Key Facts: Race, Ethnicity, and Medical Care - Chartbook · Figure 27 No Usual Source of Health Care: Adults 18–64 by Race/Ethnicity and Poverty Status, 2003–2004 . . .22 Figure

January 2007

Key FactsRace, Ethnicity &

Medical Care

Prepared by

Cara James, Megan Thomas, and Marsha Lillie-Blanton of The Henry J. Kaiser Family Foundation, and Rachel Garfield of Harvard University.

Acknowledgments

Special thanks to Diane Rowland for her review and comments, Cathy Hoffman and Karyn Schwartz for their analytic support, Sarah Carkhuff for her editorial assistance, and Ardine Hockaday for graphic design and layout.

Key FactsRace, Ethnicity &

Medical Care

January 2007

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Section 1 Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Figure1 PercentDistributionofU .S .PopulationbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Figure2 DistributionofU .S .PopulationbyRace/Ethnicity,2000and2050 . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Figure3 ShareofPopulationthatisaRacial/EthnicMinoritybyState,2004–2005 . . . . . . . . . . . . . . . . . . . . 5

Figure4 PovertyStatusofNonelderlyPopulationbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Figure5 PovertyStatusofElderlyPopulationbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Section 2 Health Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Figure6 FairorPoorHealthStatusbyRace/Ethnicity,2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Figure7 FairorPoorHealthStatusbyRace/EthnicityandIncome,2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Figure8 InfantMortalityRatebyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Figure9 InfantMortalityRatesforMothersAge20+byRace/EthnicityandEducation,2001–2003 . . . . . . . . 9

Figure10 MortalityRatiosbyAge,Gender,andRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Figure11 DeathRateduetoHeartDiseasebyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Figure12 CancerDeathRatesbyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Figure13 LeadingCausesofDeathbyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Figure14 DiabetesPrevalenceAmongAdultsAge20andOver,byRace/Ethnicity,2001–2004 . . . . . . . . . . . 12

Figure15 OverweightandObesityRatebyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Section 3 Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Figure16 HealthInsuranceCoverageoftheNonelderlybyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . 14

Figure17 HealthInsuranceCoverageoftheLow-IncomeNonelderlyPopulationbyRace/Ethnicity,2005 . . . 14

Figure18 HealthInsuranceCoverageoftheNonelderlybyAgeandRace/Ethnicity,2005 . . . . . . . . . . . . . . . 15

Figure19 NonelderlyMedicaidBeneficiariesbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Figure20 MedicaidCoverageoftheNonelderlybyAge,Gender,andRace/Ethnicity,2005 . . . . . . . . . . . . . . 16

Figure21 MedicareBeneficiariesbyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Figure22 NonelderlyUninsuredbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure23 UninsuredRatesAmongtheNonelderlybyIncomeandRace/Ethnicity,2005 . . . . . . . . . . . . . . . . 17

Figure24 UninsuredRatesAmongWorkersbyRace/Ethnicity,2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure25 NonelderlyUninsuredRatesbyStateandRace/Ethnicity,2004–2005 . . . . . . . . . . . . . . . . . . . . . . 19

Section 4 Preventive and Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Figure26 NoUsualSourceofHealthCare:Adults18–64byRace/Ethnicity,1993–1994and2003–2004 . . . . 22Figure27 NoUsualSourceofHealthCare:Adults18–64byRace/EthnicityandPovertyStatus,2003–2004 . . . 22Figure28 NoHealthCareVisitsWithinthePast12MonthsbyRace/Ethnicity,1997and2004 . . . . . . . . . . . 23

Figure29 NoHealthCareVisitsWithinthePast12MonthsbyRace/EthnicityandPovertyStatus,2004 . . . 23

Figure30 LateorNoPrenatalCarebyRace/Ethnicity1990and2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure31 LateorNoPrenatalCarebyHispanicSubgroup,2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure32 NoDentalVisitinthePastYearbyRace/Ethnicity,2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Continued on next page

Figure33 NoDentalVisitinthePastYearbyRace/EthnicityandPovertyStatus,2004 . . . . . . . . . . . . . . . . . 25

Figure34 NoMammogramWithinthePast2YearsbyRace/Ethnicity,1994and2003 . . . . . . . . . . . . . . . . . 26

Figure35 NoPapSmearWithinthePast3YearsbyRace/Ethnicity,1994and2003 . . . . . . . . . . . . . . . . . . . 26

Figure36 CancerScreeningRatesbyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Figure37 HighBloodPressureandCholesterolScreeningbyRace/Ethnicity,2003 . . . . . . . . . . . . . . . . . . . . 27

Section 5 Specialty Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

DiabetesFigure38 ReceiptofRecommendedTestsforDiabetesbyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . . 30

Figure39 HospitalAdmissionsforUncontrolledDiabetesbyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . 31

Figure40 RateofDiabetesRelatedEnd-StageRenalDiseaseamongDiabetics,2002 . . . . . . . . . . . . . . . . . . 31

HIV/AIDSFigure41 HIVTestingRateofAdultsAges18–64byRace/Ethnicity,2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Figure42 OddsofHealthServicesUseAmongPersonswithHIV/AIDSinCarebyRace/Ethnicity,2000–2002 . . . . 33

Figure43 NewAIDSCasesandHIV-InfectionDeathsbyRace/Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

AsthmaFigure44 PrevalenceofEverHavingAsthmabyRace/Ethnicity,2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Figure45 AdultAsthmaControlProblemsbyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Figure46 HospitalAdmissionsforAsthmabyRace/Ethnicity,2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Section 6 Tracking Changes in Quality and Access Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Figure47 ComparisonofQualityofCareMeasuresforMinorityPopulationGroupsvs .Whites . . . . . . . . . . . 38

Figure48 ComparisonofAccesstoCareMeasuresforMinorityPopulationGroupsvs .Whites . . . . . . . . . . . 38

Figure49 ChangesinQualityofCareDisparitiesOverTime:SummarybyRace/Ethnicity . . . . . . . . . . . . . . . 39

Table1 WorseningQualityofCareDisparitiesbyRace/Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Appendix Distribution of U .S . Population by Race/Ethnicity, With and Without Territories . . . . . . . . . . . . . 42

Data Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

1

INTRODUCTION

ThisupdateofKey Facts: Race, Ethnicity, and Medical Care,likeitspredecessors,isintendedtoserveasaquickreferencesourceonthehealth,healthinsurancecoverage,accessandqualityofhealthcareofracialandethnicgroupsintheUnitedStates .Thedocumenthighlightssomeofthebestavailabledataandresearchintheseareas .

Sincethefirsteditionof Key Factsin1999,theissueofracial/ethnicdisparitiesinhealthcarehasreceivedasignificantlevelofattention .TheInstituteofMedicinereleasedUnequal Treatmentin2002summarizingtheresearchtodateonracialandethnicdisparitiesinhealthcareandofferingguidanceastowhatquestionsremainedunansweredandwhatinformationwasneededtoanswerthosequestions .TheAgencyforHealthcareResearchandQuality(AHRQ)releasedthefirstNational Healthcare Disparities Report (NHDR)in2003 .Thereport,whichisissuedannuallybyAHRQ,providesacomprehensivereviewofdisparitiesinhealthcareamongracial,ethnic,andsocioeconomicgroupsintheUnitedStates .

Asmoreinformationhasbecomeavailableonhealthcaredisparities,thefocusofresearchhasturnedfromdocumentingdisparitiestotryingtounderstandtheircausesanddevelopinginterventionstoalleviatethem .Thisisnottosaythatdocumentationoftheproblemisnolongerneeded .Dataarestilllimitedforsomeracialandethnicsubgroups,andforindividualswhoself-identifywithmorethanoneracialgroup .Assuch,informationthatdocumentshealthcaredisparitiesisimportanttounderstandingwhereprogresshasbeenmadeandthechallengesthatremain .ThisversionofKey Facts,wherepossible,highlightsdatathatshowwhetherhealthcaredisparitiesarenarrowing,widening,orpersistingforspecificracial/ethnicgroupsandpresentsnewlycollecteddataforpeoplewhoidentifywithmorethanoneracialgroup .

Key Factsisdividedintosixsections,beginningwithanoverviewofthedemographiccharacteristicsoftheU .S .population .Section2presentshealthmeasures,stratifiedwhenpossiblebyameasureofsocioeconomicstatus .Section3profilespatternsofhealthinsurancecoverage .Section4offersapictureofthedataastheyrelatetopreventiveandprimarycare .Section5focusesonthreemedicalconditions:diabetes,HIV/AIDS,andasthma .Finally,Section6presentsfindingsfromthe2005 NHDRthatareusefulintrackingnationalchangesinhealthcaredisparitiesovertime .

Section 1Demographics

TheUnitedStatesisraciallyandethnicallydiverse,andthenation’sdiversityisgrowingovertime .Asof2005,nearlyone-thirdoftheU .S .populationidentifiedthemselvesasamemberofaracialorethnicminoritygroup;by2050,thisshareisexpectedtoincreasetonearlyhalf .Theracialandethniccompositionofthepopulationvariesbystate,withstatesintheWestandSouthhavingthehighestsharesofminorityresidents .Peopleofcoloraremorelikelythannon-HispanicWhitestohavelow-incomes,whichmayhaveimplicationsforboththeirhealthandinsurancestatus .

3

Bytheyear2050,theU .S .CensusestimatesthatnearlyhalfoftheU .S .populationwillbeHispanic,AfricanAmericanandAsian .TheproportionofHispanicsandAsiansintheU .S .isexpectedtodoubleinthenext50years .

4

Peopleofcolor(Hispanics,AfricanAmericans,Asians,NativeHawaiians/PacificIslanders,andAmericanIndian/AlaskaNatives)makeupnearlyathirdoftheU .S .population .Hispanicsarethelargestminoritygroupandareidentifiedbythecensusasanethnic,notracial,group .

Individualshavebeenallowedtoidentifythemselvesbymorethanoneracialcategorysincethe2000Census .However,only1%(4millionpeople)ofthenon-HispanicpopulationintheU .S .identifiedthemselvesasbeingof“Twoormoreraces”in2005 .

Figure 2

Distribution of U.S. Population by Race/Ethnicity, 2000 and 2050

69.4%

12.6%

12.7%

50.1%

24.4%

14.6%

8.0%5.3%3.8%

2000Total = 282.1 million

2050Total = 419.9 million

2.5%

White, Non-Hispanic

Hispanic

African American, Non-Hispanic

Asian Only

Other

NOTES: Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marina Islands. “Other” category includes American Indian/Alaska Native, Native Hawaiian or Other Pacific Islander, and individuals reporting “Two or more races.” African-American, Asian, and Other categories jointly double-count 1% (2000) and 2% (2050) of the population that is of these races and Hispanic; thus, totals may not add to 100%.

DATA: U.S. Census Bureau, 2004, US Interim Projections by Age, Sex, Race, and Hispanic Origin.

SOURCE: http://www.census.gov/population/www/projections/popproj.html

Asian4%

(12.4 million)

Native Hawaiians/Pacific

Islanders0%

(0.4 million) Two or more races1%

(4.0 million)

American Indian/ Alaska Native

1%(2.2 million)

White, Non-Hispanic

67%(198.4 million)

Hispanic14%

(42.7 million)


12%(36.3 million)

Total = 296.4 million

Figure 1

Percent Distribution of U.S. Populationby Race/Ethnicity, 2005

NOTES: Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Mariana Islands. For the purposes of this chart, Asians and Native Hawaiians or Other Pacific Islanders are combined into one category. Totals may not add to 100% due to rounding.

SOURCE: Table 3: Annual Estimates of the Population by Sex, Race and Hispanic or Latino Origin for the United States: April 1, 2000 to July 1, 2005 (NC-EST2005-03). Population Division, U.S. Census Bureau

ThereislargevariationinthegeographicdistributionoftheracialandethnicminoritypopulationacrosstheUnitedStates .StatesintheWestsuchasHawaii,California,andNewMexicohavesomeofthehighestpercentagesofindividualswhoareracial/ethnicminorities .Percentagesinthesestatesrangefrom55to81percentminority,whilestatesinthenortheastsuchasMaine,Vermont,andNewHampshirehavesomeofthelowestpercentages,rangingfrom1to5percent .

Peopleofcoloraremorelikelytohavefamilyincomeslessthan200%ofthefederalpovertylevelthanareWhites(which,forexample,wouldbelessthan$39,342forafamilyoffourin2005) .OverhalfofHispanics,AfricanAmericans,andAmericanIndians/AlaskaNativesarepoorornearpoor,comparedwith26%ofWhitesand33%ofAsiansandPacificIslanders .Theproportionofchildrenwhoarepoorornearpoorisevenhigher .

5

OR

AZ

HIAK

NM

TX

OK

LAMS AL

SC

NC

VAWVUT

NV

COCA

WA

ID

WY

TN

KYMO

IL

MN

WI

IANE

KS

ND

SD

IN

MI

OH PA

ME

NY

VT NH

MT

GA

FL

AR

RI

MA

CT

DENJ

MD

DC

Less than 13% (13 States)

13% to 18% (12 States)

19% to 37% (14 States)

More than 37% (12 States)

Figure 3

Share of Population that is a Racial/Ethnic Minority by State, 2004–2005

DATA: March 2006 and March 2005 Current Population Survey.

SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.


Figure 4

Poverty Status of Nonelderly Population by Race/Ethnicity, 2005

White, Non-Hispanic

Hispanic AfricanAmerican,

Non-Hispanic

Asian andPacific

Islander

AmericanIndian/Alaska

Native

Two or MoreRaces

166.6 million

40.8 million

32.6 million

11.8 million

1.5million

4.2million

Non-Poor (200%+ of FPL)

Poor (<100% of FPL)

Near Poor (100–199% of FPL)

12%

14%

74%

29%

29%

42%

33%17%

34%

21%

16%

23%

46%

68%

43%

21%

20%

59%

NOTES: Individuals who reported more than one race group were categorized as “two or more races.” Nonelderly includes individuals under age 65. FPL= Federal Poverty Level. The FPL for a family of four in 2005 was $19,971. DATA: March 2006 Current Population Survey.

6

Similarly,elderlyminorityAmericansarefarmorelikelythantheirWhitecounterpartstohavefamilyincomeslessthan200%ofthefederalpovertylevel .Nearly70%ofelderlyHispanics,two-thirdsofelderlyAfricanAmericans,andhalfofelderlyAsiansandPacificIslandersandAmericanIndian/AlaskaNativesarepoorornearpoor,comparedwith38%ofelderlyWhites .


Figure 5

Poverty Status of Elderly Population by Race/Ethnicity, 2005

White, Non-Hispanic


Non-Hispanic

Asian andPacific

Islander


Native

Two or MoreRaces

28.7 million

2.3 million

2.9 million

1.1 million

0.1million

0.3million

Non-Poor (200%+ of FPL)

Poor (<100% of FPL)

Near Poor (100–199% of FPL)

NOTES: Individuals who reported more than one race group were categorized as “two or more races.” Elderly includes individuals age 65 and over. FPL= Federal Poverty Level. The FPL for a family of four in 2005 was $19,971.

10%

28%

62%

34%

35%

31%

30%

37%

33%

28%

23%

49%

26%

33%

41%

13%

32%

56%

DATA: March 2006 Current Population Survey.

7

Section 2Health Status

Healthstatusisafunctionofseveralfactors,includingaccesstocareandinsurancecoverage,socioeconomicconditions(education,occupation,income,andplaceofresidence),genetics,andpersonalbehavior .Racialorethnicminoritypopulationgroups(otherthanAsians)ratetheiroverallhealthworsethannon-HispanicWhites .Whilepoororlow-incomepeopleofallracesreportworsehealthstatusthanhigherincomepeople,differencesinoverallhealthstatusbyrace/ethnicitypersistevenwithinincomegroups .MinorityAmericansfrequentlyreporthigherprevalenceofspecifichealthproblems,suchasdiabetesorobesity,whichcanhaveseriousconsequencesforhealthandlongevity .

ThepoorerhealthstatusofracialandethnicminorityAmericansisalsoreflectedinhigherdeathratesformanycommoncauses .Forexample,infantmortalityrates,aswellasoverallmortalityratiosatdifferentagegroups,arehigheramongAfrican-AmericansandAmericanIndian/AlaskaNativesthanamongothergroups .Heartdiseaseandcancerarecommoncausesofdeathamongallracesandethnicities,butAfrican-Americansexperiencehigherdeathratesfromthesediseasesthanothergroups .

8

AmericanIndian/AlaskaNatives,AfricanAmericans,Hispancis,andthosewhoidentifythemselvesasoftwoormoreracesaremorelikelytoratetheirhealthasfairorpoorcomparedtoWhitesandAsians .EstimatesforNativeHawaiians/PacificIslanderswereunreliable .

Figure 6

Fair or Poor Health Status by Race/Ethnicity, 2004

White, Non-Hispanic


Non-Hispanic

AsianOnly*


Native

8.0%

13.3%14.6%

8.6%

16.5%

Two or MoreRaces

12.6%

Share reporting fair or poor health:

NOTES: Respondents assessed their health status as excellent, very good, good, fair or poor. *The sample size for Native Hawaiian/Pacific Islander was not large enough for reliable estimates.

DATA: National Center for Health Statistics, National Health Interview Survey, 2004.

SOURCE: Health, United States, 2006, Table 60.

Peoplewithfamilyincomesbelow100%ofpovertyaremorelikelytoratetheirhealthasfairorpoorcomparedtothenear-poorandnon-poor .Whencomparingracial/ethnicgroupsofsimilarincomes,thedisparityinself-reportedhealthisreducedbutnoteliminated .

Figure 7

Fair or Poor Health Statusby Race/Ethnicity and Income, 2004

White, Non-Hispanic Hispanic African American, Non-Hispanic

Share reporting fair or poor health:

NOTES: Respondents assessed their health status as excellent, very good, good, fair or poor. The federal poverty level for a family of four in 2004 was $19,307 (http://www.census.gov/hhes/www/poverty/threshld/thresh04.html).



20.8% 20.2%

25.7%

13.8%15.2% 16.7%

5.7%8.8% 9.6%

<100% of Poverty 100 – 199% of Poverty 200% + of Poverty

Figure 8

Infant Mortality Rate by Race/Ethnicity, 2003

White, Non-Hispanic


Non-Hispanic


Native

4.85.7

8.7

13.6

5.6

Infant deaths per 1,000 live births:

NOTE: Births are categorized according to race/ethnicity of mother.

DATA: National Center for Health Statistics, National Vital Statistics System, Linked Birth/Infant Death Data Set.


Asian and NativeHawaiian/Pacific

Islander

TheinfantmortalityrateforAfricanAmericansismorethantwicethatofWhites .InfantmortalityratesforAfricanAmericansandAmericanIndian/AlaskaNativesarehigherthanthoseforWhites,Hispanics,andAsians .

9

Infantmortalityrates,consideredoneofthemostsensitiveindicatorsofthehealthandwell-beingofapopulation,arehigheramongAfricanAmericansandAmericanIndians/AlaskaNativesthanamongotherracial/ethnicgroups,evenwhencomparingwomenofsimilarsocioeconomicconditions,asmeasuredbyyearsofeducationcompleted .

DATA: National Center for Health Statistics, National Vital Statistics System, National Linked Birth/Infant Death Data.

Figure 9

Infant Mortality Rates for Mothers Age 20+ by Race/Ethnicity and Education, 2001–2003

4.6

5.3

5.2

3.9

5.6

5.0

4.2

6.5

9.2

9.2

10.7

11.5

13.4

15.1African American, Non-Hispanic

American Indian/Alaska Native

White, Non-Hispanic

Asian and Native Hawaiian/Pacific Islander

Hispanic



White, Non-Hispanic


Hispanic



White, Non-Hispanic


Hispanic

Less

than

High School

High School

College+


7.0

10

In2003,thedeathrateduetoheartdiseaseformenwashigherthanthedeathrateforwomen .Regardlessofgender,thedeathrateforAfricanAmericanswasthehighestofallgroups,whilethedeathratewaslowestamongAsianandPacificIslanders .ThedeathrateforHispanicsandAmericanIndians/AlaskaNativeswaslowerthanthatofWhites .

SOURCE: Health US, 2005, Table 36.

Figure 11

Death Rate due to Heart Disease by Race/Ethnicity, 2003

White, Non-

Hispanic

Hispanic AfricanAmerican

Asian and

PacificIslander

AmericanIndian/AlaskaNative

White, Non-

Hispanic

Hispanic AfricanAmerican

Asian and

PacificIslander


DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

286.9

206.8

364.3

158.3

203.2187.1

145.8

253.8

104.2127.5

Deaths per 100,000 population:

Men Women

NOTE: Rates are age-adjusted.

Figure 10

Mortality Ratios by Age, Gender, and Race/Ethnicity, 2003

DATA: National Center for Health Statistics, National Vital Statistics System.

NOTE: The chart compares death rate of each racial/ethnic group to that of Asian/Pacific Islander, the group with the lowest death rates at each age.

SOURCE: National Vital Statistics Report, 54(13): April 19. 2006.

0

1

2

3

4

5

0–14 15–24 25–44 45–64

Age

Mortality Ratio


American Indian/Alaska NativeWhite, Non-Hispanic

Hispanic

Asian or Native Hawaiian/Pacific Islander

Onaverage,Hispanics,AfricanAmericans,AmericanIndians/AlaskaNativesandWhiteshavehighermortalityratesthanAsiansandNativeHawaiians/PacificIslandersateachstageofthelifespan .However,aggregateddatamaskthehighermortalityratesofparticularAsianandPacificIslandersubpopulations,suchasVietnameseandNativeHawaiians .

AfricanAmericanshaveahigherdeathratefrombreast,lung,andcolorectalcancerthananyotherracialorethnicgroup .AmericanIndians/AlaskaNatives,Hispanics,AsiansandPacificIslandershavelowerdeathratesforbreast,lung,andcolorectalcancerthanWhites .

Figure 12

Cancer Death Rates by Race/Ethnicity, 2002

White, Non-Hispanic

Hispanic


Asian and Pacific Islander


White, Non-Hispanic

Hispanic




White, Non-Hispanic

Hispanic




Breast Cancer

Deaths per 100,000 population:

Lung Cancer

ColorectalCancer

NOTE: Breast cancer rate is per 100,000 female population; other rates are for both genders.

DATA: Centers for Disease Control and Prevention, National Center for Vital Statistics.

SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.

2616

35

1314

5824

6326

33

20

1427

13

14

Diabetes

CVD

CVD

Accidents

Cancer

Heart Disease

Hispanic

Diabetes

DiabetesAccidents

DiabetesAccidents

Accidents

Chronic LungDisease

AccidentsCVDCVDCVD

CancerHeart DiseaseCancerCancer

Heart DiseaseCancerHeart DiseaseHeart Disease

AmericanIndian/

Alaska Native

Asian andPacific

Islander

AfricanAmerican,

Non-Hispanic

White,Non-HispanicRank

HIV

HomicideHomicide

Cancer

Cancer

Accidents

Cancer

Suicide

SuicideSuicide

Accidents

Liver Disease

Liver Disease

Liver Disease

Accidents

Heart Disease

Heart Disease

Heart DiseaseHeart Disease

Heart DiseaseCancer

AccidentsCancer

HIV

Accidents

Figure 13

Leading Causes of Death by Race/Ethnicity, 2003

HispanicAmerican

Indian/Alaska Native

Asian andPacific

Islander

AfricanAmerican,

Non-Hispanic

White,Non-HispanicRank

AllAges

Ages25–44

1

3

4

1

3

5

4

5

2

2

11

In2003,heartdiseasewastheleadingcauseofdeathamongallracial/ethnicgroups,exceptAsiansandPacificIslanders,forwhomtheleadingcauseofdeathwascancer .Among25–44yearolds,accidentsweretheleadingcauseofdeathforthreeofthefiveracial/ethnicgroups .HIVandhomicidewereamongthetopfiveleadingcausesofdeathforAfricanAmericansandHispanics .Yetneitherwereamongtheleadingcausesofdeathforthethreeotherracial/ethnicgroups .SuiciderankedamongthetopfiveleadingcausesofdeathforAsiansandPacificIslanders,AmericanIndians/AlaskaNativesandWhites,butnottheothertworacial/ethnicgroups .

NOTE:CVD=Cerebrovasculardisease .

DATA:NationalCenterforHealthStatistics,NationalVitalStatisticsSystem

SOURCE:http://www .cdc .gov/nchs/data/dvs/lcwk3_2003 .pdfandhttp://www .cdc .gov/nchs/data/dvs/lcwk6_2003 .pdf .

Figure 15

Overweight and Obesity RateAmong Adults by Race/Ethnicity, 2005

White, Non-Hispanic


Non-Hispanic

Asian andPacific Islander


Native

37.1%

57.8% 59.6%65.5% 67.9%

58.2%

Other

Percent overweight or obese:

NOTE: Overweight or obese is defined as having a body mass index greater than or equal to 25.0 kg/meters squared.

DATA: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Survey Data, 2005.

SOURCE: www.StateHealthFacts.org.

12

Obesityisacontributingfactortonumerousdiseases .Peoplewhoareoverweightorobesetendtohavehigherratesofdiabetesandcardiovascularproblems .MoreAfricanAmericansandAmericanIndians/AlaskaNativesareoverweightorobesethannon-HispanicWhitesandAsiansandPacificIslanders .AsiansandPacificIslandersareleastlikelyofallracialandethnicgroupstobeoverweightorobese .

Peoplewithdiabetesareatahigherriskforstrokeanddyingfromheartdiseasethanpeoplewithoutdiabetes .Additionally,diabetesistheleadingcauseofend-stagerenaldisease .ThepercentofAfricanAmericansandMexicanAmericanswithdiabetesishigherthanthepercentofWhiteswithdiabetes .

Figure 14

Diabetes Prevalence Among AdultsAge 20 and Over by Race/Ethnicity, 2001–2004

White, Non-Hispanic

Mexican American African American,Non-Hispanic

8.9%

14.9% 14.3%

Percent with diabetes:

NOTE: Diabetes prevalence includes physician-diagnosed (self-reported) and undiagnosed diabetes (fasting blood glucose of at least 126 mg/dL).

DATA: National Center for Health Statistics, National Health and Nutrition Examination Survey.


13

Section 3Health Insurance Coverage

Healthinsurancecoveragefacilitatestimelyaccesstohealthcare .Peoplemayreceivehealthinsurancecoverageasafringebenefitthroughtheirjob,maybeeligibleforpublicly-financedcoverage,ormaypurchaseitontheirown .Approximately46millionAmericans—halfofwhomareracial/ethnicminorityAmericans—havenohealthinsurancecoverageatall .RacialandethnicminorityAmericansaremorelikelythanWhitestobeuninsured,evenafteraccountingforworkstatus .Uninsuredratesbyrace/ethnicityvarybystate,reflectingvariationinindustryandavailabilityofcoverage .

Medicaidfillsingapsincoverageforsomeracialandethnicgroupswithlower-incomes .Medicaid’sroleinprovidingcoveragetoracialandethnicminorityAmericansisparticularlyimportantforchildren,whiletheprogram’sreachamongadultsismorelimitedduetoprogramrulesregardingcategoricalandfinancialeligibility .Medicareisthefederalprogramthatprovidescoveragetopeopleover65andtopersonswhoaredisabledunderage65,regardlessoffinancialmeans .RacialandethnicminorityAmericansarealargershareofMedicare’sunder65disabledpopulationthanMedicare’selderlypopulation .

14

Amongthenonelderly,Whitesarethegroupmostlikelytohavehealthinsurance .Theyarealsomorelikelythanotherracialandethnicgroupstoreceivecoveragefromtheiremployer .Hispanicshavethelargestpercentageofuninsured,andthelowestpercentageofpeoplewithemployercoverage .AsiansandPacificIslandersareleastlikelytoreceivecoveragefromMedicaidorotherpublicinsurance,whileAfricanAmericansaremostlikelytoreceivecoveragefromMedicaidorotherpublicinsurance .

Figure 17

Health Insurance Coverage of theLow-Income Nonelderly Population by Race/Ethnicity, 2005

White, Non-Hispanic


Non-Hispanic

Asian andPacific

Islander


Native

Two or MoreRaces

42.8 million

23.7 million

17.8 million

3.8million

0.9million

1.7million

NOTES: Low-income is defined as family income less than 200% of the federal poverty level, or $39,942 for a family of four in 2005. Nonelderly includes individuals up to age 65. “Other Public” includes Medicare and military-related coverage.



Uninsured

Individual

Employer

Medicaid orOther Public

20% 23%32%

20% 24%

3%4%

10%

1%5%

33%

45%22%

35%

49%

29%44%

29%37%

44%

22%

31%

9%

32%

Figure 16

Health Insurance Coverage of the Nonelderly by Race/Ethnicity, 2005

White, Non-Hispanic


Non-Hispanic

Asian andPacific

Islander


Native

Two or MoreRaces

166.6 million

40.8 million

32.6 million

11.8million

1.5million

4.2million

NOTE: Nonelderly includes individuals up to age 65. “Other public” includes Medicare and military-related coverage; SCHIP is included in Medicaid. DATA: March 2005 Current Population Survey.


40%48%

63%43%

55%

3%3%

7%

2%

5%23%

28%

10%

23%

26%

13%

34%21% 19%

32%14%

69%

6%12%

Uninsured

Individual

Employer

Medicaid orOther Public

Forty-fourpercentoflowincomeHispanicsandAmericanIndians/AlaskaNativesareuninsured,ahigherpercentagethanWhites,AfricanAmericans,andAsiansandPacificIslanders .HispanicsandAmericanIndians/AlaskaNativesarealsoleastlikelytoreceivehealthinsurancecoveragefromtheiremployercomparedtootherracialandethnicgroups .Ahigherpercentageoflow-incomeAfricanAmericanshaveMedicaidorsomeotherpublicinsurance,thanWhites,Hispanics,AsiansandPacificIslanders,andAmericanIndian/AlaskaNatives .

15

Coveragepatternsaresimilarforchildrenandnonelderlyadults .Whitechildrenareleastlikelytobeuninsuredcomparedtoallotherracialandethnicgroups .Theyarealsothegroupmostlikelytohaveemployercoverage .AsiansandPacificIslandershavecomparablelevelsofemployercoveragetoWhites .Over45percentofAfricanAmericanchildrenand40percentofHispanicchildrenarecoveredbyMedicaidorsomeotherpublicinsurance,whichismorethantwicethepercentageofWhitechildren .Over40percentofHispanicandmorethan30percentofAmericanIndian/AlaskaNativenonelderlyadultslackhealthinsurance,comparedto15percentofWhites .

Asian and PacificIslander

3%

Two or More Races3%


1%

White, Non-Hispanic

45%

Hispanic25%


23%

Total = 35 million

Figure 19

Nonelderly Medicaid Beneficiariesby Race/Ethnicity, 2005



Figure 18

Health Insurance Coverage of the Nonelderly by Age and Race/Ethnicity, 2005

Children

NonelderlyAdults

NOTES: Nonelderly includes individuals up to age 65. Does not include those identifying themselves as “two or more races.” “Other public” includes Medicare and military-related coverage; SCHIP is included in Medicaid.



47%

63%

52%

42%

69%

35%

65%

39%

36%

68%

2%

8%4%

4%

7%

3%

5%

2%

2%

6%

16%

8%

19%

13%

9%

35%

18%

46%

40%

19%

34%

22%

25%

42%

15%

28%

13%

13%

22%

8%

Employer Private Non-Group Medicaid/Other Public Uninsured

White, Non-Hispanic

Hispanic




White, Non-Hispanic

Hispanic




Ofthe35millionnonelderlyMedicaidbeneficiariesin2005,almosthalfwereWhiteandmorethan50%wereminorityAmericans .AfricanAmericansandHispanicsaredisproportionatelyrepresentedamongMedicaidbeneficiaries .Medicaid’slargerroleinprovidingcoverageamongminorityAmericansreflectstherelativelylowerincomesofminoritypopulationgroupsandtheprogram’smissioninprovidinghealthcoveragetothelow-incomepopulation .

ThepercentageofAfricanAmericanandHispanicchildrenwhoreceivecoveragethroughMedicaidismorethantwicethepercentageofWhitechildren .WomenaremorelikelytohavecoveragethroughMedicaidthanmen,regardlessofageorrace/ethnicity .AcrosstheagespectrumAfricanAmericans(maleorfemale)aremorelikelytohaveMedicaidcoveragethanWhitesorHispanics .OlderAfricanAmericanandWhitewomenarelesslikelytoreceivecoveragethroughMedicaidthanyoungerandHispanicwomen .Thereislittledifferenceincoveragebetweenyoungerandoldermen .

Medicareprovidescoveragefor36millionpeopleovertheageof65andanother6millionpeoplewhoaredisabledandyoungerthan65 .ThemajorityofbeneficiariesinbothgroupsareWhite .Non-HispanicAfricanAmericansandHispanicscomprisealargershareofMedicare’sdisabledbeneficiariesunderage65(29%)thanbeneficiariesage65andover(15%) .

16

Figure 21

Medicare Beneficiaries by Race/Ethnicity, 2003

White, Non-Hispanic

Hispanic


Other

8%19%

7%

10%

81%

66%

5%4%

Over Age 65Total = 36 million

Under-65 DisabledTotal = 6 million

DATA: Medicare Current Beneficiary Survey, 2003.

SOURCE: Centers for Medicare and Medicaid Services, The Characteristics and Perceptions of the Medicare Population Data Tables, available at: http://www.cms.hhs.gov/apps/mcbs/PublDT.asp.

Figure 20

Medicaid Coverage of the Nonelderly by Age, Gender, and Race/Ethnicity, 2005



5%

6%

5%

9%

18%

10%

15%

8%

14%

39%

11%

15%

11%

20%

44%

Men Age 45–64

Women Age 45–64

Men Age 19–44

Women Age 19–44

Children

White, Non-HispanicHispanicAfrican American, Non-Hispanic

Racialandethnicminorities,comprisejustoverhalfofthenonelderlyuninsured–inpartbecausetheyaremorelikelytobeinlow-incomefamilieswhoseemployersarelesslikelytooffercoveragethanworkerswhoarenotinlow-incomefamilies .Almostathird(30%)ofthenonelderlyuninsuredareofHispanicorigin .

Asian and PacificIslanders

5%

Two or more races1%


1%

White, Non-Hispanic

48%

Hispanic30%


15%

Total = 46.1 Million Uninsuered

Figure 22

Nonelderly Uninsured by Race/Ethnicity, 2005

NOTE: Nonelderly includes individuals up to age 65.



17

Figure 23

Uninsured Rates Among the Nonelderly by Income and Race/Ethnicity, 2005

<200% ofPoverty

200% ofPovertyand Up

White, Non-Hispanic

Percent uninsured:

Hispanic




White, Non-Hispanic

Hispanic




NOTE: 200% of the poverty threshold for a family of four in 2005 was $39,942.



16%

11%

21%

8%

44%

37%

44%

29%

12%

29%

Whilebeingfromalow-incomefamilyraisestheriskofbeinguninsuredmarkedly,itdoesnotaccountforallofthedifferencesinhealthcoverageacrossracialandethnicgroups .Insurancedisparitiespersistformostgroupsatbothlowerandhigherincomelevels .

18

MostAmericansreceivetheirhealthinsurancethroughtheiremployers .However,evenamongworkers,disparitiespersist .MorethanhalfofuninsuredworkersareWhite,andHispanicworkersrepresentthelargestgroupofminorityworkerswholackinsurance .However,uninsuredratesamongworkersarehigherforallminoritygroupscomparedtoWhites .

Figure 24

Uninsured Rates Among Workers by Race/Ethnicity, 2005

Percent of workers without health insurance coverage:

NOTE: Workers includes all workers aged 18 to 64.



14.1%

39.6%

22.8%18.8%

32.1%

19.5%

White Hispanic AfricanAmerican

Asian andPacific

Islander


Native

Two or MoreRaces

1919

Figure 25

Nonelderly Uninsured Rates by State, and Race/Ethnicity, 2004–2005

Region/State White Black Hispanic Asian and PI AI/ANTwo or

More Races

UnitedStates 13 21 34 19 31 15

Northeast

Connecticut 10 21 26 * * *

Maine 12 * * * * *

Massachusetts 10 * 22 18 * 2

NewHampshire 12 * * * * *

NewJersey 9 25 36 19 * *

NewYork 12 17 23 21 * 12

Pennsylvania 11 17 26 * * *

RhodeIsland 11 15 25 * * *

Vermont 13 * * * * *

South

Alabama 14 18 * * * *

Arkansas 18 25 * * * *

Delaware 13 16 35 * * *

DistrictofColumbia

* 14 36 * * *

Florida 19 27 37 22 * *

Georgia 15 21 47 * * *

Kentucky 15 * * * * *

Louisiana 16 27 * * * *

Maryland 11 20 39 * * 3

Mississippi 15 23 * * * *

NorthCarolina 13 18 50 * * *

Oklahoma 19 * 47 * 43 24

SouthCarolina 17 20 * * * *

Tennessee 12 23 56 * * *

Texas 17 25 40 24 * *

Virginia 11 20 39 20 * *

WestVirginia 20 * * * * *

Midwest

Illinois 11 25 29 13 * *

Indiana 15 20 30 * * *

Iowa 9 * 31 * * *

Kansas 11 * 30 * * *

Michigan 12 19 * 14 * *

Minnesota 8 13 37 8 * *

Missouri 13 21 * * * *

Nebraska 10 * 26 6 * *

NorthDakota 10 * * * 43 *

Ohio 12 18 * * * *

SouthDakota 12 * * * 36 *

Wisconsin 10 13 28 * * *

West

Alaska 17 * * 15 34 26

Arizona 14 * 34 * * *

California 13 18 32 19 * 15

Colorado 13 * 37 * * *

Hawaii * * * 11 * 10

Idaho 14 * 36 * * *

Montana 19 * * * 54 *

Nevada 16 * 36 12 * *

NewMexico 15 * 27 * 44 *

Oregon 16 * 38 * * *

Utah 13 * 38 * * *

Washington 14 * 29 16 * *

Wyoming 15 * 34 * * *

NOTE:*=samplesizetoosmallforreliableestimate .

DATA:March2006andMarch2005CurrentPopulationSurvey .

SOURCE:UrbanInstituteandKaiserCommissiononMedicaidandtheUninsuredestimates .

Insurancecoveragevariesnotjustbyrace/ethnicity,butalsobystateandregion .Factorssuchastheproportionoflow-incomefamilies,thetypesofemployment,andMedicaideligibilityaffectthenumberofuninsuredinastate,andthus,region .Forexample,uninsuredratesofNon-HispanicWhitesrangefrom8%inMinnesotato20%inWestVirginia .AmongAfricanAmericans,uninsuredratesrangefrom13%inMinnesotaandWisconsinto27%inFloridaandLouisiana,andratesamongHispanicsrangefrom22%inMassachusettsto56%inTennessee .

21

Section 4Preventive and Primary Care

Preventiveandprimarycare—suchasregulardoctorvisitsandhealthscreenings—arecrucialtomaintenanceofgoodhealthandpreventionofserioushealthproblems;theyarealsoimportantindicatorsofoverallaccesstocare .RacialandethnicminorityAmericansarelesslikelythanWhitestohaveausualplacetoreceivecareortohaveahealthcarevisit;forHispanics,thesedifferencespersistevenwhenaccountingforincome .Disparitiesinaccesstocarealsoappearinmanymeasuresofspecificservices,suchastimelyprenatalcare,dentalcare,andsomecancerscreening .Inotherareas,suchasmammographyandcholesterolscreening,disparitiesappearsmallerorhavebeenreducedovertime .

In2003–2004,Hispanics,AfricanAmericans,AsiansandAmericanIndian/AlaskaNativeswerelesslikelytohaveausualsourceofhealthcarethanwereWhites .Since1993–1994,rateshaveimprovedorremainedunchangedamongallracial/ethnicgroupsexceptHispanicsandAmericanIndians/AlaskaNatives .

Whencomparingracial/ethnicgroupsofsimilarincome,thedisparityinusualsourceofcareisnearlyeliminatedforAfricanAmericansbutnotforHispanics .Howeveracrossracial/ethnicgroups,thepercentagewithnousualsourceofcareishigheramongpeoplewithincomesbelowthepovertylevelandbetween100%and200%ofthepovertylevelcomparedtothosewithincomesabove200%ofpoverty .

22

Figure 27

No Usual Source of Health Care: Adults 18–64 by Race/Ethnicity and Poverty Status, 2003–2004

White,Non-Hispanic


Non-Hispanic

White,Non-Hispanic


Non-Hispanic

White,Non-Hispanic


Non-Hispanic

DATA: National Center for Health Statistics, National Health Interview Survey, 2002–2003


39.8%37.2%

22.7%24.0%

22.5%

14.1%

22.7% 22.0%

12.4%

0%

40%

< 100% of poverty Between 100% and 200%of poverty

200% or more of poverty

17.0%

24.0%

17.7%

N/A

28.8%

18.9% 19.1%20.8%

19.2%17.9%

30.9%

14.6%

NOTE: *The sample size for Native Hawaiian/Pacific Islander was not large enough for reliable estimates.

DATA: National Center for Health Statistics, National Health Interview Survey, 1993–1994 and 2003–2004.


Figure 26

No Usual Source of Health Care: Adults 18–64 by Race/Ethnicity, 1993–1994 and 2003–2004

White,Non-Hispanic


Non-Hispanic

AsianOnly*


Native

Two or MoreRaces

0%

40%

1993–1994 2003–2004

In2004,Hispanics,AsiansandAmericanIndians/AlaskaNativeswerelesslikelytohavehadahealthcarevisitinthepastyearthanwerenon-HispanicWhites .Non-HispanicWhiteswereslightlylesslikelytohavehadahealthcarevisitinthepastyearthanpeoplewhoself-identifiedastwoormoreraces .WhileimprovementshavebeenseenforAfricanAmericanssince1997,thesituationhasworsenedforHispanicsandAmericanIndians/AlaskaNatives .

Whencomparingracial/ethnicgroupsofsimilarincome,thedisparitiesinthepercentwithnohealthcarevisitinthepastyearisnearlyeliminatedforAfricanAmericansbutnotforHispanics .However,acrossracial/ethnicgroups,thepercentagewithnohealthcarevisitinthepast12monthsishigheramongpeoplewithincomesbelowthepovertylevelthanamongthosewithincomesabove200%ofthepovertylevel .

23


Figure 29

No Health Care Visits Within the Past 12 Months by Race/Ethnicity and Poverty Status, 2004


White, Non-Hispanic

<100% of Poverty

AfricanAmerican,

Non-Hispanic

White, Non-Hispanic


Non-Hispanic

200% + of Poverty

32%

22%

16%14%

16%

13%

0%

40%

Hispanic

Figure 28

No Health Care Visits Within the Past 12 Months by Race/Ethnicity, 1997 and 2004

White,Non-Hispanic


Non-Hispanic

AsianOnly*


Native

1997 2004


DATA: National Center for Health Statistics, National Health Interview Survey, 1997 and 2004


Two or MoreRaces

0%

30%

15%

23%

14%

N/A

25%

17% 17% 18%21%

16%

27%

14%

24

Prenatalcarethatbeginsinthefirsttrimesterofpregnancyimprovesmaternalhealthandbirthoutcomes .Thoughthepercentoflivebirthstomotherswhoreceivedlateornoprenatalcarehasdecreasedoverthepastfifteenyears,Hispanics,AfricanAmericansandAmericanIndian/AlaskaNativesarestillmorelikelythanWhitesandAsiansandNativeHawaiians/PacificIslanderstoreceivelateornoprenatalcare .

Figure 31

Late or No Prenatal Careby Hispanic Subgroup, 2004

DATA: National Center for Health Statistics, National Vital Statistics System


5.5%5.4% 5.5%

3.9%2.9%

5.1%

0%

10%

Hispanic Overall

Mexican Puerto Rican Cuban Central or SouthAmerican

Other andUnknownHispanic

DATA: National Center for Health Statistics, National Vital Statistics System.

White, Non-Hispanic


Non-Hispanic

Asian andPacific

Islander


Native

1990 2004

Figure 30

Late or No Prenatal Care by Race/Ethnicity, 1990 and 2004


0%

20%

Percent of live births

3.4%

5.8%

12.0% 11.2%12.9%

7.9%

3.0%

5.7%5.4%

2.2%

Variationisfoundnotonlyamongthemajorracial/ethnicgroups,butwithinthemaswell .Asanexample,amongHispanics,5 .4%oflivebirthsweretomotherswhoreceivedlateornoprenatalcare .ThisstatisticmasksdifferencesbetweenMexicanAmericans(5 .5%),whoalongwithOtherHispanicsorHispanicsofunknownorigin,arethelargestethnicHispanicsubgroupsandCubanAmericans(2 .9%),whoarethesmallestethnicsubgroup .

25

Regulardentalvisitsprovideanopportunityfortheearlydiagnosis,preventionandtreatmentoforaldiseasesandconditionsforchildrenandadults .Racial/ethnicminoritygroupsarelesslikelythanWhitestohavehadadentalvisitinthepastyear,regardlessofage .Hispanics,regardlessofage,aretheleastlikelyofallracialandethnicgroupstohavehadadentalvisitinthepastyear .

Figure 32

No Dental Visits in the Past Yearby Race/Ethnicity, 2004


DATA: National Center for Health Statistics, National Health Interview Survey, 2004


19%

35%

27% 26%30%

22%

32%

50%

43%

36% 37%42%

0%

60%


AsianOnly*

Two orMoreRaces


2–17 Years of Age 18–64 Years of Age


AsianOnly*

Two orMoreRaces


Whenstratifyingbyameasureofsocioeconomicstatus,suchaspoverty,theracial/ethnicdisparityindentalvisitspersistsamongadultsandnon-poorchildren,withHispanicsandAfricanAmericansmorelikelytobewithoutadentalvisitthanWhites .Howeveramongchildrenlivinginpoverty,thedisparitypersistsonlybetweenHispanicsandWhites .Inthisincomegroup,AfricanAmericanchildrenareaslikelyasWhitestobewithoutadentalvisit .Additionally,thegapbetweenAfricanAmericansandWhitesandHispanicsandWhitesislargerforthoseabove200%ofpoverty .Regardlessofrace/ethnicity,thoselivinginpovertyarelesslikelytohavehadadentalvisitinthepreviousyearthantheircounterpartswithincomesabove200%ofpoverty .

Figure 33

No Dental Visit in the Past Yearby Race/Ethnicity and Poverty Status, 2004

Hispanic


White, Non-Hispanic

2–17 Years of Age



0%

70%

< 100% ofPoverty

200% + ofPoverty

< 100% ofPoverty

200% + ofPoverty

18–64 Years of Age

38%

26%

62%

40%

58%

31%

16%

51%

27%33%

22%

32%

26

In2003,Hispanics,AsiansandAmericanIndians/AlaskaNativeswerelesslikelytohavehadamammograminthepasttwoyearsthanwereWhites .WhileimprovementshavebeenseenforWhites,Hispanics,andAfricanAmericanssince1994,thesituationhasworsenedforAmericanIndians/AlaskaNatives .

Figure 35

No Pap Smear Within the Past 3 Years by Race/Ethnicity, 1994 and 2003

White,Non-Hispanic


Non-Hispanic

AsianOnly*


Native

1994 2003


DATA: National Center for Health Statistics, National Health Interview Survey, 1987 and 2003.


Two or MoreRaces

N/A

23%

34%

18%

26%

16%

26%

15%

32%

16%

25%21%

0%

30%

Figure 34

No Mammogram Within the Past 2 Years by Race/Ethnicity, 1994 and 2003

White,Non-Hispanic


Non-Hispanic

AsianOnly*


Native

1994 2003


DATA: National Center for Health Statistics, National Health Interview Survey, 1987 and 2003.


Two or MoreRaces

39%44%

35%

N/A

48%

36% 34% 37%42%

30%35%

30%

0%

30%

60%

In2003,HispanicandAsianwomenweremorelikelytohavegonewithoutapapsmearinthepastthreeyearsthanwereWhite,AfricanAmericanorAmericanIndian/AlaskaNativewomen .Between1994and2003thenumberofwomenwhodidnothaveapapsmearinthepast3yearsdecreasedslightlyforallracialandethnicgroups,exceptAfricanAmericans,forwhomtherateremainedunchanged .AmericanIndian/AlaskaNativewomensawthesharpestdeclineduringthattime .

27

Cancerscreeningrateshaveincreasedoverthepasttwodecadesbutstillvarybyrace/ethnicity .Forexample,HispanicandAsianwomenarelesslikelytobescreenedforbreastorcervicalcancerthanareWhiteorAfricanAmericanwomen .However,despiteevidenceofcomparablescreeningratesbetweenWhiteandAfricanAmericanwomen,mortalityratesforbreastandcervicalcancerarehigherforAfricanAmericanwomenthanforWhitewomen .

Colorectalcancerscreeningoccurslessfrequentlythanothertestsamongwomenandmenacrossallracialandethnicgroups,andHispanicsaretheleastlikelytoreporthavingbeenscreenedforcolonandrectumcancerwithinthepasttwoyears .However,aswithbreastandcervicalcancer,mortalityratesfromcolonandrectumcancerarehigheramongAfricanAmericansthanamongWhites,despitecomparablescreeningrates .

Figure 37

High Blood Pressure and Cholesterol Screening by Race/Ethnicity, 2003

White,Non-

Hispanic


Non-Hispanic

AsianOnly


NOTES: Blood pressure screening rate is for adults who report receiving screening in past 2 years and can recall the results; blood cholesterol screening rate is for adults who report receiving screening in past 5 years. Data for Native Hawaiians/Pacific Islander not included because data do not meet criteria for statistical reliability, quality, or confidentiality.

91.9%

73.4%83.2%

68.4%

92.1%

75.3%

87.1%75.5%

89.1%

68.3%

Blood Pressure Blood Cholesterol

White,Non-

Hispanic


Non-Hispanic

AsianOnly


Percent of Adults Receiving:

DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.


Figure 36

Cancer Screening Rates by Race/Ethnicity,* 2003

Breast Cancer (Mammography)

Cervical Cancer(Pap Test)

Colon and RectumCancer

(Fecal Occult Blood Test) 18.3%

67.8%

58.2%

22.3%

82.6%

70.0%

15.4%

74.6%

65.1%

22.7%

80.2%

70.4%White, Non-Hispanic

Hispanic


Asian Only

White, Non-Hispanic

Hispanic


Asian Only

White, Non-Hispanic

Hispanic


Asian Only

DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.


NOTES: *Data for American Indians/Alaska Natives and Native Hawaiians/Pacific Islanders do not meet the criteria for statistical reliability, data quality or confidentiality. Age-adjusted percentages of women 40 and older who reported a mammography within the past 2 years, women 18 and older who reported a pap test within the pas t 3 years, and adults 50 and older (male and female) who reported a fecal occult blood test within the past 2 years.

Propermanagementofhighbloodpressureandcholesterolarecriticaltothepreventionofstrokeandheartdisease .AfricanAmericanshaveslightlyhigherratesofscreeningforbothbloodpressureandcholesterolthanWhites .Hispanicshavethelowestpercentageofadultsscreenedforhighbloodpressure,andHispanicsandAmericanIndians/AlaskaNativeshavethelowestpercentageofadultsscreenedforhighcholesterolcomparedwithWhites,AfricanAmericansandAsians .

29

Section 5Specialty Care

Specialtycareisusedbyindividualswithspecifichealthneeds .Measuresofspecialtycarethereforeallowcomparisonofaccessandutilizationamongpeoplewithademonstratedneedforservices .Further,manyinitiativestoeliminatedisparitiesaretargetedatspecialtycareareas;thus,thesemeasuresenableustoexamineprogressandchallengesincurrentefforts .Disparitieshavebeenstudiedforawiderangeoftypesofspecialtycare,suchasheartdiseasecareandcancercare .Specialtyareasexaminedhere—diabetes,HIV/AIDS,andasthma—arejustafewofthepotentialareasthatcouldbeincluded .

30

DiabetesThe number of Americans diagnosed with diabetes continues to rise . African Americans, Hispanics, and American Indians and Alaska Natives have higher rates of diabetes compared to non-Hispanic Whites . Data suggest that prevalence rates are higher for Asians and Native Hawaiians/Pacific Islanders than non-Hispanic Whites, but the total prevalence for these two groups is unknown . Diabetes is among the top five causes of death for all racial and ethnic groups in the U .S . except Whites . Patients with uncontrolled or poorly managed diabetes are at risk for developing complications including higher rates of heart disease, stroke, lower limb amputation, and kidney failure . African Americans are more likely to be hospitalized for complications from diabetes than non-Hispanic Whites .

Figure 38

Receipt of Recommended Tests for Diabetes by Race/Ethnicity, 2002

DATA: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey.


91.3%

69.9% 73.5%

55.1%

86.5%

58.1%63.4%

37.9%

88.3%

66.7%73.0%

54.1%

Hemoglobin A1c Retinal Eye Exam Foot Exam All 3 RecommendedTests

White, Non-Hispanic Hispanic African-American, Non-Hispanic

NOTES: Data show share of adults with diabetes who received test within past year. Data for Asian/Pacific Islander and American Indian/Alaska Native not presented because data do not meet criteria for statistical reliability, quality, or confidentiality.

Percent of adults with diabetes who received:

Propermanagementofdiabetesiscriticalinthepreventionofmoreseriousconditionsincludingheartattack,stroke,end-stagerenaldisease,blindnessoramputationoflowerextremities .TreatmentguidelinesfordiabetesrecommendcheckinghemoglobinA1clevelsatleasttwiceayearandhavinganeyeandfootexamatleastonceayear .HispanicsarelesslikelythanWhitesandAfricanAmericanstohavehadtherecommendedtestsinthepastyear,andlesslikelytohavehadanyoneofthetestsinthepastyear .AfricanAmericanshadsimilartestingratesasWhites .

31

TheratesofhospitaladmissionsforuncontrolleddiabetesforAfricanAmericansandHispanicsweremorethan5and3timesrespectively,therateforWhitesandAsiansandPacificIslanders .AsiansandPacificIslandershadthelowestratesofhospitaladmissionswith10admissionsper100,000 .

Figure 40

Rate of Diabetes Related End-Stage Renal Disease Among Diabetics, 2002

SOURCE: http://www.cdc.gov/diabetes/statistics/esrd/Fig5Detl.htm

Rate per 100,000 People with Diabetes:

222.7

470.2

322.2

165.8

344.5

259.6

White

Men

HispanicAfricanAmerican

White

Women

HispanicAfricanAmerican

Figure 39

Hospital Admissions for Uncontrolled Diabetes by Race/Ethnicity, 2002

NOTE: Data are for adult population only and reflect admissions for uncontrolled diabetes without complication.

DATA: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project.


Admissions per 100,000 population:

15.2

50.1

85.2

10.0

White, Non-Hispanic

Hispanic African American,Non-Hispanic


DiabeticmenhadhigherratesofdiabetesrelatedEnd-StageRenalDisease(ESRD)thanwomen .TherateofdiabetesrelatedESRDamongdiabeticAfricanAmericanmaleswasmorethantwicetherateofWhitemales .TherateofdiabetesrelatedESRDamongdiabeticAfricanAmericanwomenwashigherthantheratesofWhiteandHispanicmenandwomen .AmongdiabeticHispanicwomen,therateofdiabetesrelatedESRDwashigherthatthatofbothWhitemenandwomen .

32

Figure 41

HIV Testing Rate of Adults Ages 18–64 by Race/Ethnicity, 2006

Total White African American Hispanic

Percent saying:

NOTE: ‘Don’t know’ responses not shown; not all numbers may add up to 100 percent due to rounding.

SOURCE: Kaiser Family Foundation, Survey of Americans on HIV/AIDS (conducted March 24–April 16, 2006).

21%

34%

42%

16%

36%

45%41%

29%

24%28% 28%

41%

Tested within Past Year Tested More than 1 YearAgo

Never Tested

Increasingawarenessofone’sHIVstatusiscriticalforthepreventionandcareofHIVdisease .In2006,overhalf(55%)ofadultsages18–64intheU .S .saidtheyhadbeentestedforHIVatsomepoint,including21%whosaidtheyhadbeentestedinthepastyear .AfricanAmericans(70%)reportedpreviousHIVtestingmorefrequentlythanHispanics(57%)orWhites(52%) .ThepercentwhoreportedhavingbeentestedforHIVinthepasttwelvemonthswashigheramongAfricanAmerican(41%)andHispanics(28%)thanamongWhites(16%) .

HIV/AIDSThe CDC estimated that at the end of 2005 there were 1 .2 million people living with HIV/AIDS in the US, 25 percent of whom do not know they are infected . Minority groups, particularly African Americans and Hispanics continue to be disproportionately affected by the disease . African Americans and Hispanics represent 70 percent of new AIDS cases in the US . For African Americans and Hispanics between the ages of 25 and 44, HIV is one of the top five causes of death . Death rates from AIDS have decreased substantially, due in large part to the use of highly active antiretroviral therapy (HAART) . However, the only nationally representative study of people with HIV, which was conducted in 1996–1998, found that African Americans fared worse than Whites on several measures of access and quality . These differences diminished over time but were not completely eliminated .

33

AdvancementsinHIVtreatmenthavebenefitedallracial/ethnicgroups .However,AIDSdeaths,whichhavedeclinedoverall,havedecreasedmoredramaticallyamongWhitesthanamongotherracial/ethnicgroups .

PeopleofcolorcontinuetofaremorepoorlythanWhitesonsomehealthcareaccessandqualitymeasures .SincetherearenoroutinelycollectednationaldatasourcesonHIV,datafromtheHIVResearchNetwork,whichconsistsofprimaryandspecialtycaresitesindifferentgeographicareasoftheU .S .provideinsightintopatternsofhealthservicesuseamongHIV-infectedadultsincare .Datacollectedfrom2000to2002indicatethatAfricanAmericansdidnotdifferfromWhitesintheaveragenumberofoutpatientvisits,buttheyhadhigherhospitalizationrates .Higherinpatientrates,whencontrollingfordifferencesinpopulationdemographicandhealthcharacteristics,aresometimesanindicationoflessthanadequateprimarycare .Incontrast,HispanicshadahigheraveragenumberofoutpatientvisitsthanWhites,butdidnotdifferintheirhospitalizationrates .

1.18*1.03 0.90 1.02

1.11*1.04

0

1

2

Black Hispanic Other Black Hispanic Other

Figure 42

Odds of Health Services Use Among Persons with HIV/AIDS in Care by Race/Ethnicity, 2000–2002

NOTE: Compared to Whites

*Difference is statistically significant

Equal likelihood

Odds

SOURCE: Fleishman et al., Hospital and Outpatient Health Services Utilization Among HIV-Infected Adults in Care 2000–2002. Medical Care, Vol. 43, No. 9 suppl, (Sept.) 2005.

Odds Ratio of Any Inpatient Hospitalization

Odds Ratio of Outpatient Visits

†

†

ThedisproportionateimpactoftheAIDSepidemiconpopulationsofcolorisseeninhigherHIVmortalityratesandnewAIDScases .RatesofHIVdeathsandnewAIDScasesarepotentialindicatorsofdifferencesinqualityofcaresinceearly,appropriatetreatmentcandelayprogressiontoAIDS .Forexample,withincreasinguseofhighlyactiveantiretroviraltherapy(HAART)inthemid1990s,ratesofnewAIDScaseshavedeclined .TheNationalHealthcareDisparitiesReporttracksnewAIDScasesasoneofits46coremeasuresofqualityofcare .In2003,therateofnewAIDScasesamongadults/adolescentswas10timeshigheramongAfricanAmericans(75per100,000)thantherateamongWhites(7per100,000) .TherateamongHispanics(26per100,000)was3timeshigherthantherateamongWhites .

Figure 43

New AIDS Cases and HIV-Infection Deathsby Race/Ethnicity

White,Non-

Hispanic


Non-Hispanic

Asianand

PacificIslander


DATA: Centers for Disease Control and Prevention, HIV/AIDS Surveillance System and National Vital Statistics System.


White,Non-

Hispanic


Non-Hispanic

Asianand

PacificIslander


Rate per 100,000 population:

2.17.2 5.8

26.4 23.0

74.6

0.84.7 2.2

10.3

New AIDS Cases, 2003(age 13 and up)

HIV-Infection Deaths, 2002

34

Figure 44

Prevalence of Ever Having Asthma by Race/Ethnicity, 2004

DATA: National Health Interview Survey, 2004.

White, Non-Hispanic

Hispanic


Two or More Races

Asian

SOURCE: Summary Health Statistics for U.S. (Children/Adults): National Health Interview Survey, 2004. Vital and Health Statistics. Series 10, Number 228; May 2006.

12%10%

17%

11%10%

8%6%

8%10%

16%

21%

15%

Children Adults


In2004,theprevalenceofasthmawasslightlyhigheramongchildrenthanadultsforallracialandethnicgroupsexceptAsians .Amongchildren,thosewhoidentifiedastwoormoreracesandAfricanAmericanshadthehighestratesofasthma,whileAmericanIndians/AlaskaNativesandindividualsoftwoormoreraceshadthehighestratesamongadults .Datapresentedinthisfigurerepresenttheproportionofpeoplewhohaveeverbeentoldtheyhaveasthma .Theproportionofpeoplewhocurrentlyhaveasthmawillbesmaller,particularlyamongadults .

AsthmaMinorities, the poor, and children are disproportionately affected by asthma . Regardless of age, African Americans are more likely to be hospitalized for an asthma attack, and more likely to die than non-Hispanic Whites . Among Hispanics, Puerto Ricans have significantly higher asthma rates than non-Hispanic Whites and other Hispanic subgroups such as Mexicans, a fact that is concealed by average estimates for all Hispanics . The environment plays an important role in the onset of an asthma attack . By taking prescribed medications, keeping regularly scheduled appointments with their provider, and controlling exposures to triggers such as dust mites, cockroaches, mold, and second-hand smoke, individuals can better manage their disease and reduce their risk of an attack .

35

Propercontrolofasthmasymptomsisessentialtothepreventionoffutureasthmaattacks .In2002,ahigherpercentageofAfricanAmerican,HispanicandAmericanIndian/AlaskaNativeadultsreportedmorenegativeindicatorsofasthmacontrol(e .g .limitstoactivity,difficultysleeping,asthmaattacks,urgentcarevisitsforworseningasthmasymptoms,andvisitstotheemergencydepartment)thanWhites .AfricanAmericanandHispanicadultsvisitedtheemergencydepartmentmoreoftenthanWhitesandAsians .

AsianandPacificIslanderadultsandchildrenhavethelowestratesofhospitalizationsforasthmaamongallracialandethnicgroups .AfricanAmericanshavethehighestratesofhospitalization .ForAfricanAmericanchildren,ratesofhospitalizationare4and5timeshigherthantherateamongWhitesandAsiansandPacificIslanders,respectively .ForAfricanAmericanadults,theratesare3and4timeshigherthantheratesforWhitesandAsiansandPacificIslanders .

Figure 45

Adult Asthma Control Problems by Race/Ethnicity, 2002

DATA: Behavioral Risk Factor Surveillance System.

White, Non-Hispanic

Hispanic


Asian

SOURCE: Centers for Disease Control and Prevention. “Asthma Prevalence and Control Characteristics by Race/Ethnicity, United States, 2002.” MMWR 2004: 53: 145-8.

26%

15%

40%

65%

52%

26%

48%

36% 37%

47%52%

24%

37%40%

63%

26%

N/A N/A

64%

35%

20%

48%

17%

35%

19%

Limits toActivity

DifficultySleeping

Asthma Attack Urgent Visit ED Visit


Share with asthma reporting:

Figure 46

Hospital Admissions for Asthma by Race/Ethnicity, 2002

White,Non-

Hispanic


Non-Hispanic

DATA: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Costand Utilization Project, State Inpatient Databases.

Children Adults

White,Non-

Hispanic


Non-Hispanic

Asian andPacific

Islander

Asian andPacific

Islander

Rate per 100,000 population:


144.387.1

184.5 162.5

527.1

307.7

102.9 84.1

Section 6Tracking Changes in Quality and

Access Disparities

DatafromtheNational Healthcare Disparities Report (NHDR)areusefulfortrackingchangesinabroadarrayofhealthcarequalityandaccessmeasuresamongracial,ethnic,andsocioeconomicgroupsintheUnitedStates .Thereport,whichhasbeenissuedannuallybytheAgencyforHealthcareResearchandQuality(AHRQ)since2003,isamajoreffortbythefederalgovernmenttotrackanddisseminateinformationondisparitiesatthenationallevel .ItisacompanionreporttotheNational Healthcare Quality Report, whichisalsoissuedannually .

The2005NHDRreportsinformationfor46“corereportmeasures”ofqualityand8measuresofaccess .Thequalitymeasurescapturetheeffectiveness,safety,timeliness,andpatientcenterednessofcareforarangeofclinicalconditions,whiletheaccessmeasuresmonitorfacilitatorsandbarrierstocare .Thesemeasureswerechosenbasedon“clinicalimportance,policyrelevance,anddatareliability .”

The2005NHDRfocusesontrenddatainanattempttotrackprogressineliminatinghealthcaredisparitiesandidentifyareastotargetforfutureimprovement .Italsoemphasizesimprovementstomeasurementandassessmentofdisparities .Thereporthighlightsfourthemesthatemergedfromthereviewofthedata;theyare:

1)Disparitiesstillexist

2)Somedisparitiesarediminishing

3)Opportunitiesforimprovementremain

4)Informationaboutdisparitiesisimproving

Inthefollowingsection,wepresentselectedsummaryhighlightsfromthereport .

Thefullreportandsupportingdocumentsanddataareavailableathttp://www .ahrq .gov/qual/nhqr05/nhqr05 .htm

37

38

Figure 48

Comparison of Access to Care Measures for Minority Population Groups vs. Whites

SOURCE: AHRQ, National Healthcare Disparities Report, 2005

African Americanvs. White (n=8)

Asian and PI vs. White

(n=7)


Native vs. White(n=6)

Hispanic vs. Non-Hispanic White

(n=8)

Better Same Worse

NOTES: “Better” means population received better quality of care than comparison group for the measure; “same” means population received quality of care about the same same as comparison group for the measure; and “worse” means population received poorer quality of care than comparison group for the measure. Data on all measures are not available for all groups; “n” refers to the number of measures on which the groups were compared. Totals may not add to 100% due to rounding.

50% 43% 50%

88%

50%

43%

50%

13%14%

Tomonitorfacilitatorsandbarrierstocare,the2005NHDRprovidesinformationontwocorereportmeasuresofaccessforeachofthefollowingareas:insurancecoverage,usualsourceofcare,problemsobtaininghealthcare,andpatient-providercommunication .Themeasuresshowedthat,formanymeasures,minoritypopulationgroupshavepooreraccesstocarethanWhites .HispanicsfaredworsethanWhitesonnearlyallaccessmeasures(7outof8) .AfricanAmericansandAmericanIndians/AlaskaNativesfaredworsethanWhitesonhalfoftheavailablemeasures(4of8and3of6,respectively) .OnlyAsianshadbetteraccesstocarethanWhitesforanymeasure(1outof7available);however,AsiansandPacificIslandersfaredworsethanWhitesforalargernumberofmeasures3outof7) .

The2005NDHR’ssummaryofthecorereportmeasuresofqualityconcludedthat,foralargenumberofmeasures,minoritypopulationsreceivelowerqualityofcarethanWhites .ForAfricanAmericans,qualityofcarewaspoorerthanthatforWhitesfor20outof46measures(43%),whilecarewasbetterqualitythanWhitesforjust5outof46measures(11%) .Amongthe38measuresthatwereavailableforHispanics,20(53%)showedthattheyreceivedpoorerqualitythannon-HispanicWhites,andjust6(16%)showedbetterqualitythannon-HispanicWhites .Ofthe21measuresavailableforAmericanIndians/AlaskaNatives,8(38%)showedpoorerqualitythanWhitesandjust3(14%)showedbetterqualitythanWhites .AsiansandPacificIslandershadbetterqualitythanWhitesfor12ofthe32availablemeasures(38%)butstillhadpoorerqualityfor7outof32measures(22%) .

Figure 47

Comparison of Quality of Care Measures for Minority Population Groups vs. Whites


43%22%

38% 53%

46%

41%

48%32%

11%38%

14% 16%

African Americanvs. White (n=46)


(n=32)




(n=38)

Better Same Worse

NOTES: Data on all measures are not available for all groups; “n” refers to the number of measures on which the groups were compared. “Better” means population received better quality of care than comparison group for the measure; “same” means population received quality of care about the same same as comparison group for the measure; and “worse” means population received poorer quality of care than comparison group for the measure. Totals may not add to 100% due to rounding.

39

The2005NHDRsummarizedtrendsindisparitiesinqualityforthecorereportmeasuresforwhichdatawereavailableovertime .ForAfricanAmericans,42%ofthecorequalitymeasureswereworseningand58%wereimproving .RoughlyhalfofthecoremeasuresforAsiansandPacificIslandersandforAmericanIndians/AlaskaNativeswereworseningandhalfwereimproving .Hispanicsdidnotseethesamelevelofimprovementasanyoftheotherpopulationgroups,andfaredworseinoverhalf(59%)ofthecorequalitymeasures .TheNHDRdefinedadisparityasworseningwhenboththeabsolutedifferenceandrelativedifferencebetweenthepopulationandcomparisongroupwerebecominglargerovertime .

Figure 49

Changes in Quality of Care Disparities Over Time: Summary by Race/Ethnicity


NOTES: “Improving” means disparity is becoming smaller over time; “worsening” means disparity becoming larger over time. Data on all measures are not available for all groups; “n” refers to the number of measures on which the groups were compared. Totals may not add to 100% due to rounding. Time period differs by measure and includes oldest and newest years of available data.

42% 48% 50% 59%

58% 52% 50% 41%

Black vs. White(n=40)


(n=25)




(n=34)

Improving Worsening

40

NOTES: “X” indicates measures for which the difference between Whites and the racial/ethnic group is became larger. “—“ indicates measures for which the difference between Whites and the racial/ethnic group remained the same. Shaded area indicates measures for which data over time are unavailable. Time period differs by measure and includes oldest and newest years of available data.

DATA: Special data request from Kaiser Family Foundation to Agency for Healthcare Quality and Research.

SOURCE: National Healthcare Disparities Report, 2005.

Table1showsthecoremeasuresforwhichqualityofcaredisparitieswereworseningforspecificpopulationgroups .Thisinformationishelpfulinidentifyingspecificopportunitiesforimprovementinasinglepopulationgrouporacrossmorethanonepopulationgroup .Forexample,NHDRanalysisshowsworseningqualityofhospitalcareforheartfailurepatientsofallfourracialandethnicgroups .Thismeasureisacompositeindicatorthatincludessixmeasuresofrecommendedcareafteraheartattack .Improvingthequalityofcareforheartfailuremayimproveoutcomesofcareforoneoftheleadingcausesofdeath .

Core Measure Black N=44

Hispanic N=35

Asian and Pacific

Islander N=25

American Indian/Alaska

Native N=18

1)Mammographyscreening

2)Diagnosisofadvancedstagebreastcancer X X

3)Deathratesforbreastcancer -- X

4)Receiptofrecommendeddiabetescare X

5)Amputationratesforpatientswithdiabetes

6)AdequacyofhemodialysisforESRDpatients X X

7)TransplantationregistrationforESRDpatients X X

8)Smokingcessationcounseling X

9)Hospitalcareforheartattackpatients X X X X

10)Deathrateforheartattackpatients X X

11)Hospitalcareforheartfailurepatients X

12)HIVpatientswithPCPprophylaxis

13)NewAIDScases X

14)Receiptofprenatalcare X —

15)Infantmortalityrate X

16)Childvaccinationrates X — X

17)HepatitisBvaccinationratesamongteens

18)Hospitaladmissionsforpediatricstomachflu X

19)Exercisecounselingamongchildren

20)Dentalcareforchildren X

21)Receiptofneededmentalhealthcare X

22)Suicidedeathrate X X X

23)Receiptofneededsubstanceabusecare X X

24)Completionofsubstanceabusetreatment

25)Flushotsamongtheelderly X X X

26)Hospitalcareforpneumoniapatients X X X

27)Antibioticprescriptionsforcommoncold X

28)CompletionofTBtreatment X X

29)Hospitaladmissionsforpediatricasthma X

30)Physicalrestraintofnursinghomepatients X —

31)Pressuresoresinhigh-risknursinghomepatients X X

32)Pressuresoresinshort-staynursinghomepatients

33)Improvementamonghomehealthpatients X X

34)Hospitaltransferofhomehealthpatients X X

35)Hospital-acquiredinfections —

36)Ventilator-associatedpneumonia X

37)Postoperativehipfractures X

38)Postoperativebloodclots —

39)Hospital-acquiredpneumothorax X X

40)Centralvenouscathetercomplications

41)Obstetrictrauma X X

42)Elderlywithinappropriatemedications

43)Timelyreceiptofcareamongadults X X

44)EDvisitswhenpatientleftwithoutbeingseen —

45)Listening,explaining,respect,andvisitlengthofprovidersforadultpatients X

46)Listening,explaining,respect,andvisitlengthofprovidersforchildpatients X X

Table 1

Worsening Quality of Care Disparities by Race/Ethnicity

4141

CONCLUSION

Key Facts: Race, Ethnicity and Medical Carepresentscompellingevidenceofracialandethnicdifferencesinhealthinsurancecoverage,accesstoprimarycare,andtreatmentforspecificmedicalconditions .Insomecases,thesedifferencesarereduced,ifnoteliminated,whencomparingminoritypopulationsandWhitesofsimilarsocio-economicconditions .

Formanymeasurespresentedinthe2007 Key Facts,thereareonlymodestchangesbetweenthedatapresentedinthiseditionandthepriorone .However,thereareseveraldifferencesworthyofaconcludingnote .First,therewasaslightdecreaseintheshareoftheU .S .populationthatself-identifiedasWhiteandnotofHispanicorigin,reflectingthenation’sgrowingracial/ethnicdiversity .Second,therewasanincreaseinthenumberofuninsuredfrom41millionin2001to46millionin2005 .Personsfromlow-incomefamiliesandcommunitiesofcolorareatgreaterriskofbeinguninsuredthantheircounterparts,andthusmorelikelytoexperiencedisparitiesinhealthcareaccessandqualityofcare .Third,thechangetothe2000Censusallowingindividualstoidentifywithmorethanoneracialgrouphasallowedamoreaccurateportrayalofthehealthneedsofthisverydiversegroup,yetposesanewsetofchallengeswhendescribingracial/ethnicgroups .Whendatawereavailable,thisreportpresentsfindingsseparatelyonpersonswhoreportedasingleracialcategoryandpersonsreportingtwoormoreracialgroups .ForpopulationssuchasAmericanIndians/AlaskaNatives(AI/ANs),inwhichabout40%reporttwoormoreracialgroups,thischangehasimplicationsforourknowledgeaboutthepopulationoverall .

FindingsfromtheNational Healthcare Disparities Report (NHDR)areanimportantnewcomponentofthe2007 Key Facts.TheNHDRprovidesevidencethat,inmanycases,minoritypopulationgroupsreceiveworsecarethanWhites,andforsomemeasures,gapsincarearegettinglargerratherthansmaller .TheNHDRprovidesmixedevidenceaboutthenation’sprogressinaddressingdisparitiesinthequalityofhealthcare .Furtherresearchisneededtobetterunderstandthecausesandconsequencesofthehealthcaredifferentialspresentedinthisreport .Whileitisknownthatfinancialincentivesandbarriersaffectpatternsofhealthcareuse,lessisknownabouthowotherfactors,suchaspatientpreferences,siteofmedicalcare,orneighborhoodofresidenceinfluencepatternsofcareobtained .Thisresearchisneededtodisentanglethemanycomplexfactorsthataccountforthesedifferentials,sothatthesourcesofhealthcareinequitycanbeaddressed .

4242

Accordingtothe2000CensusofPopulationandHousing,morethan4millionpeopleor1 .5percentofthetotalU .S .populationliveintheU .S .territories,whichincludePuertoRico,Guam,AmericanSamoa,theU .S .VirginIslands,andtheCommonwealthoftheNorthernMarianaIslands .Themajority(3 .8million)oftheseindividualsliveinPuertoRico,and90percentofthemareHispanic .NativeHawaiians/PacificIslandersrepresentthenextlargestracialorethnicgroupwith144,000or3percentofthepopulationlivingintheU .S .territories .

Appendix

Distribution of U .S Population by Race/Ethnicity, With and Without Territories, 2000

Population without

Territories*Population with

TerritoriesPopulation of

TerritoriesPercent Distribution

of Territories

NumberinThousands

White 194,553 194,611 59 1 .4%

Hispanic ‡ 35,306 39,084 3,778 89 .8%

African American 33,948 34,031 81 2 .0%

Asian 10,123 10,217 93 2 .2%

Native Hawaiian/Pacific Islander 354 497 144 3 .4%

American Indian/Alaska Native 2,069 2,069 1 0 .0%

Two or More Races 4,602 4,639 37 0 .9%

Some Other Race† 468 478 11 0 .3%

Total 281,422 285,621 4,199 100%

NOTES:*Datawerereportedbyraceandethnicity .‡OnlyindividualssurveyedinPuertoRicoandtheU .S .VirginIslandswereaskedaquestionaboutHispanicorigin .Asaresult,datafromPuertoRicowerereportedbyrace/ethnicity,whiledatafromtheotherterritorieswerereportedonlybyrace .†IntheU .S .VirginIslands“SomeOtherRace”categoryincludesAmericanIndian/AlaskaNative,Asian,NativeHawaiianandOtherPacificIslanderandindividualsreporting“Someotherrace .”Totalmaynotsumduetorounding .

DATA:2000CensusofPopulationandHousing .

SOURCE:U .S .CensusBureau,2000 .

43

DATA NOTES2000 CensusThe2000Censusaskedrespondentstochoosefromtwoethnicities:“HispanicorLatino”and“NotHispanicorLatino .”ThequestionnairethenaskedrespondentstochoosefromthefiveOMB-specifiedracecategories,andgaverespondentstheoptionofselectingoneormoreracecategoriestoindicatetheirracialidentities .Forrespondentsunabletoidentifywithanyofthesesixracecategories,theCensusquestionnairealsoincludedasixthcategory:“Someotherrace .”Mostoftherespondentswhoreported“Someotherrace”wereLatino .

PeoplewhorespondedtothequestiononracebyindicatingonlyoneracearereferredtobytheU .S .CensusBureauasthe“racealone”population,orthegroupthatreportedonlyoneracecategory .Individualswhochosemorethanoneofthesixracecategoriesarereferredtoasthe“Twoormoreraces”population,orasthegroupthatreportedmorethanonerace .Allrespondentswhoindicatedmorethanoneracecanbecollapsedintothe“Twoormoreraces”category,whichcombinedwiththesixalonecategories,yieldssevenmutuallyexclusiveandexhaustivecategories .Thus,thesixrace“alonecategoriesandthe“Twoormoreraces”categorysumtothetotalpopulation(whichisasumofresponses ratherthanrespondents) .

Race/Ethnicity DataInaFederal RegisternoticeofOctober30,1997,theOfficeofManagementandBudget(OMB)announcedrevisionstothestandardsforclassificationofFederaldataonraceandethnicity .TheOMBspecifiedtwocategoriesfordataonethnicity(“HispanicorLatino”and“NotHispanicorLatino”)andfiveminimumcategoriesfordataonrace(“AmericanIndianorAlaskaNative,”“Asian,”“BlackorAfricanAmerican,”“NativeHawaiianorOtherPacificIslander,”and“White”) .

Inthisdocument,thepresentationofdataonracial/ethnicgroupsmayvaryfromfiguretofigure .Insomeinstances,“Asians”and“NativeHawaiiansorOtherPacificIslanders”arecombinedintoonecategory .Inanumberofcases,datawereavailablefor“Asians”andnotfor“NativeHawaiiansorOtherPacificIslanders .”Inthosecircumstances,dataarereportedfor“AsiansOnly .”Inothercases,duetosmallsamplesize,the“Other”categoryincludesAmericanIndian/AlaskaNative,NativeHawaiianorOtherPacificIslander,andindividualsreporting“Twoormoreraces .”Theseclassificationsarenotedonfigureswhereapplicable .

Inallcaseswheredataarepresentedfor“White,Non-Hispanic”and“AfricanAmerican,Non-Hispanic,”theotherracialgroupsarealsoNon-Hispanic .

Foramoredetaileddiscussionofthistopic,seetheCensusBriefOverview of Race and Hispanic Origin 2000,March2001 .

Population EstimatesThepopulationestimatesintheDemographicssectionaredrawnfromtheU .S .CensusBureau .TheCensusBureau’sestimatesincludedataonthe50U .S .statesandtheDistrictofColumbia,butdonotincludedataonresidentsofPuertoRico,Guam,theU .S .VirginIslands,ortheNorthernMarinaIslands .

Becauseoftheneedtohavecensusdatacomparablewiththereportingcategoriesusedbystateandlocalagenciesandforcompilingotheradministrativedatausedinproducingpopulationestimatesandprojections,theCensusBureaudevelopedaproceduretoassignanOMBracetothosewhoreported"Someotherrace ."Thus,individualswhoidentifiedthemselvesas“Someotherrace”wereassignedtooneofthefiveOMBracecategories .FormoreinformationaboutraceclassificationsinCensus2000,visittheCensusBureau’sInternetsite:www .census .gov/population/www/socdemo/race/racefactcb .html .

Federal Poverty ThresholdThefederalpovertythresholdforafamilyoffourwas$19,971in2005 .Poorpersonsaredefinedasthosewithincomesbelowthepovertythreshold .Nearpoorpersonsaredefinedasthosewithincomesof100%tolessthan200%ofthepovertythreshold .Low-incomepersonsaredefinedasthosewithincomeslessthan200%ofthepovertythreshold .Non-poorpersonsaredefinedasthosewithincomesof200%orgreaterthanthepovertythreshold .

44

Grouping Household MembersFamilyincomeandtheworkstatusoffamilymembersareimportantfactorsrelatedtohealthcoverage,sothewayinwhichindividualslivingtogetherinonehouseholdaregroupedbecomesimportanttotheanalysis .IntheUrbanInstituteandKaiserCommissiononMedicaidandtheUninsuredanalysesoftheMarch2005CurrentPopulationSurveyusedinthisreport,individualsaregroupedaccordingtotheirinsuranceeligibility,ratherthanrelatedness .Otheranalysts,includingtheU .S .CensusBureau,maygroupindividualsbyhouseholdsorrelatedness .Groupingindividualsbyhealthinsurabilityversusrelatednessorhouseholdsincreasesthenumberoflow-incomepeople .Foramoredetaileddiscussionofthistopic,seetheDataNotessectionofHealth Insurance Coverage in America: 2004 Data Update,November2005 .

National Healthcare Disparities ReportDevelopedbytheAgencyforHealthcareResearchandQuality(AHRQ),theNational Healthcare Disparities Report (NDHR)isthefirstnationalcomprehensiveefforttotrackandmeasuredifferencesinqualityandaccesstohealthcareservicesintheUnitedStatesforboththegeneralpopulationandforcongressionallydesignatedprioritypopulations .These“prioritypopulations,”aredefinedinAHRQ’sauthorizingstatute(section901(c)ofthePublicHealthServiceAct)asencompassingbothspecificpopulationgroupsaswellasgeographically-definedgroups .

Inaccordancewiththeseguidelines,theNHDRincludesdataandanalysisonthefollowing:low-incomegroups;racialandethnicminoritygroups(federallyrecognizedracialcategoriesare:AmericanIndianorAlaskaNative;Asian;BlackorAfricanAmerican;NativeHawaiianorotherPacificIslander;andWhite;andfederallyrecognizedethniccategoriesare:HispanicorLatino,ornotHispanicorLatino);women;children;theelderly;individualswithspecialhealthcareneeds,thedisabled,peopleinneedoflong-termcare,peoplerequiringend-of-lifecare,andplaceofresidence(e .g .,ruralcommunities) .Althoughotherdemographicgroupsmayalsosufferfromhealthcaredisparities,theyarebeyondthescopeofthisreport .

RequiredbyCongressin1999,thisannualreport,whichhasbeencompiledsince2003,presentsdataondifferencesintheuseofservices,accesstohealthcare,andimpressionsofqualityforsevenclinicalconditions,includingcancer,diabetes,end-stagerenaldisease,heartdisease,HIVandAIDS,mentalhealth,andrespiratorydiseaseaswellasdataonmaternalandchildhealth,nursinghomeandhomehealthcare,andpatientsafety .

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TheHenryJ .KaiserFamilyFoundation .OverweightandObesityRatebyRace/Ethnicity,2005 .http://www .StateHealthFacts .org .Washington,DC .

National Healthcare Disparities Report, 2005. AgencyforHealthcareResearchandQuality,Rockville,MD .http://www .ahrq .gov/qual/nhdr05/nhdr05 .htm

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U .S .DepartmentofHealthandHumanServices .2005 .Health, United States, 2005.Hyattsville,MD:NationalCenterforHealthStatistics .

U .S .DepartmentofHealthandHumanServices .2006 .Health, United States, 2006.Hyattsville,MD:NationalCenterforHealthStatistics .

U .S .DepartmentofHealthandHumanServices .2006 .National Vital Statistics Reports.Hyattsville,MD:NationalCenterforHealthStatistics .

U .S .DepartmentofHealthandHumanServices .2003 .CentersforDiseaseControl .Deaths, Percent of Total Death, and Death Rates for the 15 Leading Causes of Death in Selected Age Groups, by Race and Sex: United States, 2003.Hyattsville,MD:NationalCenterforHealthStatistics .

U .S .DepartmentofHealthandHumanServices .2003 .MedicareCurrentBeneficiariesSurvey:The Characteristics and Perceptions of the Medicare Population DataTables .Hyattsville,MD:CentersforMedicareandMedicaidServices .

U .S .RenalDataSystem,USRDS2005AnnualDataReport:AtlasofEnd-StageRenalDiseaseintheUnitedStates,NationalInstitutesofHealth,NationalInstituteofDiabetesandDigestiveandKidneyDiseases,Bethesda,MD,2006 .

U .S .DepartmentofHealthandHumanServices .CentersforDiseaseControlandPrevention .“AsthmaPrevalenceandControlCharacteristicsbyRace/Ethnicity,UnitedStates,2002 .”MMWR2004:53:145-8 .

The Henry J . Kaiser Family Foundation is a nonprofit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

The Henry J . Kaiser Family Foundation

Headquarters

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Phone 650-854-9400 Fax 650-854-4800

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www.kff.org

Additional copies of this report (#6069-02) are available on the Kaiser Family Foundation’s website at

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Documents

Key Facts: Race, Ethnicity, and Medical Care - Chartbook · Figure 27 No Usual Source of Health Care: Adults 18–64 by Race/Ethnicity and Poverty Status, 2003–2004 . . .22 Figure