Doctoral Dissertation Research: Application of Markov Chain Theory to Identify Health Disparities

Columbia University, New York NY

Investigators

Abstract

Chronic diseases pose major health and economic burdens for Americans. Not only are chronic diseases the leading causes of disability and death, but they also account for approximately 75% of total health care costs in the United States. Building upon existing life table-based methodologies, this project will use models of chronic disease progression that incorporate current biological understanding of chronic diseases and Markov Chain theory, a statistical theory used to describe discrete stochastic processes, to model individuals' chance of transitioning across different disease progression-related health states. This project has two objectives. First, the project will design biologically plausible models of chronic disease progression for diabetes and chronic obstructive pulmonary disease (COPD) complemented by surveillance data to inform disease-specific multistate life tables. Second, the project will use Markov Chain Theory to estimate the likelihood of transitioning across the health states of these biologically plausible models conditional on age and sociodemographic factors and calculate health-state specific life expectancies. In collaboration with South Carolina's Office of Research and Statistics, the project also will apply this methodology to statewide data on State Health Plan recipients from 1999 to 2008, complemented by information on mortality from the state death registry and the National Death Index - Plus. The intellectual merit of this research is its interdisciplinary construct, which combines biological models of chronic disease progression, statistical theories of stochastic processes, social theories of the fundamental causes of health disparities, and epidemiologic knowledge of population health. Broader impacts of this research include the potential benefits to public health professionals of a methodology for identifying health disparities in the lifetime burden of specific chronic diseases. In addition, it is likely that this methodology will be generalizable to other chronic diseases and to other populations. As a Doctoral Dissertation Research Improvement award, support is provided to enable a promising student to establish a strong, independent research career.