1. 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

2. 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.

3. 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

4. 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

5. Midcourse Review (MCR) Disparity Assessment

6. 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

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

8. 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

9. DRAFT

10. 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

11. 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:

12. DRAFT

13. 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 10-49 50-99 100 Disparity Increasing Disparity Decreasing Magnitude of Change in Percentage Points

14. DRAFT

15. 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

16. DRAFT

17. Summary by Size of Disparity

18. DRAFT

19. Race and Ethnicity Percent of objectives Percent difference from the “best” group rate: 0 20 40 60 80 100 or Alaska Native other Pacific Islander DRAFT

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

21. 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

22. 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

23. Summary by Change in Disparity

24. Number of Objectives with No Change* in Disparity by Population Characteristic DRAFT Characteristic Total N Number (%) with No Change Race/ethnicity200162 (81%) Gender238198 (83%) Education10992 (84%) Income5352 (98%) Geog. location3835 (92%) Disability status4845 (94%) * Changes in disparity are measured from baseline to most recent data point.

25. Number of Objectives with Changes* in Disparity by Race and Ethnicity * Changes in disparity are measured from baseline to most recent data point. DRAFT 162 23 15 7 2 14 Decreasing 10-49 50-99 More the 100 10 Increasing 10-49 50-99 More the 100 3 2 No Change Percentage points

26. Number of Objectives with Changes* in Disparity by Education Level * Changes in disparity are measured from baseline to most recent data point. DRAFT 92 14 3 3 Decreasing 13 Increasing 10-49 50-99 1 Percentage points 10-49 No Change

27. 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)

28. 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

29. 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

30. New Cases of Hepatitis A, United States, 1997-2003 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

31. 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

32. Contact Information Suzanne Proctor Hallquist CDC/National Center for Health Statistics 3311 Toledo Road, Room 6315 Hyattsville, MD 20782 sop9@cdc.gov