Health Disparities in MA Council for the Elimination of Racial and Ethnic Disparities.
-
Upload
brittany-hicks -
Category
Documents
-
view
229 -
download
0
Transcript of Health Disparities in MA Council for the Elimination of Racial and Ethnic Disparities.
Health Disparities in MA
Council for the Elimination of Racial and Ethnic Disparities
2
Racial and Ethnic Disparities in Health Outcomes Are Seen Consistently in
Massachusetts
• Such disparities are particularly apparent in premature or excessive death rates for cancer, HIV, diabetes and asthma and in higher hospitalizations rates for many diseases and conditions
• Disparities are seen across the Commonwealth – in all corners of the State
• The causes of these disparities are multiple, including poverty, lack of acess to care and racism, discrimination and the legacy of slavery
3
Race and Ethnic Breakdown of PopulationCentral Region and Massachusetts: 2005
Central Region Massachusetts
White*
86.0%
Black*
3.2%
Hispanic
7.3%
Asian*
3.3%
* Non-Hispanics
White*
81.0%
Black*
6.0%
Hispanic
7.9%
Asian*
4.9%
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
American Indian*
0.3%
American Indian*
0.2%
Population Total = 806,015 Population Total = 6,349,097
4
Black*6.0%
Hispanic7.9%
Asian*4.9%
White*81.0%
American Indian*0.2%
Race and Ethnic Breakdown of PopulationWorcester and Massachusetts: 2005
White*, 66.7
Black*, 8.6
Hispanic, 17.4
Asian*, 7.0
American Indian*,
0.4
Worcester
* Non-Hispanics
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Massachusetts
Population Total = 6,349,097Population Total = 172,648
5
WORCESTER 13%
FITCHBURG 13%
SOUTHBRIDGE 17%
HARVARD 7%
LANCASTER 8%
LEOMINSTER 10%
SHIRLEY 8%
WEST BOYLSTON 6%
CLINTON 10%
Spanish LanguageSpoken at Home (%)
Cities/Towns in Central Region
10.0% - 55.3%
5.0% - 9.9%
0.2% - 4.9%
Central Region
5
Miles
Spanish Spoken at Home
Central Region: 2000
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Examples of Racial and Ethnic Disparities
7
8
Diabetes
9
32
123 121
54 64
0
25
50
75
100
125
150
175
200
225
2005
Age a
dju
sted r
ate
per
1000
Asian Hispanic Black (NH) White Total
Prevalence of Diabetes in Massachusetts Varies Significantly by Race/Ethnicity
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
10
Diabetes Hospital Discharges, 2003-2005
133114
368
242
45
0
50
100
150
200
250
300
350
400
Hospital discharge rate
Ra
te p
er
10
0,0
00
MA White Black Hispanic Asian
Source: Division of Health Care Finance and Policy, Inpatient Hospital Discharge Database
11
Mortality Rates for Diabetes as the Primary Cause of Death, by Race, 1994 - 2004
47.8 43.9 43.0
54.546.1 42.9
34.3
44.6 42.6 45.7
34.7
16.723.8 20.5
26.8 25.9
36.142.4
25.8
41.0
30.7 26.8
12.7
23.515.1
19.7 19.211.7 11.3
22.216.7 19.7 17.9
0
1020
30
4050
60
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Years
Rate
per
100,0
00
White, NH Black, NH Hispanic Asian/Pacific Islander, NH
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
Mortality Rates are Much Higher for Blacks and Hispanics
12
Diabetes Mortality Rates, 2003-2005
18 17
38
29
14
0
50
Age-Adjusted Death Rate
Ra
te p
er
10
0,0
00
MA White Black Hispanic Asian
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
13
3.5 3.6
4.3
6.7
2.5
3.7
3.0
5.2
0
2
4
6
8
White Non-Hispanic
Hispanic Black Non-Hispanic
Asian
%G
DM
2000 2006
GDM by Race and Hispanic EthnicityMassachusetts: 2000 vs. 2006
* Statistically higher than 2000 rate (p<0.05)
N=
1,8
30
N=
1,4
85
N=
211
N=
277
N=
238
N=
379
N=
274 N
=3
68
*
*
14
Asthma
15
Age-Adjusted Asthma ED Visits and Hospitalizations by Race/Ethnicity
2003-2005
676
1564 1524
235
783
227
2080
841
2276
1038
0
500
1000
1500
2000
White Black Hispanic Asian MA
Rat
e p
er 1
00,0
00
ED Visits Hospitalizations
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
16
Age-Adjusted Asthma Mortality, 2003-2005
1.0
2.72.5
1.31.1
0
1
2
3
White Black Hispanic Asian MA Total
Rat
e p
er 1
00,0
00
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
17
Cancer
18
Age-Adjusted Cancer Incidence, MA Males, 2000-2004
87 89
49 5070
54 49 47
244
301
135121
272
171184
78
0
50
100
150
200
250
300
White Black Hispanic Asian
Rat
e p
er 1
00,0
00
Prostate Lung Colon All CA Deaths
Source: MDPH, MA Cancer Registry
19
Age-Adjusted Cancer Incidence, MA Females, 2000-2004
64
48
27 30
50 4636 34
173 176
92 91103
140
93
69
0
50
100
150
200
White Black Hispanic Asian
Rat
e p
er 1
00,0
00
Breast Lung Colon All CA Deaths
Source: MDPH, MA Cancer Registry
20
Birth outcomes
21
4.2
5.8
11.1
0
2
4
6
8
10
12
14
16
18
20
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
IMR
(#
de
ath
s/1
,00
0 li
ve
bir
ths
)IMR by Race & Hispanic Ethnicity
Massachusetts: 1990-2006
White Non-Hispanic
Black Non-Hispanic
Hispanic
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
22
HIV
23
People Diagnosed with HIV Infection by Gender and Race/Ethnicity: Massachusetts, 2004-2006
48%
18%
25%
50%
25%29%
3% 3%
0%
10%
20%
30%
40%
50%
60%
Male FemaleRace/Ethnicity
Pe
rce
nt
of
To
tal H
IV D
iag
no
se
s
White (non-Hispanic) Black (non-Hispanic)Hispanic Other
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07
24
Females Diagnosed with HIV Infection by Race/Ethnicity and Place of Birth:
Massachusetts,2004-2006
88%
35% 37%
36%
11%
65%
27%1%
0%
0%
20%
40%
60%
80%
100%
White NH, N=130 Black NH, N=354 Hispanic, N=204
Race/Ethnicity
Pe
rce
nt
of
To
tal D
iag
no
se
s
US Puerto Rico/US Dependency Non-US1 97% of people diagnosed with HIV infection from 2004-2006 that were born in a US Dependency were born in Puerto Rico; NH=Non-Hispanic; Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07
1
25
Percentage of HIV Cases Among 13-24 Year Olds, by Race/Ethnicity: 1999–20061
0%
10%
20%
30%
40%
50%
60%
70%
1999 2000 2001 2002 2003 2004 2005 2006
Year of Diagnosis
Percent
White Black Hispanic Other
White NH
Black NH
Hispanic
Other
1
2006 Data are preliminary; Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 11/1/07
26
People Diagnosed with HIV Infection by Age at Diagnosis & Race/Ethnicity: Massachusetts, 2003-2005
26%
40%44%
32%
26% 25%
3% 3%
0%
10%
20%
30%
40%
50%
60%
13-24 years, N=201 25+ years, N=2461
Pe
rce
nt
of
To
tal H
IV D
iag
no
se
s
White Black Hispanic Other
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 7/06
Violence in Massachusetts
28
550521
355
445
416
356
245
133
167 154 162
222
179 177
268
341
616
100
200
300
400
500
600
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Gun Violence in Boston Homicides & Non-Fatal Shootings
(1990 - PRESENT)
DATA SOURCE: Councilor Ross (5.06 Presentation)
# o
f S
ho
oti
ng
s
Year
29
Nonfatal Gunshot Injuries by Race/Ethnicity Boston, 2003-2005 Combined
White, 4.5%
Other/Unknown 6.0%
Latino, 12.9%
Cape Verdean, 2.2%
Asian/Pac Isl, 1.0%
Black, 73.5%
DATA SOURCE: Weapon-related injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office
Black Bostonians are 24% of total population and 74% of victims of gunshots
Disparities Are Seen Across the
Commonwealth
31
Diabetes Hospital Discharge Rate by Race/Ethnicity
Western Region and Massachusetts: 2003-2005
368
114118
452
396
242
4536
0
50
100
150
200
250
300
350
400
450
500
Western Region Massachusetts
Dis
char
ges
p
er 1
00,0
00
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
*
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state
32
Diabetes Death Rate by Race/EthnicityCentral Region and Massachusetts: 2003-2005
17
37 39
49
29
37
14
22
0
10
20
30
40
50
60
Central Region Massachusetts
De
ath
s p
er
10
0,0
00
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
33
Diabetes Hospital Discharge Rate by Race/Ethnicity
Berkshires, Pittsfield & Massachusetts: 2003-2005
114
368242
45181122
1,584
975
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
Berkshires Pittsfield Massachusetts
Dis
char
ges
p
er 1
00,0
00
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state
*
NA NA NA NA
*
34
Infant Mortality Rates by Race/Ethnicity Western Region and Massachusetts: 2002-2005
NA= Calculations based on less than 5 events are excluded
4.1*4.5
11.3 *
15.1*
8.0*7.0 *
3.0*
0
2
4
6
8
10
12
14
16
Western Region Massachusetts
De
ath
s p
er
10
00
liv
e b
irth
s
White^ Black^ Hispanic Asian^
NA
(*) Statistically different from State (p ≤.05)
Source: MDPH, Bureau of Health Information, Statistics, Research, & Evaluation Bureau, Division of Research & Epidemiology
State Overall:
4.9
^ = Non-Hispanic
35
HIV/AIDS Death Rate by Race/EthnicityWestern Region and Massachusetts: 2003-2005
1 2
1916
13
1
29
0
5
10
15
20
25
30
35
Western Region Massachusetts
De
ath
s p
er
10
0,0
00
White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic
NA
*
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program
36
Asthma Emergency Department Visit Rates Children Ages 0-14
Western Region and Massachusetts: 2005
2,096
238
569 516
1,683
2,196
1,573
356
0
500
1,000
1,500
2,000
2,500
Western Region Massachusetts
Vis
its
per
100
,000
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
**
*
Age-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Department Visits
Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower
The Health Profiles of Each Racial and Ethnic Group and Sub-group
are Different
38
39
40
41
Brazilian 45.3%
Nigerian 42.9%
Haitian 41.0%
Filipino 39.8%
Asian Indian 37.7%
European 35.2%
MA 33.4%
Chinese 29.7%
African-American 29.4%
Puerto Rican 27.6%
Vietnamese 27.4%
Japanese 26.1%
Colombian 24.1%
Honduran 23.0%
Salvadoran 22.7%
Guatemalan 21.7%
Cambodian 17.4%
0% 10% 20% 30% 40% 50% 60% 70%
Cesarean Rate by Maternal Ethnicity1,Massachusetts 2006
1 Only ethnic groups statistically different from the state rate are included
**
**
**
****
**
* Statistically higher than state rate (p ≤.05)** Statistically lower than state rate (p<.05)
****
********
**
42
What are the contributing factors?
Social and economic determinants of health matter
44
45
46Source: NEHI/Boston Foundation: Boston Paradox
3+ fold variatio
n
$75,000 +
<$25,000
Substantial Variation in Diabetes Rates by Household Income
47
Diabetes by Education, 2006
6.47.9
15.6
5.44.4
0
5
10
15
20
25
< HS HS grad 1-3 years college 4+ years college MA
Per
cen
t
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program
48
49
The Experience of Racism and Discrimination
2.9%
18.1%20.8%
0.0%
10.0%
20.0%
30.0%
40.0%
Black Latino White
Pe
rce
nta
ge
o
f re
sp
on
de
nts
8.3%4.0% 1.9%
0.0%
10.0%
20.0%
30.0%
40.0%
Black Latino White
Pe
rce
nta
ge
of
res
po
nd
en
ts
Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity
Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity
Note: Data about Asian residents not shown due to inadequate sample sizeSOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission
50
51