Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics,...

Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation

Health Disparities in Massachusetts: Data and Trends

Disparities CouncilJune 16, 2008


Racial Disparities in Health Indicators


Fair or Poor Self-Perceived Health Status, MA 1993-2007

0

10

20

30

40

50

93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

pre

vale

nce

(%)

white Nh black nH Hispanic

Percentages are age adjusted to 2000 US populationTime trend in prevalence is shown when it is significant p<=0.05

source: MA BRFSS

Average( median) prevalence by race/ethnicity over time

10.5

16.8

33.7

0.0

10.0

20.0

30.0

40.0

w hite,Nh black, Nh Hispanic

prev

alen

ce(%

)


0

5

10

15

20

93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

pre

vale

nce

(%)

white Nh black nH Hispanic


Poor Self-Perceived Mental Health, MA 1993-2007

source: MA BRFSS


12.911.18.9

0.0

5.0

10.0

15.0

20.0


prev

alen

ce(%

)


Overweight or Obese, MA 1990-2007

20

30

40

50

60

70

80

90

100

90-91 92-93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

prev

alen

ce(%

)

white NH black NH Hispanic

*

**


source: MA BRFSS


49.564.4 63.1

20.0

40.0

60.0

80.0

100.0


prev

alen

ce(%

)


Diabetes, MA 1990-2007

0

5

10

15

20

90-91 92-93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

pre

vale

nce

(%)


*

*


source: MA BRFSS


4.5

9.7 10.6

0.0

5.0

10.0

15.0

20.0


prev

alen

ce(%

)


Current Smokers, MA 1990-2007

0

5

10

15

20

25

30

90-91 92-93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

pre

vale

nce

(%)


*


source: MA BRFSS


17.821.1

20.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0


prev

alen

ce(%

)


Binge Drinkers, MA 1990-2007

0

5

10

15

20

25

30

90-91 92-93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

prev

alen

ce(%

)



source: MA BRFSS


12.613.0

19.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0


prev

alen

ce(%

)


20

30

40

50

60

70

80

90

100

92-93 94-95 96-97 98-99 00-01 02-03 04-05 06-07

pre

va

len

ce

(%)



Had mammography in the past two years , MA 1992-2007

source: MA BRFSS

*

* Average( median) prevalence by race/ethnicity over time

82.184.7 85.2

20.030.040.050.060.070.080.090.0

100.0


prev

alen

ce(%

)


Racial Disparities in Birth Outcome Indicators


Ratio of Rates Used to Compare Outcomes of Blacks1, Hispanics, And Asians1 to that of Whites1

Interpretation of ratio of rates and of its trend over time1. Values of ratio of rates

• <1 rates are lower than that of whites

• =1 rates are equal to that of whites

• >1 rates are higher than that of whites

2. Where the observed ratio crosses the Y axis, it indicates the magnitude of the gap between a particular race and Whites, for a given outcome.

3. When the Annual Percent Change (APC) is statistically different from 0 (p<0.05) and: • APC<0, this indicates that the gap (or ratio) is decreasing

• APC=0, this indicates that the gap (or ratio) is stable

• APC>0, this indicates that the gap (or ratio) is increasing

1. non-Hispanics


Interpretation of ratio of rates and APC for Adverse Outcomes

Interpretation of ratio of rates and APC for adverse outcomes

Values of ratio of rates<1, better off than whites (B)

=1, rates are equal to that of whites (E)

>1, worse off than whites (W)

Values of the Annual Percent Change (APC)If statistically different from 0 (p<0.05) and:

APC<0, indicates that the racial disparity/gap is improving

APC=0, indicates that the racial disparity/gap remains stable

APC>0, indicates that the racial disparity/gap is worsening


5.75.6

2.9

2.8

1.1

1.2

0

1

2

3

4

5

6

7

8

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

* Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

Ratio of Teen Birth Rate by RaceCompared to White non-Hispanics

Massachusetts Births 1996-2006

Worse Off

Better Off

Asians

Blacks

Hispanics

-4.7% * APC

-2.4% * APC

-2.5% * APC


1.41.3

3.3

2.7

0.4

1.1

0

1

2

3

4

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Ratio of Infant Mortality Rate by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

1.0% APC

3.5% * APC

1.9% APC



0.83

0.80

0.96

1.00

0.86

0.79

0.72

0.74

0.76

0.78

0.80

0.82

0.84

0.86

0.88

0.90

0.92

0.94

0.96

0.98

1.00

1.02

1.04

1.06

1.08

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Worse Off

Better Off

Blacks

Hispanics

-0.5% APC

-0.7% * APC

Ratio of Cesarean Rates by RaceCompared to White non-Hispanics


Asians1.4% * APC



1.21.0

1.2

1.5

1.9

2.1

0.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Ratio of Gestational Diabetes Mellitus by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

-3.2% APC

-1.0% APC

-0.3% APC



1.5

1.6

2.4

2.1

1.31.5

0.5

1.0

1.5

2.0

2.5

3.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Ratio of Singleton Low Birth Weight Rate by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

-1.4% * APC

-1.0% * APC

-1.4% APC



0.77

0.60

0.78

0.83

0.170.15

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

1.10

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Blacks

Hispanics

-1.1% * APC

-3.5% * APC

Ratio of Smoking During Pregnancy Rate by RaceCompared to White non-Hispanics


Asians4.8% * APC

Worse Off

Better Off



0.85

0.880.88

0.86

0.950.93

0.82

0.84

0.86

0.88

0.90

0.92

0.94

0.96

0.98

1.00

1.02

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Blacks

Hispanics

0.3% APC

0.6% * APC

Ratio of Adequate Prenatal Care (APNC) by RaceCompared to White non-Hispanics


Asians0.3%* APC

Better Off

Worse Off



1.03

1.06

1.03

1.00

1.11

1.04

0.92

0.94

0.96

0.98

1.00

1.02

1.04

1.06

1.08

1.10

1.12

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ra

tio

of

Ra

tes

Blacks

Hispanics

1.1% * APC

0.5% * APC

Ratio of Breastfeeding Rate by RaceCompared to White non-Hispanics


Asians0.5% * APC

Better Off

Worse Off



Summary of Racial Disparities in Selected Birth Outcomes

BLACK TO WHITES

HISPANICS TO WHITES

ASIAN TO WHITES

WHITES

Outcome

Current Ratio (2006)

Trend of

Ratio


Trend of

Ratio


Trend of

Ratio

Trend of

RateStatus

Ratio

Status

Ratio

Status

Ratio

Teen Birth

W >1 IMPROVING

W >1 IMPROVING

E 1 STABLE

Infant Death

W >1 STABLE W >1 WORSENING

B <1 STABLE

Cesareans

B <1 STABLE B <1 IMPROVING

B <1 WORSENING

WORSENING

GDM W >1 STABLE E 1 STABLE W >1 STABLE

LBW among singletons

W >1 IMPROVING

W >1 IMPROVING

W >1 STABLE

Smoke B <1 IMPROVING

B <1 IMPROVING

B <1 IMPROVING

WORSENING

APNC (Kotelchuck)

W <1 IMPROVING

W <1 IMPROVING

W <1 IMPROVING

Breastfeed

B >1 IMPROVING

B 1 IMPROVING

B 1 IMPROVING

WORSENING


Racial Disparities in Incidence of Selected Cancers


0.87

0.75

0.87

0.93

0.78

0.71

0.4

0.6

0.8

1.0

1.2

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Ra

tio

of

Ra

tes

Ratio of Colorectal Cancer Incidence by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

-1.1% APC

4.0% * APC

-0.9% APC



1.04

1.07

1.46

1.57

0.35

0.33

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Ra

tio

of

Ra

tes

Ratio of Prostate Cancer Incidence by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

-1.0% APC

3.4% * APC

-1.1% APC



1.5

1.1

0.3

0.6

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Female Breast Cancer Mortality RatesCompared to White non-Hispanics

Massachusetts: 1996-2006

Blacks to Whites

Hispanics to Whites

* Statistically Significant (p ≤.05) APC = Annual Percentage Change

Worse Off

Better Off

+ 1.7% APC

+ 5.0%* APC

Asians to Whites


0.90.9

0.30.2

0.70.6

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Lung Cancer Mortality RatesCompared to White non-Hispanics


Asians to Whites

Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

- 0.5% APC

-1.4% APC

- 1.5% APC


1.8

2.7

1.31.5

3.63.6

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Ra

tio

of

Ra

tes

Ratio of Liver Cancer Incidence by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

2.3% APC

4.7% APC

-5.0% * APC



2.1

2.01.9

1.4

1.7

2.1

0.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Ra

tio

of

Ra

tes

Ratio of Stomach Cancer Incidence by RaceCompared to White non-Hispanics


Worse Off

Better Off

Asians

Blacks

Hispanics

0.1% APC

0.4% APC

-2.9% APC



Summary of Racial Disparities in Incidence of Selected Cancers

BLACK TO WHITES HISPANICS TO WHITES ASIAN TO WHITES WHITES


Trend of Ratio


Trend of Ratio


Trend of Ratio

Trend of Rate

Status Ratio Status Ratio Status Ratio

Colorectal E 1 STABLE None 1 WORSENING B <1 STABLE

Prostate W >1 STABLE None 1 WORSENING B <1 STABLE

Liver E 1 STABLE W >1 STABLE W >1 IMPROVING

Stomach W >1 STABLE W >1 STABLE W >1 STABLE

W racial group is worse off than Whites

E racial group has an equal rate than Whites

B racial group is better of than Whites


Disparities in Mortality in Massachusetts


Note Regarding Mortality Rates for Hispanics, Asians and Native Americans

• There are limitations to data from death certificates: there is an undercount of Hispanics, Asians, and Native Americans which may result in artificially low mortality rates


All Cause MortalityAge-Adjusted Death Rates: 1994-2004

956.7

392.8498.2

987.0

810.3

0

200

400

600

800

1,000

1,200

1,400

1,600

White non-Hispanic

Black non-Hispanic

Hispanic American Indiannon-Hispanic

American Indian(AlternativeEstimate)

De

ath

s p

er

10

0,0

00

po

pu

lati

on

Adjusted Estimate

Underestimate

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population


1.2

1.3

0.5

0.70.6

0.5

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of All Cause Mortality RatesCompared to White non-Hispanics


Asians to Whites

Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

- 1.5%* APC

+ 10.9%* APC

- 1.0%* APC


0.960.97

0.4

0.6

0.40.4

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Heart Disease Mortality RatesCompared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

+ 0.3% APC

+ 1.7% APC + 15.0% APC

- 1.9% APC

Asians to Whites

- 1.5% APC


2.5

2.1

1.0

1.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Diabetes Mortality RatesCompared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

+ 0.04% APC

+ 3.8% APC


4.8

2.2

3.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Asthma Mortality Rates Compared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

+ 3.0% APC


0.6

0.4

0.6

0.3

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Suicides RatesCompared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off - 0.3% APC

- 3.6% APC


14.0

11.8

3.3

4.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Homicide Rates Compared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

+ 2.3%* APC

-0.3% APC


8.610.3

5.65.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of HIV/AIDS Mortality RatesCompared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

- 0.8% APC

- 0.7% APC


1.4

1.8

0.80.9

0.50.7

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

io o

f R

ates

Ratio of Premature Mortality RatesCompared to White non-Hispanics


Blacks to Whites

Hispanics to Whites


Worse Off

Better Off

- 2.2%* APC

+ 4.8%* APC - 3.9% APC

Asians to Whites

- 2.7%* APC


0.6

1.4

0.4

0.6

1.0

1.6

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Blacks to Whites Hispanics to Whites Asians to Whites

Rat

io o

f ra

tes

2000 2006

Ratio of Mortality Rates for Causes Amenable to Health Care Compared to White non-Hispanics

Massachusetts: 2000 and 2006

* Statistically higher than 2000 rate (p<0.O5)

Worse Off

Better Off

Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics,...

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