Health Disparities in MA Council for the Elimination of Racial and Ethnic Disparities

2 Racial and Ethnic Disparities in Health Outcomes Are Seen Consistently in Massachusetts Such disparities are particularly apparent in premature or excessive death rates for cancer, HIV, diabetes and asthma and in higher hospitalizations rates for many diseases and conditions Disparities are seen across the Commonwealth – in all corners of the State The causes of these disparities are multiple, including poverty, lack of acess to care and racism, discrimination and the legacy of slavery

3 Race and Ethnic Breakdown of Population Central Region and Massachusetts: 2005 Central RegionMassachusetts White* 86.0% Black* 3.2% Hispanic 7.3% Asian* 3.3% * Non-Hispanics White* 81.0% Black* 6.0% Hispanic 7.9% Asian* 4.9% Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program American Indian* 0.3% American Indian* 0.2% Population Total = 806,015 Population Total = 6,349,097

4 Race and Ethnic Breakdown of Population Worcester and Massachusetts: 2005 Worcester * Non-Hispanics Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Massachusetts Population Total = 6,349,097Population Total = 172,648

5 Spanish Spoken at Home Central Region: 2000 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

Examples of Racial and Ethnic Disparities

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8 Diabetes

9 Prevalence of Diabetes in Massachusetts Varies Significantly by Race/Ethnicity Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

10 Diabetes Hospital Discharges, Source: Division of Health Care Finance and Policy, Inpatient Hospital Discharge Database

11 Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program Mortality Rates are Much Higher for Blacks and Hispanics

12 Diabetes Mortality Rates, Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

13 GDM by Race and Hispanic Ethnicity Massachusetts: 2000 vs * Statistically higher than 2000 rate (p<0.05) N=1,830 N=1,485 N=211 N=277 N=238 N=379 N=274 N=368 * *

14 Asthma

15 Age-Adjusted Asthma ED Visits and Hospitalizations by Race/Ethnicity Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

16 Age-Adjusted Asthma Mortality, Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

17 Cancer

18 Age-Adjusted Cancer Incidence, MA Males, Source: MDPH, MA Cancer Registry

19 Age-Adjusted Cancer Incidence, MA Females, Source: MDPH, MA Cancer Registry

20 Birth outcomes

21 IMR by Race & Hispanic Ethnicity Massachusetts: White Non-Hispanic Black Non-Hispanic Hispanic Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

22 HIV

23 People Diagnosed with HIV Infection by Gender and Race/Ethnicity: Massachusetts, Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07

24 Females Diagnosed with HIV Infection by Race/Ethnicity and Place of Birth: Massachusetts, % of people diagnosed with HIV infection from that were born in a US Dependency were born in Puerto Rico; NH=Non-Hispanic; Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07 1

25 Percentage of HIV Cases Among Year Olds, by Race/Ethnicity: 1999– White NH Black NH Hispanic Other Data are preliminary; Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 11/1/07

26 People Diagnosed with HIV Infection by Age at Diagnosis & Race/Ethnicity: Massachusetts, Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 7/06

Violence in Massachusetts

28 Gun Violence in Boston Homicides & Non-Fatal Shootings ( PRESENT) DATA SOURCE: Councilor Ross (5.06 Presentation) # of Shootings Year

29 Nonfatal Gunshot Injuries by Race/Ethnicity Boston, Combined DATA SOURCE: Weapon-related injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office Black Bostonians are 24% of total population and 74% of victims of gunshots

Disparities Are Seen Across the Commonwealth

31 Diabetes Hospital Discharge Rate by Race/Ethnicity Western Region and Massachusetts: Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year Inpatient Hospital Discharge Database * * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state

32 Diabetes Death Rate by Race/Ethnicity Central Region and Massachusetts: Age-adjusted to the 2000 US standard population. Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state *

33 Diabetes Hospital Discharge Rate by Race/Ethnicity Berkshires, Pittsfield & Massachusetts: Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year Inpatient Hospital Discharge Database * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state * NA *

34 Infant Mortality Rates by Race/Ethnicity Western Region and Massachusetts: NA= Calculations based on less than 5 events are excluded NA (*) Statistically different from State (p ≤.05) Source: MDPH, Bureau of Health Information, Statistics, Research, & Evaluation Bureau, Division of Research & Epidemiology State Overall: 4.9 ^ = Non-Hispanic

35 HIV/AIDS Death Rate by Race/Ethnicity Western Region and Massachusetts: NA * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

36 Asthma Emergency Department Visit Rates Children Ages 0-14 Western Region and Massachusetts: 2005 ** * Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year Emergency Department Visits Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

The Health Profiles of Each Racial and Ethnic Group and Sub-group are Different

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41 Cesarean Rate by Maternal Ethnicity 1,Massachusetts Only ethnic groups statistically different from the state rate are included * * * * * * ** * Statistically higher than state rate (p ≤.05) ** Statistically lower than state rate (p<.05) **

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What are the contributing factors? Social and economic determinants of health matter

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46 Source: NEHI/Boston Foundation: Boston Paradox 3+ fold variation $75,000 + <$25,000 Substantial Variation in Diabetes Rates by Household Income

47 Diabetes by Education, 2006 Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

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49 The Experience of Racism and Discrimination Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity Note: Data about Asian residents not shown due to inadequate sample size SOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission

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