Midcourse Assessment of Healthy People 2010 Goal II Suzanne P. Hallquist, MSPH Kenneth G. Keppel, PhD National Center for Health Statistics Centers for Disease Control and Prevention NCHS Data Users Conference July 12, 2006

Healthy People 2010 Goal II “… to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.” - Healthy People 2010: Understanding and Improving Health, U.S. Department of Health and Human Services, 2000.

Population Data Template Race and ethnicity Gender Family income level Education level Geographic location* Disability status* Female Male Less than high school High school graduate At least some college Poor Near poor Middle/high income Urban/metropolitan Rural/non-metropolitan Persons with disabilities Persons without disabilities American Indian/ Alaska Native Asian/Pacific Islander Asian Native Hawaiian/ other Pacific Islander Two or more races Hispanic or Latino Black not Hispanic White not Hispanic * Optional

Measuring Health Disparities: Key Issues Choice of reference point Another group rate Average population rate Total population rate 2010 target “Best” group Absolute vs. relative statistics

Midcourse Review (MCR) Disparity Assessment

Purpose of Assessment Assess the availability of data for population groups and characteristics Quantify the size of disparities at the most recent data point Quantify the size and direction of changes in disparity between the baseline and the most recent data point Summarize findings by population group and characteristic

Scope of Assessment 27 of 28 focus areas 498 population-based objectives Five characteristics: Race/ethnicity Gender Education or income level Geographic location Disability

Data Availability Race and ethnicity (498): Gender (412): Family income level (285): Education level (244): Geographic location* (68): Disability status* (183): Female Male Less than high school High school graduate At least some college Poor Near poor Middle/high income Urban/metropolitan Rural/non-metropolitan Persons with disabilities Persons without disabilities American Indian/ Alaska Native Asian/Pacific Islander Asian Native Hawaiian/ other Pacific Islander Two or more races Hispanic or Latino Black not Hispanic White not Hispanic * Optional

DRAFT

Percent Difference Measures disparity between two groups R B is the “best” group rate R i is the comparison group rate R i - R B x 100 R B

Less than 10% or not statistically significant 10-49% 50-99% 100% or more Decoding the Disparity Table “B” identifies the “best” group Colors indicate the size of the disparity between the individual group and the “best” group rate at the most recent data point: Percent difference:

DRAFT

Decoding the Disparity Table Arrows indicate the size and direction of the change in disparity between the baseline and MR data points < 10 or not statistically significant Disparity Increasing Disparity Decreasing Magnitude of Change in Percentage Points

DRAFT

Summary Index PD i is the percent difference from the “best” group rate for each comparison group rate (i) n-1 is the number of groups minus 1 Measures disparity among several groups ∑ i PD i n – 1

DRAFT

Summary by Size of Disparity

DRAFT

Race and Ethnicity Percent of objectives Percent difference from the “best” group rate: or Alaska Native other Pacific Islander DRAFT

Education Level Percent of objectives DRAFT Percent difference from the “best” group rate:

Race/ethnicityAsian or Pacific Islander GenderFemale Education At least some college education IncomeMiddle/high income Geographic locationUrban or metropolitan Disability status Persons without disabilities Groups that have the “Best” Rate for the Greatest Proportion of Objectives DRAFT

Groups with the Greatest Proportion of Disparities that are > 100 Percent CharacteristicGroup Percent (no.) of objectives Race/ethnicityAmerican Indian/ Alaska Native24% (37) GenderMale8% (24) EducationLess than high school25% (40) IncomePoor12% (12) Geographic locationUrban or metropolitan8% (4) Disability statusPersons with disabilities6% (4) DRAFT

Summary by Change in Disparity

Number of Objectives with No Change* in Disparity by Population Characteristic DRAFT Characteristic Total N Number (%) with No Change Race/ethnicity (81%) Gender (83%) Education10992 (84%) Income5352 (98%) Geog. location3835 (92%) Disability status4845 (94%) * Changes in disparity are measured from baseline to most recent data point.

Number of Objectives with Changes* in Disparity by Race and Ethnicity * Changes in disparity are measured from baseline to most recent data point. DRAFT Decreasing More the Increasing More the No Change Percentage points

Number of Objectives with Changes* in Disparity by Education Level * Changes in disparity are measured from baseline to most recent data point. DRAFT Decreasing 13 Increasing Percentage points No Change

Summary of Findings Substantial disparities between population groups are evident for many objectives Few changes in disparity since the baseline Overall, no consistent pattern of change in disparity for any population group (except males)

Limitations Short time period of analysis Number of years available for assessment varied by population characteristic Lack of data for: - Specific characteristics - Specific groups Lack of estimates of variability for some objectives

Limitations Disparity analysis focuses on differences between groups, regardless of whether or not the rates for specific groups are moving towards or away from the target Summary counts and charts, while helpful, mask the objective-specific successes and failures

New Cases of Hepatitis A, United States, New cases per 100,000 population Source: STD Surveillance System, NCHSTP,CDC 2010 target (4.3) Hispanic American Indian/Alaska Native Black, not Hispanic White, not Hispanic Asian/Pacific Islander Objective 14-06

Conclusions Healthy People 2010 has developed a consistent framework for measuring disparities Healthy People 2010 Midcourse Review First comprehensive assessment of disparity for Healthy People Document to be published in Fall 2006

Contact Information Suzanne Proctor Hallquist CDC/National Center for Health Statistics 3311 Toledo Road, Room 6315 Hyattsville, MD