1. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Is There Progress Toward Eliminating Racial/Ethnic Disparities in the Leading Causes of Death? Kenneth Keppel, PhD Jeffrey Pearcy, MS Melonie Heron, PhD National Center for Health Statistics, Centers for Disease Control and Prevention

2. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Outline Research Objectives Background - Healthy People 2010 Data & Methods - relative vs. absolute measures of disparity; index of disparity Results

3. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Research Objectives Estimate age-adjusted death rates by major racial/ethnic group  Five leading causes of death overall  1990 to 2006 Determine whether racial/ethnic disparities have increased or decreased over time  Percent change in death rates  Change in index of disparity

4. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Background Healthy People – HHS national health promotion initiative Latest version: Healthy People 2010  Improve minority health and reduce racial/ethnic health disparities on key targets  Use reduction in relative differences as evidence of progress

5. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Data Mortality data from the National Vital Statistics System  Coverage: 50 states and DC  Based on the underlying cause of death  Focus: five leading causes of death in the general U.S. population (heart disease, cancer, stroke, CLRD, accidents)  Two separate periods: 1990-1998 and 1999-2006

6. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Methods - I Estimated age-adjusted death rates  For each year in the study  Overall and for four racial/ethnic groups: non-Hispanic white, Hispanic or Latino, black or African American, and Asian or Pacific Islander  Excluded data for the American Indian and Alaska Native population - high racial misclassification  Year 2000 standard population

7. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Methods - II Compared percent changes in age- adjusted death rates over time  Examine patterns of change overall  Changes in rates tested for statistical significance (p<.05)  Help assess changes in relative differences between racial/ethnic groups  Why relative and not absolute differences?

8. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Methods - III Absolute difference = Rate for group i - Rate for ref group Relative difference =  Rate for group i – Rate for ref group * 100 Rate for ref group  Percentage difference Reference group - most favorable rate

9. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Methods - IV Computed an index of disparity  [∑ i=1 to 3 (Rate i – Rate r)] / 3 * 100 Rate r  For each year in the study  Absolute changes in index over time tested for statistical significance (p<.05)  Assess changes in disparities relative to the most favorable (reference) group

10. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 1: Age-adjusted death rates for the five leading causes of death: United States, 1990-2006

11. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 2a: Age-adjusted death rates for heart disease by race/ethnicity: United States, 1990-2006

12. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 2b: Age-adjusted death rates for heart disease by race/ethnicity: United States, 1990-2006 71.585.01.2, 13.6*

13. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 2b_zoom: Age-adjusted death rates for heart disease by race/ethnicity: United States, 1990-2006

14. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 3: Age-adjusted death rates for cancer by race/ethnicity: United States, 1990-2006

15. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 4: Age-adjusted death rates for stroke by race/ethnicity: United States, 1990-2006

16. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 5: Age-adjusted death rates for chronic lower respiratory diseases by race/ethnicity: United States, 1990-2006

17. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Figure 6: Age-adjusted death rates for unintentional injuries by race/ethnicity: United States, 1990-2006

18. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Summary and Conclusions Age-adjusted death rates for 4 of 5 leading causes have declined over time Age-adjusted death rates have declined for most major racial/ethnic groups, BUT Of the 5 leading causes, racial/ethnic disparity declined significantly only for stroke between 1990 and 1998

19. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Summary and Conclusions (cont’d) For other causes, disparity increased or remained unchanged over time  Reliance on only absolute measures of difference can be misleading Reduction in relative differences is key for closing racial/ethnic gaps  Requires greater improvement in less favorable group rates relative to favorable group rates