# Presentation: 733775

## 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

**Notes:**
The color codes are all about the size of the rate for one of the other groups relative to the size of the rate for the best group.  For race and ethnicity the comparisons are made to the best race and ethnic group rate.  For gender the comparison is made for one gender group to the gender group with the best rate, and so forth. 

The dark red code means that the rate for this group is at least 100 percent worse (or two times)  the rate for the best group.  Obviously the actual percent difference is not shown.  The largest percent difference is actually 3300 percent for blacks compared to whites on congenital syphilis.  

## 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*

## Decoding the Disparity Table

- 		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

**Notes:**
The color codes are all about the size of the rate for one of the other groups relative to the size of the rate for the best group.  For race and ethnicity the comparisons are made to the best race and ethnic group rate.  For gender the comparison is made for one gender group to the gender group with the best rate, and so forth. 

The dark red code means that the rate for this group is at least 100 percent worse (or two times)  the rate for the best group.  Obviously the actual percent difference is not shown.  The largest percent difference is actually 3300 percent for blacks compared to whites on congenital syphilis.  

## 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**

## 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

**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

## Education Level

**Education Level**

**Percent of objectives **

- DRAFT

**Percent difference from the “best” group rate:**

## Groups that have the “Best” Rate for the Greatest Proportion of Objectives

| Race/ethnicity | Asian or Pacific Islander |
| --- | --- |
| Gender | Female |
| Education | At least some college education |
| Income | Middle/high income |
| Geographic location | Urban 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

| Characteristic | Group | Percent (no.) of objectives |
| --- | --- | --- |
| Race/ethnicity | American Indian/ Alaska Native | 24% (37) |
| Gender | Male | 8% (24) |
| Education | Less than high school | 25% (40) |
| Income | Poor | 12% (12) |
| Geographic location | Urban or metropolitan | 8% (4) |
| Disability status | Persons with disabilities | 6% (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 | 200 | 162 (81%) |
| Gender | 238 | 198 (83%) |
| Education | 109 | 92 (84%) |
| Income | 53 | 52 (98%) |
| Geog. location | 38 | 35 (92%) |
| Disability status | 48 | 45 (94%) |

- * Changes in disparity are measured from baseline to most recent data point.

## Number of Objectives with Changes* in Disparityby Race and Ethnicity

**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**_

_**Percentage points**_

## Number of Objectives with Changes* in Disparityby Education Level

**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**_

_**Percentage points**_

**10-49**

**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, 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**

## 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 20782
- _sop9@cdc.gov_