLoS Med  Dec. 3, 2011 (responding to Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, et al.  (2011) Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda.  PLoS Med 8(11); e1001115. Doi:10):

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2Fa03ee9ea-5a5e-4da1-ac8b-45db407ec574&root=info%3Adoi%2F10.1371%2Fannotation%2Fa03ee9ea-5a5e-4da1-ac8b-45db407ec574

119.  Assumption of constant relative risk reductions across different baseline rates is unsound.  BMJ Nov. 21, 2011 (responding to Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452-454): http://www.bmj.com/content/310/6977/452?tab=responses

118.  Ratio measures are not transportable.  BMJ Nov. 11, 2011 (responding to Schwartz LS, Woloshin S, Dvorin EL, Welch HG.  Ratio measures in leading medical journals:  structured review of underlying absolute risks.  BMJ 2006;333:1248-1252): http://www.bmj.com/content/333/7581/1248?tab=responses

117.  Studies of trends in the relationship of marital status to mortality must consider the implications of general changes in mortality.  BMC Public Health Nov. 7, 2011 (responding to Berntsen KN. Trends in total and cause-specific mortality by marital status among elderly Norwegian men and women. BMC Public Health 2011; 11:537): http://www.biomedcentral.com/1471-2458/11/537/comments#608693

116.  Editorial on Holt-Lunstad study raises three data interpretation issues. PLoS Medicine.  Oct. 22, 2011 (responding to The PLoS Medicine Editors. Social Relationships Are Key to Health, and to Health Policy. PLoS Med 2010;7(8): e1000334. doi:10.1371/journal.pmed.1000334):

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=info:doi/10.1371/annotation/31b7ca8f-a4d1-402a-8f1e-b68339d847de&root=info:doi/10.1371/annotation/31b7ca8f-a4d1-402a-8f1e-b68339d847de

115. As mortality declines relative differences in mortality tend to increase.  BMJ Oct. 12, 2011 (responding to Moser KA, Leon Dam Gwatkin DR,  How does progress toward the child mortality millennium development goal affect inequalities between the poorest and the least poor? Analysis of Health Survey data.  BMJ 2005;331:1180-3):

http://www.bmj.com/content/331/7526/1180.full/reply#bmj_el_271310

114a. Study of differences in rates of dying above median age at death raises a number of statistical issues – Part I.  BMJ Sept. 7, 2011 (responding to Barr HL, Britton J, Smyth AR, Fogarty AW.  Association between socioeconomic  status, sex, and age at death from cystic fibrosis in England and Wales (1959 to 2008): Cross sectional study. BMJ 2011:343:d4662 doi:10.1136/bmj.d4662): http://www.bmj.com/content/343/bmj.d4662.full/reply#bmj_el_269661

114b. Study of differences in rates of dying above median age at death raises a number of statistical issues – Part II.  BMJ Sept. 7, 2011 (responding to Barr HL, Britton J, Smyth AR, Fogarty AW.  Association between socioeconomic  status, sex, and age at death from cystic fibrosis in England and Wales (1959 to 2008): Cross sectional study. BMJ 2011:343:d4662 doi:10.1136/bmj.d4662): http://www.bmj.com/content/343/bmj.d4662.full/reply#bmj_el_269663

113. Discussion of patterns of health inequalities must consider measurement issues. BMJ July 12, 2011 (responding to Mackenbach JP.  What would happen to health inequalities if smoking were eliminated. BMJ 2011; 342:d3460).

http://www.bmj.com/content/342/bmj.d3460.full/reply#bmj_el_266635

112. Standard measures of differences between outcome rates are problematic for identifying subgroup effects.  BMC Medical Research Methodology June 8, 2011 (responding to White IA, Elbourne D.  Assessing subgroup effects with binary data: can the use of different effects measures lead to different conclusions?  BMC Medical Research Methodology 2005, 5;15):

http://www.biomedcentral.com/1471-2288/5/15/comments#515697

111. Systematizing the analysis of effect heterogeneity requires rethinking some fundamentals.  Trials June 1, 2011 (responding to Gabler NB, Naihua D, Liao D, et al.  Dealing with heterogeneity treatments: is the literature up to the challenge.  Trials 2009,10:43):

http://www.trialsjournal.com/content/10/1/43/comments#512684

110. Assessing heterogeneity of treatment effects in light of fundamental statistical tendencies.  Trials May 26, 2011(responding to Kent DM, Rothwell PM, Ionnadis JPA, et al.  Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials 2010,11:85): http://www.trialsjournal.com/content/11/1/85/comments#498686

109.  Interpreting effects on referral inequalities of policies that increase overall referral rates.  BMJ May 6, 2011 (responding to McBride D, Hardoon S, Walters K, et al.. Explaining variation in referral from primary to secondary care: Cohort study.  BMJ 2010;341:c6267):

http://www.bmj.com/content/341/bmj.c6267.full/reply#bmj_el_260111

108. Efforts to investigate health inequalities in the United Kingdom have suffered from the failure to address measurement issues.  Journal Review Dec. 29, 2010 (responding to Bambra C, Smith KE, Garthwaite K, et al. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review.  J Epidemiol Community Health doi:10.1136/jech.2010.111195):

http://jpscanlan.com/images/Bambra_Smith_JECH_2010.pdf

107. One cannot determine whether high BMI increases mortality more in different age groups based on relative differences in mortality.  Journal Review Dec. 29, 2010 (responding to . Berrington de Gonzalez, Hartge P, Cerchan JR, et al.  Body-mass index and mortality among 1.46 million white adults.  N Engl J Med 2010;363:2211-19):

http://jpscanlan.com/images/Berrington_NEJM_2010.pdf

106.  Perceptions about progress in addressing health inequalities in the UK are suspect for lack of a sound statistical foundation.  BMJ Nov. 27, 2010 (responding to Hawkes N. So whose business is public health.  BMJ 2010;341:c6743v): http://www.bmj.com/content/341/bmj.c6743.full/reply#bmj_el_245510

105.  Subgroup analyses should not be undertaken without consideration of methodological issues.  Health Affairs Nov. 27, 2010 (responding to Mullins CJ, Onukwugha, Cooke JL, et al. The potential impact of comparative effectiveness research on minority populations. Health Affairs (Millwood) 2010;29(11):2098-2104):

http://content.healthaffairs.org/content/29/11/2098.abstract/reply#healthaff_el_457426

104.  Systematic analyses of health disparities cannot ignore measurement issues. Journal Review Nov. 27, 2010 (responding to Koh HK, Oppenheimer SC, Massin-Short SB, et al. Translating research evidence into practice to reduce health disparities: A social determinants approach.  Am J Public Health 2010;100:S72-S80.doi:AJPH.2009):

http://jpscanlan.com/images/Koh_AJPH_2010.pdf

103.  Study raises issues concerning nonsignificant findings and implications of large differences in health services utilization between the healthy and the unhealthy. BMJ Nov. 12, 2010  (responding to Saxena S, Eliahoo , Majeed A.  Socioeconomic and ethnic differences in self reported health status and use of health services by children and young people in England: cross sectional study.  BMJ 2002;325:520-523): http://www.bmj.com/content/325/7363/520.1/reply#bmj_el_244510

102. Effects of health improvements on health inequalities must be examined with other than standard measures of differences between outcome rates.  PLoS Med Nov. 2, 2010 (responding to Capewell S, Graham H (2010) Will Cardiovascular Disease Prevention Widen Health Inequalities? PLoS Med 7(8): e1000320. doi:10.1371/journal.pmed.1000320):

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2Fd7b6f791-e7a5-484b-a372-76c83a1a7029&root=info%3Adoi%2F10.1371%2Fannotation%2Fd7b6f791-e7a5-484b-a372-76c83a1a7029

101. Difficulties interpreting percentage point changes in outcome rates.  Health Affairs Oct. 19, 2010 (responding to Muenning PA, Glied SA. What changes in survival rates can tell us about US Health Care.  Health Affairs doi: 10.1377/hlthaff.2010.0073): http://content.healthaffairs.org/cgi/eletters/hlthaff.2010.0073v1#454605

100. Additional reason to require reporting of underlying rates. BMJ Oct. 17, 2010 (responding to Gigerenzer G, Wewarth O, Feuful M.  Misleading communication of risk. BMJ 2010; 341:c4830): http://www.bmj.com/content/341/bmj.c4830/reply#bmj_el_243180

99. A fundamental problem with case control studies. BMJ Oct. 2, 2010 (responding to Sedgwick P. Confounding in case control studies.  BMJ 2010; 341:c5136): http://www.bmj.com/content/341/bmj.c5136/reply#bmj_el_242476

98. Caution is warranted in tying policy decisions to perceptions about effects on health inequalities. BMJ Sept. 29, 2010 (responding to Tugwell P, Petticrew M, Kristjansson E., et al.   Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health. BMJ 2010; 341:c4739):  http://www.bmj.com/content/341/bmj.c4739.full/reply#bmj_el_242311

97. In making a useful point, Sedgwick and Marston overlook a more common problem. BMJ Sept. 29, 2010 (responding to Sedgwick P, Marston L. Relative risk. BMJ 2010; 341:c3983): http://www.bmj.com/content/341/bmj.c3983.full/reply#bmj_el_242314

96. Comparisons of the size of health inequalities must be based on measures that are unaffected by the overall prevalence of an outcome. BMC Medical Research Methodology Sept. 22, 2010 (responding to Jackson AL, Davis CA, Leyland AH.  Do differences in the administrative structure of populations confound comparisons of geographic health equalities? BMC Medical Research Methodology 2010: http://www.biomedcentral.com/1471-2288/10/74): http://www.biomedcentral.com/1471-2288/10/74/comments

95. Problems in identifying interaction where groups have different base rates. BMJ Sept. 21, 2010 (responding to Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ 2003;326:219):

http://www.bmj.com/content/326/7382/219/reply#bmj_el_241943

94. Recognizing implications of different base rates in measuring improvements in healthcare. Health Aff (Millwood) Aug. 13, 2010 (responding to Guthrie B, Auerbck G, Bindman AB.  Health plan competition for Medicaid enrollees based on performance does not improve quality of care.  Health Aff (Millwood) 2010;29:1507-1515)

http://content.healthaffairs.org/cgi/eletters/29/8/1507

93. Health and healthcare disparities cannot be usefully measured without consideration of overall prevalence. ________  Aug. 6, 2010 (responding to Hoover K, Bohm M, Keppel K.  Measuring disparities in the incidence of sexually transmitted disease.  Sexually Transmitted Diseases.  December Supplement 2008, Vol. 35, No. 12:S40-S44): http://jpscanlan.com/images/Comment_on_Hoover.pdf

92. Resolving measurement issues should be the pressing health disparities research concern. Journal Review August 6, 2010 (responding to Flores G, Committee on Pediatric Research.  Technical report – racial and ethnic disparities I the health and healthcare of children.  Pediatrics  201; 1253979-1020): http://jpscanlan.com/images/Flores_Pediatrics_2010.pdf

91. To be of value health inequalities research must address measurement issues. BMJ July 23, 2010 (responding to Thomas B, Dorling D, Davey Smith G.  Inequalities in premature mortality in Britain: observational study from 1921 to 2007.  BMJ 2010;341:c3639): http://www.bmj.com/cgi/eletters/341/jul22_1/c3639

90. Appraising mortality inequalities among different age groups.  BMC Public Health July 19, 2010 (responding to Menvielle G, Leclerc A, Chastang, J-F, Luce D.  Socioeconomic inequality in cause specific morality among older people in France.  BMC Public Health 2010, 10:260): http://www.biomedcentral.com/1471-2458/10/260/comments#413678

89. Rethinking the premises of subgroup analyses. BMJ June 7, 2010 (responding to Sun X, Briel M. Walter SD, and Guyatt GH.  Is as subgroup effect believable? Updating criteria to evaluated the credibility of subgroup analyses. BMJ 2010;340:850-854): http://www.bmj.com/cgi/eletters/340/mar30_3/c117

88.  Relative differences cannot effectively identify reporting heterogeneity. Journal Review  May 21, 2010 (responding to Huisman M, van Lenthe F, Mackenbach JP. The predictive ability of self assessed health for mortality in different educational groups. Int J Epidemiol 2007;36:1207–1213):http://jpscanlan.com/images/Huisman_IJE_2007.pdf

87. Research into effects of interventions on inequalities must first address measurement issues. Journal Review Apr. 28, 2020 (responding to Bambra C, Gibson M, Sowden A, et al.  Tackling the wider social determinants of health and health inequalities:  evidence from systematic review.  J Epidemiol Community Health 2010;64:284-291):

http://jpscanlan.com/images/Bambra_Gibson_JECH_2010.pdf

86. Interpreting racial differences in hypertension control. Journal Review Apr. 28, 2020 responding to Rehman SU, Hutchison FN, Hendrix K, et al.  Ethnic differences in blood pressure control among men at Veterans Affairs clinic and other health care sites.  Arch Intern Med 2005;165:1041-104): http://jpscanlan.com/images/Rehman_Arch_Int_Med_2005.pdf

85. Additional Issues to be considered by a World Council of Epidemiology and Causality. Emerging Themes in Epidemiology April 8, 2010  (responding to Bhopal R. Seven mistakes and potential solutions in epidemiology, including a call for a World Council of Epidemiology and Causality. Emerging Themes in Epidemiology 2009,6:6):

http://www.ete-online.com/content/6/1/6/comments#396680

84. Incentive programs to reduce healthcare disparities should await better understanding of how to measure those disparities.  Journal Review March 2, 2010 (responding to Siegel B, Nolan L.  Leveling the field – ensuring equity through National Health Care Reform.  N Engl J Med 2009;361:2401-2403):

http://jpscanlan.com/images/Siegel_NEJM_2009.pdf

83. Interpreting data on comparative efficacy of an intervention in settings with different base rates. Journal Review Feb. 28, 2010 (responding to Madhi SA, Cunliffe NA, Steele D, et al.  Effect of human rotavirus vaccine on severe diarrhea in African infants.  N Engl J Med 2010;362:289-98: http://jpscanlan.com/images/Madhi_NEJM_2010.pdf

82. Importance of distinguishing disparities in survival from disparities in mortality. ______ Feb. 17, 2010 (responding to Keegan, THM, Clarke CA, Chang ET, et al.  Disparities in survival after Hodgkin lymphoma: a population based study. Cancer Causes Control 2009;20:1881-1892:  http://www.jpscanlan.com/images/Comment_on_Keegan.pdf

81. The importance of distinguishing mortality inequalities from survival inequalities.  Journal Review Feb. 17, 2010 (responding to Hill S, Sarfati D, Blakely t, et al.  Survival disparities in indigenous and non-indigenous New Zealanders with colon cancer:  the role of patient comorbidity, treatment, and health service factors.  J Epidemiol Community Health 2010;64:117-123):http://jpscanlan.com/images/Hill_JECH_2010.pdf

80. Health disparities cannot be measured without consideration of the overall prevalence of an outcome. Journal Review Feb.10, 2010 (responding to Orsi JM, Margellos-Anast H., Whitman S.  Black-white health disparities in the United States and Chicago:  A 15-Year Progress Analysis.  Am J Public Health. 201;100:349-356:http://jpscanlan.com/images/Orsi_AJPH_2010.pdf

79. Understanding the forces driving cross-national variations in relative differences in outcome rates.  Eur J Pub Health Jan. 25, 2009 (responding to Huijts T, Eikemo TA. Causality, social selectivity or artefacts?   Why socioeconomic inequalities in health are not smallest in the Nordic countries. Eur J Pub Health 2009;19:452-53): http://eurpub.oxfordjournals.org/cgi/eletters/19/5/452

78. Authors recommending financial incentives to reduce disparities must confront measurement issues. Pediatrics Jan. 9, 2010 (Chin MH, Alexander-Young M, Burnet DJ.  Health care quality-improvement approaches to reducing child health disparities.  Pediatrics 2009;14:S224-S236): http://pediatrics.aappublications.org/cgi/eletters/124/Supplement_3/S224

77. The effect of changes in the overall prevalence of an outcome on relative differences in experiencing and avoiding it.  BMJ Dec. 28, 2009 (responding to Gregory IN. Comparison between geographies of mortality and deprivation from the 100s and 2001: spatial analysis of census and mortality statistics. BMJ 2009;339:b3454):

http://www.bmj.com/cgi/eletters/339/sep10_2/b3454

76. Disparities quality index is flawed in several respects.  Journal Review Dec. 19, 2009 (responding to Siegel B, Bear D, Andres E, Mead H.  Measuring equity: An index of health care disparities.  Q Manage Health Care 2009;18(2):84-90): http://jpscanlan.com/images/Siegel_QMHC_2009.pdf

75. Mastering tools to monitor health disparities should precede expansion of monitoring.  Journal Review  Dec. 5, 2009 (responding to Rosenthal MB, Landon Bruce E., Normand ST, et al.  Engagement of health plans and employers in addressing racial and ethnic disparities in healthcare.  Med Care Res Rev 2009;66(2):219-231): http://jpscanlan.com/images/Rosenthal_MCRR_2009.pdf

74.  Article on disparities in control of cardiovascular disease and diabetes raises several measurement issues.  Ann Int Med Nov. 30, 2009 (responding to McWilliams JM, Meara E., Zaslavsky AM, Ayanian JZ.  Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education, U.S. trends from 1999 to 2006 and effects of Medicare coverage.  Ann Int Med 2009;150:505-515):

http://www.annals.org/content/150/8/505/reply#annintmed_el_120732

73. Measuring disparities in risk factors by means of absolute differences between rates. Journal Review Nov. 28, 2009 (responding to Kanjilat S, Gregg EW, Cheng YJ, et al.  Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adjust, 1971-2002.  Arch Intern Med 2006;166:2348-2355): http://jpscanlan.com/images/Kanjilat_Arch_Int_Med_2006.pdf

72. The relationship between overall prevalence and measures of differences between outcome rates. International Journal for Equity in Health __________ (responding to Eikemo TA, Skalicka V, Avendano M. Variations in health inequalities: are they a mathematical artifact? International Journal for Equity in Health 2009;8:32: http://www.equityhealthj.com/content/pdf/1475-9276-8-32.pdf): http://jpscanlan.com/images/Comment_on_Eikemo_et_al..pdf

(This comment was submitted to the referenced journal on October 3, 2009.  The journal originally planned to it after receiving replies from the authors of the articles it addresses, but subsequently indicated it would publish only a much shorter version, which I have not yet submitted.  Meanwhile a version of the comment may be accessed by the indicated link.)

71. Effects of standard adjustment approaches on relative and absolute inequalities.  J Epidemiol and Community Health Nov. 2, 2009 (responding to Lynch J, Davey Smith G, Harper S, Bainbridge K. Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches. J Epidemiol Community Health 2006:60:436-441): http://jech.bmj.com/content/60/5/436.abstract/reply#jech_el_2400

(Item 71 comment is a follow-up to item 11.  It also addresses issues raised in Singh-Manoux A, Nabi H, Shipley M, et al. The role of conventional risk factors in explaining social inequalities in coronary heart disease – the relative and absolute approaches.  Epidemiology 2008;19:599-605.)

70. Measurement lessons learned, then forgotten.  Journal Review May 6, 2009 (responding to Mackenbach JP, Stirbu I, Roskam AJ, et al.  Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008;358:2468-2481: http://jpscanlan.com/images/Comment_on_Mackenbach.pdf

69. Study raises a number of issues about analyzing disparities between and among demographic groups. Journal Review March 23, 2009 (responding to Harper S, Lynch J, Meersman SC, et al.  Trends in area-socioeconomic disparities in breast cancer screening, mortality, and survival among women ages 50 years and over (1987-2005).  Cancer Epidemiol Biomarkers Prev 2009;18(1):121-131):

http://jpscanlan.com/images/Comment_on_Harper.pdf

68. Relative differences in survival and relative differences in mortality are different things. Journal Review Mar. 3, 2009 (Woldemichael G, Christiansen D, Thomas S, Benbow N.  Demographic characteristics and survival with AIDS in Chicago, 1993-2001)  Am J Public Health 2009;XXX-XXX.doi:10.2105/AJPH.2007.124750: http://jpscanlan.com/images/Woldemichael_AJPH_2009.pdf

67. Recommendations to incorporate reductions in disparities in P4P programs cannot ignore measurement issues. Journal Review  Feb. 21, 2009 (responding to Chien AT, Chin MH.  Incorporating disparity reduction into pay-for-performance.  J Gen Intern Med 2008;24(1):135-136): http://jpscanlan.com/images/Chien_JGIM_2008.pdf

66. Tying pay-for-performance to healthcare disparities should await mastery of measurement issues. BMJ  Feb. 8, 2009 (responding to Bierman AS, Clark JP.  Performance measure and equity.  BMJ 2007;334:1333-1334):  http://www.bmj.com/cgi/eletters/334/7608/1333

65. Measuring racial disparities in hypertension control. Ann Fam Med Jan. 25, 2009 (responding to Satcher D.  Examining racial and ethnic disparities in health and hypertension control.  Ann Fam Med 2008;6:483-485): http://www.annfammed.org/cgi/eletters/6/6/483

64. Interpreting patterns of changes in absolute differences between rates when common outcomes become even more common.  BMJ Dec. 7, 2008 (responding to Ashworth M, Medina J, Morgan M.  Effect of social deprivation on blood pressure monitoring and control in England:  a survey of data from the quality and outcomes framework.  BMJ 2008;337:a2030): http://www.bmj.com/cgi/eletters/337/oct28_2/a203063

63. “Inverse equity hypothesis” overlooks important statistical tendencies.  Journal Review Dec. 2, 2008 (responding to Victora CG, Vaughan JP, Barros FC, et al.  Explaining trends in inequities:  evidence from Brazilian child health studies.  Lancet 2000;356:1093-1098): http://jpscanlan.com/images/Comment_on_Victora.pdf

62. Interpreting patterns of changes in measures of demographic differences in folate status in light of overall improvements in folate status.  Journal Review Dec. 2, 2008 (responding to Dowd JB, Aiello AE.  Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US. Int J Epidemiol 2008:37:1059-1066): http://jpscanlan.com/images/Comment_on_Dowd_and_Aiello.pdf

61. Measures of health and healthcare disparities that are unaffected by the overall prevalence of an outcome (responding to Low A, Low A. Importance of relative measures in policy on health inequalities. BMJ. 2006;332:967-969. BMJ Nov. 29, 2008): http://www.bmj.com/cgi/eletters/332/7547/967

60. Illustrating whether the relationship between race and allostatic load scores increases with age.  Journal Review July 24, 2008 (responding to Geronimus A, Hicken M, Keene D, and Bound J. Weathering and age patterns of allostatic load scores among blacks and whites in the United States. Am J Pub Health 2006;96:826-833): http://jpscanlan.com/images/Geronimus_AJPH_2005.pdf

59. Relative differences in outcome rates tend to be large where outcomes are rare.  Journal Review May 31, 2008 (responding to Kawachi I, Daniels N, Robinson DE.  Health disparities by race and class: why both matter.  Health Affairs 2005;24(2):343-352): http://jpscanlan.com/images/Kawachi_Health_Affairs_2005.pdf

58. Identifying meaningful differences in inequalities in revascularization rates in different settings.  Journal Review May 9, 2008 (responding to Hetemaa T, Keskimäki I, Manderbacka, et al.  How did the recent increase in the supply or coronary operations in Finland affect socioeconomic and gender equity in their use?  J Epidemiol Community Health 2003;57:178-185):http://jpscanlan.com/images/Second_Hetemaa_Comment.pdf

57.  Health disparities curricula must address measurement issues.  Ann Intern Med May 12, 2008 (responding to Smith WR, Betancourt JR, Wynia MK. Recommendations for teaching about racial and ethnic differences in health and health care. Ann Intern Med 2007;147:654-665): http://www.annals.org/cgi/eletters/147/9/654

56. Study shows different adjustment approaches rather than different relative and absolute perspectives.  Journal Review May 1, 2008 (responding to Khang YH, Lynch JW, Jung-Choi K, Cho HJ. Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean public servants: relative and absolute perspectives. Heart 2008;94:75-82):http://jpscanlan.com/images/Khang_Heart_2009.pdf

55. Understanding patterns of absolute differences in vaccination rates in different settings. Journal Review Apr. 22, 2008 (responding to Schneider EC, Cleary PD, Zaslavsky AM, Epstein AM.  Racial disparity in influenza vaccination:  Does managed care narrow the gap between blacks and whites?  JAMA 2001;286:1455-1460):

http://jpscanlan.com/images/Schneider_JAMA_2001.pdf

54.  Misinterpreting patterns of relative differences in mortality.  Am J Public Health Apr. 13, 2008 (responding to Wilkinson RG, Pickett KE.  Income inequality and socioeconomic gradients in mortality. Am J Public Health 2008;98:699-704): http://www.ajph.org/cgi/eletters/98/4/699

53. Comparisons of the sizes of differences between black and white rates for different procedures are not informative without consideration of the overall levels for each procedure. Journal Review Mar. 28, 2008 (responding to Baicker K, Chandra A, Skinner JS, Wennberg JE.  Who you are and where you live: how race and geography affect the treatment of Medicare beneficiaries.  Health Affairs 2004:Var-33-Var-44):

http://jpscanlan.com/images/Baicker_Health_Affairs_2004.pdf

52. Study illustrates ways in which the direction of a change in disparity turns on the measure chosen. Pediatrics Mar. 27, 2008 (responding to Morita JY, Ramirez E, Trick WE. Effect of school-entry vaccination requirements on racial and ethnic disparities in Hepatitis B immunization coverage among public high school students. Pediatrics 2008;121:e547-e552): http://pediatrics.aappublications.org/cgi/eletters/121/3/e547

51. First learn to measure healthcare disparities. Health Affairs Mar. 12, 2008 (responding to Casalino LP, Elster A, Eisenberg A, et al. Will pay-for-performance and quality reporting affect health care disparities? Health Affairs 2007;26(3):405-414): http://content.healthaffairs.org/cgi/eletters/26/3/w405

50. Reconsidering a landmark study.  Lancet Feb. 25, 2008 (responding to  Mackenbach JP, Kunst AE, Cavelaars, et al. Socioeconomic inequalities in morbidity and mortality in western Europe, Lancet 1997; 349: 1655-59):

http://jpscanlan.com/images/Mackenbach_Lancet_1997.pdf

49. Inclusion of healthcare disparities issues in pay-for-performance programs should await development of reliable means of measuring changes in disparities over time. Journal Review Feb. 16, 2008 (responding to Casalino LP, Elster A, Eisenberg A, et al. Will pay-for-performance and quality reporting affect health care disparities? Health Affairs 2007;26(3):405-414): http://jpscanlan.com/images/Casalino_Health_Affairs_2007.pdf

48. Perceptions of changes in healthcare disparities among the elderly dependant on choice of measure,  Journal Review 2/12/08 (responding to Escarce JJ, McGuire TG.  Changes in racial differences in use of medical procedures and diagnostic tests among elderly persons: 1986-1997. Am J Public Health 2004;94:795-1799):http://jpscanlan.com/images/Escarce_McGuire_2004.pdf

47. Pay-for-performance and the measurement of healthcare disparities.  Journal Review Feb. 10, 2008 (responding to Chien AT, Chin MH, Davis AM, Casalino LP.  Pay for performance, public reporting, and racial disparities in health care: how are programs being designed.  Med Car Res Rev 2007;64:283S-304S): http://jpscanlan.com/images/Chien_MCRR_2007.pdf

46a. Implications of the focus on racial/ethnic disparities in control rather than processes in the context of pay-for-performance .  Journal Review Feb. 10, 2008 (responding to Werner, RM, Asch DA, Polsky D. Racial profiling: The unintended consequences of coronary artery bypass graft report cards. Circulation 2005;111:1257–63):

http://jpscanlan.com/images/Werner_Follow.pdf

46. Pay-for-performance implications of the failure to recognize the way changes in prevalence of an outcome affect measures of racial disparities in experiencing the outcome.  Journal Review Feb. 8, 2008 (responding to Werner, RM, Asch DA, Polsky D. Racial profiling: The unintended consequences of coronary artery bypass graft report cards. Circulation 2005;111:1257–63): http://jpscanlan.com/images/Werner_Circulation_2005.pdf

45. Comparing health inequalities across time and place with an understanding of the usual correlations between various measures of difference and overall prevalences. Journal Review Jan. 30, 2008 (responding to Moser K, Frost C, Leon D.  Comparing health inequalities across time and place—rate ratios and rate differences lead to different conclusions: analysis of cross-sectional data from 22 countries 1991–200.  Int J Epidemiol 2007;36:1285-1291: http://jpscanlan.com/images/Moser_IJE_2007.pdf

44. Increases in relative differences in adverse health outcomes do not necessarily reflect increasing health inequality.  Am J Public Health Jan. 24, 2008 (responding to Frohlich KL, Potvin L. Transcending the Known in Public Health Practice: The inequality paradox: The population approach and vulnerable populations. Am J Pub Health 2008;98:216-221): http://www.ajph.org/cgi/eletters/98/2/216

D43. Comparing the size of inequalities in dichotomous measures in light of the standard correlations between such measures and the prevalence of an outcome.  Journal Review Jan. 14, 2008 (responding to Boström G, Rosén M.  Measuring social inequalities in health – politics or science?  Scan J Public Health 2003;31:211-215):

http://www.jpscanlan.com/images/Bostrom_and_Rosen_Comment.pdf

42. Recognizing the way correlations between improvements in healthcare and reductions in healthcare disparities tend to turn on the choice of disparities measure.  Journal Review Nov. 9, 2007 (responding to Aaron KF, Clancy CM.  Improving quality and reducing disparities.  JAMA 2003;289:1033-34):

http://jpscanlan.com/images/Aaron_Clancy_JAMA_2003.pdf

41a. Correction to statements concerning the measurement of healthcare disparities by the Agency for Healthcare Research and Quality in earlier comment on Trivedi et al.  Journal Review Nov. 15, 2007:

http://jpscanlan.com/images/Trivedi_JAMA_2006_Correction.pdf

(Correcting item 41.)

41. Understanding patterns of correlations between plan quality and different measures of healthcare disparities.  Journal Review Aug. 30, 2007 (responding to Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ.  Relationship between quality of care and racial disparities in Medicare health plans.  JAMA 2006;296:1998-2004): 

http://jpscanlan.com/images/Trivedi_JAMA_2006.pdf

40a. Correction to statements concerning the measurement of healthcare disparities by the Agency for Healthcare Research and Quality in earlier comment on Sequist et al.  Journal Review Nov. 15, 2007: http://jpscanlan.com/images/Sequist_Correction.pdf

D40. Understanding the ways improvements in quality affect different measures of disparities in healthcare outcomes regardless of meaningful changes in the relationships between two groups’ distributions of factors associated with the outcome.  Journal Review Aug. 30, 2007 (responding to Sequist TD, Adams AS, Zhang F, Ross-Degnan D, Ayanian JZ. The effect of quality improvement on racial disparities in diabetes care. Arch Intern Med 2006;166:675-681): http://jpscanlan.com/images/Sequist_Archives_Int_Med_2006.pdf

39. Understanding widening socioeconomic differences in child mortality.  Journal Review Aug. 27, 2007 (responding to Singh GK, Kogan MD. Widening socioeconomic disparities in US childhood mortality, 1969-2000.  Am J Public Health 2007:97:1658-1665): http://jpscanlan.com/images/Singh_AJPH_2007.pdf

38. Interpreting patterns of differing effects of chronic conditions on self-assessed health.  Journal Review June 30, 2007 (responding to Brown AF, Ang A, Pebley AR.  The relationship between neighborhood characteristics and self-rated health for adults with chronic conditions.  Am J Public Health 2007;97:926-932): http://jpscanlan.com/images/Brown_AJPH_2007.pdf

37. Recognizing expected patterns of relative differences in the Whitehall cohort.  Journal Review  June 25, 2007 (responding to van Rossum CTM, Shipley MJ, van de Mheen H, et al. Employment grade differences in cause specific mortality. A 25-year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health 2000;54:178-84): http://jpscanlan.com/images/Van_Rossum_JECH_2000.pdf

36. Understanding the way choice of measure tends to dictate the results of studies of the way improvements in healthcare affect disparities.  Journal Review June 19, 2007 (responding to  James PD, Wilkins R, Detsky AS, et al. Avoidable mortality by neighborhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health 2007;61:287-296): http://jpscanlan.com/images/James_JECH_2007.pdf

35. Problems with the measurement of changes in health inequalities over time using dichotomous variables and possibilities using continuous variables.  Journal Review  June 19, 2007 (responding to Ferrie JE, Shipley MJ, Davey Smith GD. Change in health inequalities among British civil servants: the Whitehall II study. J Epidemiol Community Health 2002:56:922-926): http://jpscanlan.com/images/Ferrie_JECH_2002.pdf

34. Recognizing why dichotomous and continuous measures may yield contrary results. BMJ June 11, 2007 (responding to Chandola T, Ferrie J, Sacker A, Marmot M.  Social inequalities in self reported health in early old age:  follow-up of prospective cohort study.  BMJ 2007:334:990-996): http://www.BMJ.com/cgi/eletters/334/7601/990

33. Recognizing the statistical basis for advances in health care to cause larger relative reductions in mortality in groups with lower base rates.  Journal Review June 9, 2007 (responding to Korda RJ, Butler JRG, Clements MS, Kunitz SJ.  Differential impacts of health care in Australia:  trend analysis of socioeconomic inequalities in avoidable mortality.  Int J Epidemiol 2007;36:157-165): http://jpscanlan.com/images/Korda_IJE_2007.pdf

32. Understanding the ways factors tend to increase outcome rates proportionately more in groups with lower base rates.  Journal Review June 7, 2007 (responding to Thurston RC, Kubzansky LD, Kawachi I, Berkman LF.  Is the association between socioeconomic position and coronary heart disease stronger in women than in men.  Am J Epidemiol 2005;162:57-64): http://jpscanlan.com/images/Thurston_AJE_2005.pdf

31.  Role of the prevalence of an outcome in the size of rate differences.  J Epidemiol Community Health June 4, 2007 (responding to Martikainen P, Blomgren J, Valkonen T. Change in the total and independent effects of education and occupational social class on mortality: analyses of all Finnish men and women the period 1971-2000. J Epidemiol Community Health 2007;61:499-505):  http://jech.bmj.com/content/61/6/499.abstract/reply#jech_el_1338

30. Interpreting departures from expected patterns of relative differences.  J Epidemiol Community Health June 4, 2007 (responding to Mustard CA, Etches J. Gender differences in socioeconomic inequality in mortality. J Epidemiol Community Health 2003;57:974-980): http://jech.bmj.com/content/57/12/974.abstract/reply#jech_el_1340

29.  A study with a variety of problems.  Journal Review June 2, 2007 (responding to  Schulman KA, Berlin JA, Harless, et al.  The effect of race and sex on physicians’ recommendations for cardiac catheterization.  N Engl J Med 1999;340:618-26):

http://jpscanlan.com/images/Schulman_NEJM_1999.pdf

28. Understanding why the accomplishments of the welfare state generally will not reduce health inequalities as they are typically measured.  Journal Review June 2, 2007 (responding to Lawlor DA, Ronalds G, Macintyre S, et al.  Family socioeconomic position at birth and future cardiovascular disease risk: findings from the Aberdeen children of the 1950s cohort study. Am J Public Health 2006;96:1271-1277): http://jpscanlan.com/images/Lawlor_AJPH_2006.pdf

27. Understanding when general increases in an outcome tend to result in increasing absolute differences between the rates of two groups.  Journal Review June 1, 2007 (responding to Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med 2005;353:692-700)(included in item 23):

http://jpscanlan.com/images/Vaccarino_NEJM_2005.pdf

26. Understanding when general increases in an outcome tend to result in increasing absolute differences between the rates of two groups.  Journal Review June 1, 2007 (responding to Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM. Racial trends in the use of major procedures among the elderly. N Engl J Med 2005;353:683-691) (included in item 23): http://jpscanlan.com/images/Vaccarino_NEJM_2005.pdf

25. Understanding expected patterns of changes in absolute differences between the rates at which racial or gender groups receive adequate care.  Journal Review May 1, 2007 )Sehgal AR. Impact of quality improvement efforts on race and sex disparities   in hemodialysis. JAMA 2003;289:996-1000): http://jpscanlan.com/images/Sehgal_JAMA_2003.pdf

24. Recognizing the role of the prevalence of an outcome in comparing the size of relative differences in experiencing or failing to experience the outcome.  Journal Review  May 31, 2007 (responding to Gan SC, Beaver SK, Houck PM, et al.  Treatment of acute myocardial infarction and 30-day mortality among women and men.  N Engl J Med 2000;343:8-15): http://jpscanlan.com/images/Gan_NEJM_2000.pdf

23a. Correction to statements concerning the measurement of healthcare disparities in the National Healthcare Disparities Reports in earlier comment on Vaccarino et al.  Journal Review Nov. 6, 2007: http://jpscanlan.com/images/Vaccarino_Correction.pdf

Correcting no. 23. 

23. Effects of choice measure on determination of whether health care disparities are increasing or decreasing.  Journal Review  May 1, 2007 (responding to Vaccarino V, Rathore SS, Wenger NK, et al. Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 2005;353:671-682):

http://jpscanlan.com/images/Vaccarino_NEJM_2005.pdf

22. Understanding why reductions in injury rates will tend to increase relative differences in injury rates.  Lancet Jan. 31, 2007 (responding to Sethi D, Racioppi F, Baumgarten I, Bertollini R. Reducing inequalities from injuries in Europe.  Lancet 2006:368:2243-50): http://jpscanlan.com/images/Sethi_Lancet_2006.pdf

21. Interpreting changes in relative inequalities in receipt of procedures. J Epidemiol Community Health Jan 25, 2007 (responding to Hetemaa T, Keskimäki I, Manderbacka, et al. How did the recent increase in the supply or coronary operations in Finland affect socioeconomic and gender equity in their use? J Epidemiol Community Health 2003;57:178-185): http://jech.bmj.com/content/57/3/178.abstract/reply#jech_el_1305

20. Interpreting patterns of inequalities in perinatal outcomes.  J Epidemiol Community Health Jan 18, 2007 (responding to Fairley L, Leyland AH. Social class inequalities in perinatal outcomes: Scotland 1980-2000. J Epidemiol Community Health 2006;601:31- 36: http://jech.bmj.com/content/60/1/31.full/reply#jech_el_1282

19. The relationship between the prevalence of an outcome and the size of the relative disparity in experiencing it.  BMJ  Dec 14, 2006 (responding to Kristensen P. Review of Social Inequalities in Health: New Evidence and Policy Implications. BMJ 2006;333:1167): http://www.BMJ.com/cgi/eletters/333/7579/117

18. Issue in the interpretation of health inequalities in New York.  J Epidemiol Community Health Dec. 14, 2006 (responding to Karpati AM, Bassett MT, McCord C. Neighborhood mortality inequalities in New York City, 1989-1991 and 1999-2001. J Epidemiol Community Health 2006;60:1060-1064): http://jech.bmj.com/content/60/12/1060.abstract/reply#jech_el_1277

17. Why we should expect Nordic countries to show large relative socioeconomic inequalities in mortality.  Lancet Oct. 7, 2006 (responding to Wilkinson R. The politics of health. Lancet 2006;368:1229-1230) :http://jpscanlan.com/images/Wilkinson_Lancet_2006_Nordic_.pdf

16. Explanation for large health inequalities in Nordic countries.  Eur J Public Health  Nov. 1, 2006 (responding to Hemmingsson T, Lundberg I. Can large relative mortality differences between socioeconomic groups among Swedish men be explained by risk indicator-associated social mobility? Eur J Public Health 200515:518 -522):  http://eurpub.oxfordjournals.org/cgi/eletters/15/5/518#22

15. Difficulties in comparing relative differences across subgroups.  J Epidemiol Community Health Dec. 4, 2006 (responding to Kaplan RM, Kronick RG. Marital status and longevity in the United States Population. J Epidemiol Community Health 2006;60:760-765): http://jech.bmj.com/content/60/9/760.abstract/reply#jech_el_853

14. Differences in average hospital stay as a measure of inequality.  Am J Public Health Aug. 18, 2006 (responding to Icks A, Haastert B, Rathmann W, et al. Trends in hospitalization and sociodemographic factors in diabetic and nondiabetic populations in Germany: National Health Survey, 1990-1992 and 1998. Am J Public Health 2006;96:1656-1661): http://www.ajph.org/cgi/eletters/AJPH.2005.063339v1

13. Understanding inequalities in injury deaths BMJ July 19, 2006 (responding to Edwards P, Green J, Roberts I, Lutchmun S. Deaths from injury in children and employment status in family: analysis of trends in class specific death rates. BMJ 2006;333:119-121):

http://www.bmj.com/content/333/7559/119?tab=responses

12. Understanding how changes in prevalence of adverse health outcomes affect health inequalities.  Lancet  May 23, 2006 (responding to Wilkinson R, Pickett K. Health inequalities and the UK Presidency of the EU. Lancet 2006;376:1126-1128:

http://jpscanlan.com/images/Wilkinson_Lancet_2006.pdf

11. Understanding social gradients in adverse health outcomes within high and low risk populations.  J Epidemiol Community Health May 18, 2006 (responding to Lynch J, Davey Smith G, Harper S, Bainbridge K. Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches. J Epidemiol Community Health 2006:60:436-441): http://jech.bmj.com/content/60/5/436.abstract/reply#jech_el_549

10. Changing inequalities in morbidity.  J Epidemiol Community Health May 16, 2006 (responding to Adams J, Holland L, White M. Changes in socioeconomic inequalities in census measures of health in England and Wales, 1991-2001. J Epidemiol Community Health 2006;60:218-222): http://jech.BMJjournals.com/cgi/eletters/60/3/218

9. Re: Relative measures have limitations too.  BMJ  May 16, 2006: http://BMJ.BMJjournals.com/cgi/eletters/332/7547/967

Responding to authors’ reply to item 8.

8. Problems with relative measures of health inequalities.  BMJ  May 8, 2006 (responding to Low A, Low A. Importance of relative measures in policy on health inequalities. BMJ. 2006;332:967-969): http://BMJ.BMJjournals.com/cgi/eletters/332/7547/967

7. Interpreting increasing health inequalities in Spain.  Am J Public Health Apr. 24, 2006 (responding to Regidor E, Ronda E, Pascual C, Martinez D, Calle ME, Dominguez V. Decreasing socioeconomic inequalities and increasing health inequalities in Spain: A case study. Am J Public Health 2006;96:102-108): http://www.ajph.org/cgi/eletters/96/1/102

6. Measuring health disparities. J Public Health Manag Pract 2006;12(3):293-296 (responding to Keppel KG, Pearcy JN. Measuring relative disparities in terms of adverse events. J Public Health Manag Pract 2005;11(6):479–483):

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=641470

5. Difficulties in the interpretation of patterns of health racial differences in allostatic load.  Am J Public Health Feb. 26, 2006 (responding to Geronimus A, Hicken M, Keene D, and Bound J. Weathering and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States. Am J Public Health 2006;96:826-833): http://www.ajph.org/cgi/eletters/96/5/826

4. Interpreting trends in racial disparities in stillbirth.  Am J Public Health Feb. 26, 2006 (responding to Ananth CV, Shiliang L, Kinzler WL, Kramer MS. Stillbirths in the United States, 1981-2000: An Age, Period and Cohort Analysis. Am J Public Health 2005;95:2213-2217): http://www.ajph.org/cgi/eletters/95/12/2213

3. Changing social inequalities in SIDS.  Am J Public Health  Dec. 11, 2005 (responding to Pickett KE, Luo Y, Lauderdale DB.  Widening social inequalities in risk for sudden infant death syndrome. Am J Public Health 2005;95:97-81): http://www.ajph.org/cgi/eletters/95/11/1976

2. Interpreting changes in mortality differences.  J Epidemiol Community Health  Sep. 8, 2005 (responding to Shaw C, Blakely T, Atkinson J, Crampton P. Do social and economic reforms change socioeconomic inequalities in child mortality?  A case study: New Zealand, 1981-1999.  J Epidemiol Community Health 2005;59:638-644): http://jech.BMJ.com/cgi/eletters/59/8/638

1. Appraising the size of racial differences in mortality.  Health Affairs Aug. 23, 2005 (responding to Satcher D, Fryer GE, McCann J, et al.  What if we were equal?  A comparison of the black-white mortality gap in 1960 and 2000.  Health Affairs 2005;24(2):459-564): http://content.healthaffairs.org/cgi/eletters/24/2/459