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

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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

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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

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abil

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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

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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

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Per

sons

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sabi

liti

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Per

sons

wit

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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

sop9@cdc.gov