1. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Health Disparities in Massachusetts: Data and Trends Disparities Council June 16, 2008

2. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Racial Disparities in Health Indicators

3. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Fair or Poor Self-Perceived Health Status, MA 1993-2007 Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 source: MA BRFSS

4. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 Poor Self-Perceived Mental Health, MA 1993-2007 source: MA BRFSS

5. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Overweight or Obese, MA 1990-2007 * * * Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 source: MA BRFSS

6. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Diabetes, MA 1990-2007 * * Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 source: MA BRFSS

7. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Current Smokers, MA 1990-2007 * Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 source: MA BRFSS

8. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Binge Drinkers, MA 1990-2007 Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 source: MA BRFSS

9. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Percentages are age adjusted to 2000 US population Time trend in prevalence is shown when it is significant p<=0.05 Had mammography in the past two years, MA 1992-2007 source: MA BRFSS * *

10. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Racial Disparities in Birth Outcome Indicators

11. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Rates Used to Compare Outcomes of Blacks 1, Hispanics, And Asians 1 to that of Whites 1 Interpretation of ratio of rates and of its trend over time 1.Values of ratio of rates <1 rates are lower than that of whites =1rates are equal to that of whites >1rates are higher than that of whites 2.Where the observed ratio crosses the Y axis, it indicates the magnitude of the gap between a particular race and Whites, for a given outcome. 3.When the Annual Percent Change (APC) is statistically different from 0 (p<0.05) and: APC<0, this indicates that the gap (or ratio) is decreasing APC=0, this indicates that the gap (or ratio) is stable APC>0, this indicates that the gap (or ratio) is increasing 1. non-Hispanics

12. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Interpretation of ratio of rates and APC for Adverse Outcomes Interpretation of ratio of rates and APC for adverse outcomes Values of ratio of rates <1, better off than whites (B) =1,rates are equal to that of whites (E) >1,worse off than whites (W) Values of the Annual Percent Change (APC) If statistically different from 0 (p<0.05) and: APC<0, indicates that the racial disparity/gap is improving APC=0, indicates that the racial disparity/gap remains stable APC>0, indicates that the racial disparity/gap is worsening

13. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change Ratio of Teen Birth Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Worse Off Better Off Asians Blacks Hispanics -4.7% * APC -2.4% * APC -2.5% * APC

14. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Infant Mortality Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Worse Off Better Off Asians Blacks Hispanics 1.0% APC 3.5% * APC 1.9% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

15. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Worse Off Better Off Blacks Hispanics -0.5% APC -0.7% * APC Ratio of Cesarean Rates by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Asians 1.4% * APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

16. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Gestational Diabetes Mellitus by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Worse Off Better Off Asians Blacks Hispanics -3.2% APC -1.0% APC -0.3% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

17. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Singleton Low Birth Weight Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Worse Off Better Off Asians Blacks Hispanics -1.4% * APC -1.0% * APC -1.4% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

18. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Blacks Hispanics -1.1% * APC -3.5% * APC Ratio of Smoking During Pregnancy Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Asians 4.8% * APC Worse Off Better Off * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

19. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Blacks Hispanics 0.3% APC 0.6% * APC Ratio of Adequate Prenatal Care (APNC) by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Asians 0.3% * APC Better Off Worse Off * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

20. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Blacks Hispanics 1.1% * APC 0.5% * APC Ratio of Breastfeeding Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006 Asians 0.5% * APC Better Off Worse Off * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

21. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Summary of Racial Disparities in Selected Birth Outcomes BLACK TO WHITES HISPANICS TO WHITES ASIAN TO WHITES WHIT ES Outcom e Curren t Ratio (2006) Trend of Ratio Current Ratio (2006) Trend of Ratio Current Ratio (2006) Trend of Ratio Trend of Rate Stat us Rat io Stat us Rati o Stat us Rati o Teen Birth W>1 IMPRO VING W>1 IMPROVI NG E1 STABLE Infant Death W>1 STABLE W>1 WORSE NING B<1 STABLE Cesarea ns B<1 STABLE B<1 IMPROVI NG B<1 WORSENI NG GDMW>1 STABLE E1 W>1 STABLE LBW among singleto ns W>1 IMPRO VING W>1 IMPROVI NG W>1 STABLE SmokeB<1 IMPRO VING B<1 IMPROVI NG B<1 IMPROVI NG WORSE NING APNC ( Kotelchuck ) W<1 IMPRO VING W<1 IMPROVI NG W<1 IMPROVI NG Breastfe ed B>1 IMPRO VING B1 B1 WORSE NING

22. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Racial Disparities in Incidence of Selected Cancers

23. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Colorectal Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Births 1996-2005 Worse Off Better Off Asians Blacks Hispanics -1.1% APC 4.0% * APC -0.9% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

24. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Prostate Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Births 1996-2005 Worse Off Better Off Asians Blacks Hispanics -1.0% APC 3.4% * APC -1.1% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

25. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Female Breast Cancer Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off + 1.7% APC + 5.0%* APC Asians to Whites

26. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Lung Cancer Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Asians to Whites Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off - 0.5% APC -1.4% APC - 1.5% APC

27. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Liver Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Births 1996-2005 Worse Off Better Off Asians Blacks Hispanics 2.3% APC 4.7% APC -5.0% * APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

28. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Stomach Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Births 1996-2005 Worse Off Better Off Asians Blacks Hispanics 0.1% APC 0.4% APC -2.9% APC * Statistically significantly different from 0 (p ≤0.05) APC = Annual Percentage Change

29. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Summary of Racial Disparities in Incidence of Selected Cancers BLACK TO WHITESHISPANICS TO WHITESASIAN TO WHITESWHITES Current Ratio (2006) Trend of Ratio Current Ratio (2006) Trend of Ratio Current Ratio (2006) Trend of Ratio Trend of Rate StatusRatioStatusRatioStatusRatio ColorectalE1 STABLE None1 WORSENING B<1 STABLE ProstateW>1 STABLE None1 WORSENING B<1 STABLE Liver E1 STABLE W>1 STABLE W>1 IMPROVING StomachW>1 STABLE W>1 STABLE W>1 STABLE W racial group is worse off than Whites E racial group has an equal rate than Whites B racial group is better of than Whites

30. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Disparities in Mortality in Massachusetts

31. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Note Regarding Mortality Rates for Hispanics, Asians and Native Americans There are limitations to data from death certificates: there is an undercount of Hispanics, Asians, and Native Americans which may result in artificially low mortality rates

32. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation All Cause Mortality Age-Adjusted Death Rates: 1994-2004 Adjusted Estimate Underestimate Rates are per 100,000 population. Age-adjusted to the 2000 US standard population

33. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of All Cause Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Asians to Whites Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off - 1.5%* APC + 10.9%* APC - 1.0%* APC

34. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Heart Disease Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off + 0.3% APC + 1.7% APC + 15.0% APC - 1.9% APC Asians to Whites - 1.5% APC

35. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Diabetes Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off + 0.04% APC + 3.8% APC

36. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Asthma Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off + 3.0% APC

37. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Suicides Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off - 0.3% APC - 3.6% APC

38. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Homicide Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off + 2.3%* APC -0.3% APC

39. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of HIV/AIDS Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off - 0.8% APC - 0.7% APC

40. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Premature Mortality Rates Compared to White non-Hispanics Massachusetts: 1996-2006 Blacks to Whites Hispanics to Whites * Statistically Significant (p ≤.05) APC = Annual Percentage Change Worse Off Better Off - 2.2%* APC + 4.8%* APC - 3.9% APC Asians to Whites - 2.7%* APC

41. Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ratio of Mortality Rates for Causes Amenable to Health Care Compared to White non-Hispanics Massachusetts: 2000 and 2006 * Statistically higher than 2000 rate (p<0.O5) Worse Off Better Off