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Midcourse Assessment of Healthy People 2010 Goal II Suzanne P. Hallquist, MSPH Kenneth G. Keppel,...
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Midcourse Assessment of Healthy People 2010 Goal II
Suzanne P. Hallquist, MSPHKenneth G. Keppel, PhD
National Center for Health StatisticsCenters for Disease Control and Prevention
NCHS Data Users ConferenceJuly 12, 2006
Healthy People 2010 Goal II
“… to eliminate health disparities among
segments of the population, including
differences that occur by gender, race or
ethnicity, education or income, disability,
geographic location, or sexual orientation.”
- Healthy People 2010: Understanding and Improving Health, U.S. Department of Health and Human Services, 2000.
Population Data Template
Race and ethnicity
Gender
Family income level
Education level
Geographic location*
Disability status*FemaleMale
Less than high schoolHigh school graduateAt least some college
PoorNear poorMiddle/high income
Urban/metropolitanRural/non-metropolitan
Persons with disabilitiesPersons without disabilities
American Indian/ Alaska NativeAsian/Pacific IslanderAsian Native Hawaiian/ other Pacific Islander Two or more races Hispanic or LatinoBlack not HispanicWhite not Hispanic
* Optional
Measuring Health Disparities:Key Issues
• Choice of reference point
Another group rate Average population rate Total population rate 2010 target “Best” group
• Absolute vs. relative statistics
Midcourse Review (MCR)Disparity Assessment
Purpose of Assessment
• Assess the availability of data for population groups and characteristics
• Quantify the size of disparities at the most recent data point
• Quantify the size and direction of changes in disparity between the baseline and the most recent data point
• Summarize findings by population group and characteristic
Scope of Assessment
• 27 of 28 focus areas
• 498 population-based objectives
• Five characteristics:
Race/ethnicity
Gender
Education or income level
Geographic location
Disability
Data Availability
Race and ethnicity (498):
Gender (412):
Family income level (285):
Education level (244):
Geographic location* (68):
Disability status* (183):FemaleMale
Less than high schoolHigh school graduateAt least some college
PoorNear poorMiddle/high income
Urban/metropolitanRural/non-metropolitan
Persons with disabilitiesPersons without disabilities
American Indian/ Alaska NativeAsian/Pacific IslanderAsian Native Hawaiian/ other Pacific Islander Two or more races Hispanic or LatinoBlack not HispanicWhite not Hispanic
* Optional
DRAFT
Am
eric
an I
ndia
n or
Ala
ska
Nat
ive
Asi
an
Nat
ive
Haw
aiia
n or
oth
erP
acif
ic I
slan
der
Tw
o or
mor
e ra
ces
His
pani
c or
Lat
ino
Bla
ck, n
ot H
ispa
nic
Whi
te, n
ot H
ispa
nic
Su
mm
ary
ind
ex
Fem
ale
Mal
e
Les
s th
an h
igh
scho
ol
Hig
h sc
hool
gra
duat
e
At l
east
som
e co
lleg
e
Su
mm
ary
ind
ex
Urb
an o
r m
etro
poli
tan
Rur
al o
r no
nmet
ropo
lita
n
Per
sons
wit
h di
sabi
liti
es
Per
sons
wit
hout
dis
abil
itie
s
Diabetes education: 18+ years
(1998, 1999) * 1 B B B B B
New cases of diabetes: 18-64 years(1997-99, 2000-02) * B B B B B
5-3. Overall cases of diabetes (1997, 2003) * ↓ B B ↓↓ ↓ B ↓ B B
Diagnosed diabetes: 20+ years
(1988-94, 1999-2000) † b
2 B B B ↑ ↑ ↑ B3
B3 B
Diabetes-related deaths(1999, 2002) * ↓ B ↑ B
Diabetes-related deaths: persons with diabetes (1999, 2002) * b B B
Cardiovascular deaths: persons with diabetes (1999, 2002) * B ↑ ↓ B ↓ B ↓
Focus Area 5. Diabetes: Disparities from the "best" group rate for each characteristic at the most recent data point and changes in disparity from the baseline to the most recent data point
5-7.
Race and ethnicity
5-5.
5-6.
B4
Gender Geog. Disability Education level
Population-based objectives 5-1.
5-2.
5-4.
Characteristics
Percent Difference
Measures disparity between two groups
RB is the “best” group rate
Ri is the comparison group rate
Ri - RBx 100
RB
Less than 10% or not statistically significant
10-49%
50-99%
100% or more
Decoding the Disparity Table
• “B” identifies the “best” group
• Colors indicate the size of the disparity between the individual group and the “best” group rate at the most recent data point:
Percent difference:
DRAFT
Am
eric
an I
ndia
n or
Ala
ska
Nat
ive
Asi
an
Nat
ive
Haw
aiia
n or
oth
erP
acif
ic I
slan
der
Tw
o or
mor
e ra
ces
His
pani
c or
Lat
ino
Bla
ck, n
ot H
ispa
nic
Whi
te, n
ot H
ispa
nic
Su
mm
ary
ind
ex
Fem
ale
Mal
e
Les
s th
an h
igh
scho
ol
Hig
h sc
hool
gra
duat
e
At l
east
som
e co
lleg
e
Su
mm
ary
ind
ex
Urb
an o
r m
etro
poli
tan
Rur
al o
r no
nmet
ropo
lita
n
Per
sons
wit
h di
sabi
liti
es
Per
sons
wit
hout
dis
abil
itie
s
Diabetes education: 18+ years
(1998, 1999) * 1 B B B B B
New cases of diabetes: 18-64 years(1997-99, 2000-02) * B B B B B
5-3. Overall cases of diabetes (1997, 2003) * ↓ B B ↓↓ ↓ B ↓ B B
Diagnosed diabetes: 20+ years
(1988-94, 1999-2000) † b
2 B B B ↑ ↑ ↑ B3
B3 B
Diabetes-related deaths(1999, 2002) * ↓ B ↑ B
Diabetes-related deaths: persons with diabetes (1999, 2002) * b B B
Cardiovascular deaths: persons with diabetes (1999, 2002) * B ↑ ↓ B ↓ B ↓
Focus Area 5. Diabetes: Disparities from the "best" group rate for each characteristic at the most recent data point and changes in disparity from the baseline to the most recent data point
5-7.
Race and ethnicity
5-5.
5-6.
B4
Gender Geog. Disability Education level
Population-based objectives 5-1.
5-2.
5-4.
Characteristics
Decoding the Disparity Table
• Arrows indicate the size and direction of the change in disparity between the baseline and MR data points
< 10 or not statistically significant
10-49
50-99
100
DisparityIncreasing
DisparityDecreasing
Magnitude of Change inPercentage Points
DRAFT
Am
eric
an I
ndia
n or
Ala
ska
Nat
ive
Asi
an
Nat
ive
Haw
aiia
n or
oth
erP
acif
ic I
slan
der
Tw
o or
mor
e ra
ces
His
pani
c or
Lat
ino
Bla
ck, n
ot H
ispa
nic
Whi
te, n
ot H
ispa
nic
Su
mm
ary
ind
ex
Fem
ale
Mal
e
Les
s th
an h
igh
scho
ol
Hig
h sc
hool
gra
duat
e
At l
east
som
e co
lleg
e
Su
mm
ary
ind
ex
Urb
an o
r m
etro
poli
tan
Rur
al o
r no
nmet
ropo
lita
n
Per
sons
wit
h di
sabi
liti
es
Per
sons
wit
hout
dis
abil
itie
s
Diabetes education: 18+ years
(1998, 1999) * 1 B B B B B
New cases of diabetes: 18-64 years(1997-99, 2000-02) * B B B B B
5-3. Overall cases of diabetes (1997, 2003) * ↓ B B ↓↓ ↓ B ↓ B B
Diagnosed diabetes: 20+ years
(1988-94, 1999-2000) † b
2 B B B ↑ ↑ ↑ B3
B3 B
Diabetes-related deaths(1999, 2002) * ↓ B ↑ B
Diabetes-related deaths: persons with diabetes (1999, 2002) * b B B
Cardiovascular deaths: persons with diabetes (1999, 2002) * B ↑ ↓ B ↓ B ↓
Focus Area 5. Diabetes: Disparities from the "best" group rate for each characteristic at the most recent data point and changes in disparity from the baseline to the most recent data point
5-7.
Race and ethnicity
5-5.
5-6.
B4
Gender Geog. Disability Education level
Population-based objectives 5-1.
5-2.
5-4.
Characteristics
Summary Index
PDi is the percent difference from the “best” group rate for each comparison group rate (i)
n-1 is the number of groups minus 1
Measures disparity among several groups
∑i PDi
n – 1
DRAFT
Am
eric
an I
ndia
n or
Ala
ska
Nat
ive
Asi
an
Nat
ive
Haw
aiia
n or
oth
erP
acif
ic I
slan
der
Tw
o or
mor
e ra
ces
His
pani
c or
Lat
ino
Bla
ck, n
ot H
ispa
nic
Whi
te, n
ot H
ispa
nic
Su
mm
ary
ind
ex
Fem
ale
Mal
e
Les
s th
an h
igh
scho
ol
Hig
h sc
hool
gra
duat
e
At l
east
som
e co
lleg
e
Su
mm
ary
ind
ex
Urb
an o
r m
etro
poli
tan
Rur
al o
r no
nmet
ropo
lita
n
Per
sons
wit
h di
sabi
liti
es
Per
sons
wit
hout
dis
abil
itie
s
Diabetes education: 18+ years
(1998, 1999) * 1 B B B B B
New cases of diabetes: 18-64 years(1997-99, 2000-02) * B B B B B
5-3. Overall cases of diabetes (1997, 2003) * ↓ B B ↓↓ ↓ B ↓ B B
Diagnosed diabetes: 20+ years
(1988-94, 1999-2000) † b
2 B B B ↑ ↑ ↑ B3
B3 B
Diabetes-related deaths(1999, 2002) * ↓ B ↑ B
Diabetes-related deaths: persons with diabetes (1999, 2002) * b B B
Cardiovascular deaths: persons with diabetes (1999, 2002) * B ↑ ↓ B ↓ B ↓
Focus Area 5. Diabetes: Disparities from the "best" group rate for each characteristic at the most recent data point and changes in disparity from the baseline to the most recent data point
5-7.
Race and ethnicity
5-5.
5-6.
B4
Gender Geog. Disability Education level
Population-based objectives 5-1.
5-2.
5-4.
Characteristics
Summary by Size of Disparity
DRAFT
Am
eric
an I
ndia
n or
Ala
ska
Nat
ive
Asi
an
Nat
ive
Haw
aiia
n or
oth
erP
acif
ic I
slan
der
Tw
o or
mor
e ra
ces
His
pani
c or
Lat
ino
Bla
ck, n
ot H
ispa
nic
Whi
te, n
ot H
ispa
nic
Su
mm
ary
ind
ex
Fem
ale
Mal
e
Les
s th
an h
igh
scho
ol
Hig
h sc
hool
gra
duat
e
At l
east
som
e co
lleg
e
Su
mm
ary
ind
ex
Urb
an o
r m
etro
poli
tan
Rur
al o
r no
nmet
ropo
lita
n
Per
sons
wit
h di
sabi
liti
es
Per
sons
wit
hout
dis
abil
itie
s
Diabetes education: 18+ years
(1998, 1999) * 1 B B B B B
New cases of diabetes: 18-64 years(1997-99, 2000-02) * B B B B B
5-3. Overall cases of diabetes (1997, 2003) * ↓ B B ↓↓ ↓ B ↓ B B
Diagnosed diabetes: 20+ years
(1988-94, 1999-2000) † b
2 B B B ↑ ↑ ↑ B3
B3 B
Diabetes-related deaths(1999, 2002) * ↓ B ↑ B
Diabetes-related deaths: persons with diabetes (1999, 2002) * b B B
Cardiovascular deaths: persons with diabetes (1999, 2002) * B ↑ ↓ B ↓ B ↓
Focus Area 5. Diabetes: Disparities from the "best" group rate for each characteristic at the most recent data point and changes in disparity from the baseline to the most recent data point
5-7.
Race and ethnicity
5-5.
5-6.
B4
Gender Geog. Disability Education level
Population-based objectives 5-1.
5-2.
5-4.
Characteristics
100 or more
50 to 99
10 to 49
Less than 10
Best group
Race and Ethnicity
Percent of objectives Percent difference from the “best” group rate:
0
20
40
60
80
100
or A
laska
Nat
ive
othe
r Pac
ific Is
land
er
DRAFT
0
20
40
60
80
100
Less thanhigh school
High schoolgraduate
At least somecollege
100 or more
50 to 99
10 to 49
Less than 10
Best group
Education Level
Percent of objectives
DRAFT
Percent difference from the “best” group rate:
Race/ethnicity Asian or Pacific Islander
Gender Female
EducationAt least some college education
Income Middle/high income
Geographic location Urban or metropolitan
Disability statusPersons without disabilities
Groups that have the “Best” Rate for the Greatest Proportion of Objectives
DRAFT
Groups with the Greatest Proportion of Disparities that are > 100 Percent
Characteristic GroupPercent (no.) of objectives
Race/ethnicity American Indian/ Alaska Native 24% (37)
Gender Male 8% (24)
Education Less than high school 25% (40)
Income Poor 12% (12)
Geographic location Urban or metropolitan 8% (4)
Disability status Persons with disabilities 6% (4)
DRAFT
Summary by Change in Disparity
Number of Objectives with No Change* in Disparity by Population Characteristic
DRAFT
Characteristic Total NNumber (%) with
No Change
Race/ethnicity 200 162 (81%)
Gender 238 198 (83%)
Education 109 92 (84%)
Income 53 52 (98%)
Geog. location 38 35 (92%)
Disability status 48 45 (94%)
* Changes in disparity are measured from baseline to most recent data point.
Number of Objectives with Changes* in Disparityby Race and Ethnicity
* Changes in disparity are measured from baseline to most recent data point.
DRAFT
162 23
15
7
2
14
Decreasing
10-49
50-99
More the 100
10
Increasing
10-49
50-99More the 100
32
No ChangePercentage points
Percentage points
Number of Objectives with Changes* in Disparityby Education Level
* Changes in disparity are measured from baseline to most recent data point.
DRAFT
9214
3
3
Decreasing
13
Increasing
10-49
50-991
Percentage points
Percentage points
10-49
No Change
Summary of Findings
• Substantial disparities between population groups are evident for many objectives
• Few changes in disparity since the baseline
• Overall, no consistent pattern of change in disparity for any population group (except males)
Limitations
• Short time period of analysis
• Number of years available for assessment varied by population characteristic
• Lack of data for:- Specific characteristics
- Specific groups
• Lack of estimates of variability for some objectives
Limitations
• Disparity analysis focuses on differences between groups, regardless of whether or not the rates for specific groups are moving towards or away from the target
• Summary counts and charts, while helpful, mask the objective-specific successes and failures
New Cases of Hepatitis A, United States, 1997-2003
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003
New cases per 100,000 population
Source: STD Surveillance System, NCHSTP,CDC
2010 target (4.3)
HispanicAmerican Indian/Alaska NativeBlack, not HispanicWhite, not HispanicAsian/Pacific Islander
Objective 14-06
Conclusions
• Healthy People 2010 has developed a consistent framework for measuring disparities
• Healthy People 2010 Midcourse Review
First comprehensive assessment of disparity for Healthy People
Document to be published in Fall 2006
Contact Information
Suzanne Proctor HallquistCDC/National Center for Health Statistics3311 Toledo Road, Room 6315Hyattsville, MD 20782