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)
African American, Non-Hispanic
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.
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 .
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
Figure 5
Poverty Status of Elderly Population by Race/Ethnicity, 2005
White, Non-Hispanic
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific
Islander
AmericanIndian/Alaska
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly*
AmericanIndian/Alaska
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).
DATA: National Center for Health Statistics, National Health Interview Survey, 2004.
SOURCE: Health, United States, 2006, Table 60.
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
Hispanic AfricanAmerican,
Non-Hispanic
AmericanIndian/Alaska
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.
SOURCE: Health, United States, 2006, Table 19.
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
African American, Non-Hispanic
American Indian/Alaska Native
White, Non-Hispanic
Asian and Native Hawaiian/Pacific Islander
Hispanic
African American, Non-Hispanic
American Indian/Alaska Native
White, Non-Hispanic
Asian and Native Hawaiian/Pacific Islander
Hispanic
Less
than
High School
High School
College+
SOURCE: Health, United States, 2006, Table 20.
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
AmericanIndian/AlaskaNative
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
African American, Non-Hispanic
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
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
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
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific Islander
AmericanIndian/Alaska
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.
SOURCE: Health, United States, 2006, Table 55.
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
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific
Islander
AmericanIndian/Alaska
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.
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific
Islander
AmericanIndian/Alaska
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.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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%
American Indian/ Alaska Native
1%
White, Non-Hispanic
45%
Hispanic25%
African American, Non-Hispanic
23%
Total = 35 million
Figure 19
Nonelderly Medicaid Beneficiariesby Race/Ethnicity, 2005
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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.
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
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
African American, Non-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
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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%
American Indian/ Alaska Native
1%
White, Non-Hispanic
48%
Hispanic30%
African American, Non-Hispanic
15%
Total = 46.1 Million Uninsuered
Figure 22
Nonelderly Uninsured by Race/Ethnicity, 2005
NOTE: Nonelderly includes individuals up to age 65.
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian and Pacific Islander
American Indian/Alaska Native
NOTE: 200% of the poverty threshold for a family of four in 2005 was $39,942.
DATA: March 2006 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
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.
DATA: March 2005 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
14.1%
39.6%
22.8%18.8%
32.1%
19.5%
White Hispanic AfricanAmerican
Asian andPacific
Islander
AmericanIndian/Alaska
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
Hispanic AfricanAmerican,
Non-Hispanic
White,Non-Hispanic
Hispanic AfricanAmerican,
Non-Hispanic
White,Non-Hispanic
Hispanic AfricanAmerican,
Non-Hispanic
DATA: National Center for Health Statistics, National Health Interview Survey, 2002–2003
SOURCE: Health, United States, 2006, Table 77.
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.
SOURCE: Health, United States, 2006, Table 77.
Figure 26
No Usual Source of Health Care: Adults 18–64 by Race/Ethnicity, 1993–1994 and 2003–2004
White,Non-Hispanic
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly*
AmericanIndian/Alaska
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
DATA: National Center for Health Statistics, National Health Interview Survey, 2004.
Figure 29
No Health Care Visits Within the Past 12 Months by Race/Ethnicity and Poverty Status, 2004
SOURCE: Health, United States, 2006, Table 80.
White, Non-Hispanic
<100% of Poverty
AfricanAmerican,
Non-Hispanic
White, Non-Hispanic
Hispanic AfricanAmerican,
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly*
AmericanIndian/Alaska
Native
1997 2004
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, 1997 and 2004
SOURCE: Health, United States, 2006, Table 80.
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
SOURCE: Health, United States, 2006, Table 7.
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
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific
Islander
AmericanIndian/Alaska
Native
1990 2004
Figure 30
Late or No Prenatal Care by Race/Ethnicity, 1990 and 2004
SOURCE: Health, United States, 2006, Table 7.
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
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, 2004
SOURCE: Health, United States, 2006, Table 91.
19%
35%
27% 26%30%
22%
32%
50%
43%
36% 37%42%
0%
60%
White Hispanic AfricanAmerican
AsianOnly*
Two orMoreRaces
AmericanIndian/AlaskaNative
2–17 Years of Age 18–64 Years of Age
White Hispanic AfricanAmerican
AsianOnly*
Two orMoreRaces
AmericanIndian/AlaskaNative
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
African American, Non-Hispanic
White, Non-Hispanic
2–17 Years of Age
DATA: National Center for Health Statistics, National Health Interview Survey, 2004.
SOURCE: Health, United States, 2006, Table 91.
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly*
AmericanIndian/Alaska
Native
1994 2003
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, 1987 and 2003.
SOURCE: Health, United States, 2005, Table 87.
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly*
AmericanIndian/Alaska
Native
1994 2003
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, 1987 and 2003.
SOURCE: Health, United States, 2005, Table 86.
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly
AmericanIndian/AlaskaNative
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
Hispanic AfricanAmerican,
Non-Hispanic
AsianOnly
AmericanIndian/AlaskaNative
Percent of Adults Receiving:
DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
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
African American, Non-Hispanic
Asian Only
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian Only
White, Non-Hispanic
Hispanic
African American, Non-Hispanic
Asian Only
DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
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.
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
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.
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
Admissions per 100,000 population:
15.2
50.1
85.2
10.0
White, Non-Hispanic
Hispanic African American,Non-Hispanic
Asian and Pacific Islander
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
Hispanic AfricanAmerican,
Non-Hispanic
Asianand
PacificIslander
AmericanIndian/AlaskaNative
DATA: Centers for Disease Control and Prevention, HIV/AIDS Surveillance System and National Vital Statistics System.
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
White,Non-
Hispanic
Hispanic AfricanAmerican,
Non-Hispanic
Asianand
PacificIslander
AmericanIndian/AlaskaNative
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
African American, Non-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
American Indian/Alaska Native
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
African American, Non-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
American Indian/Alaska Native
Share with asthma reporting:
Figure 46
Hospital Admissions for Asthma by Race/Ethnicity, 2002
White,Non-
Hispanic
Hispanic AfricanAmerican,
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
Hispanic AfricanAmerican,
Non-Hispanic
Asian andPacific
Islander
Asian andPacific
Islander
Rate per 100,000 population:
SOURCE: National Healthcare Disparities Report, 2005, available at: http://www.ahrq.gov/qual/nhdr05/index.html.
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)
AmericanIndian/Alaska
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
SOURCE: AHRQ, National Healthcare Disparities Report, 2005
43%22%
38% 53%
46%
41%
48%32%
11%38%
14% 16%
African Americanvs. White (n=46)
Asian and PI vs. White
(n=32)
AmericanIndian/Alaska
Native vs. White(n=21)
Hispanic vs. Non-Hispanic White
(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
SOURCE: AHRQ, National Healthcare Disparities Report, 2005
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)
Asian and PI vs. White
(n=25)
AmericanIndian/Alaska
Native vs. White(n=16)
Hispanic vs. Non-Hispanic White
(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 .
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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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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.
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