# Presentation: 627333

## Racial and Ethnic Disparities in Selected Healthy People 2010 Health Care Access Measures

- Suzanne Proctor, MSPH
- Ken Keppel, PhD
- National Center for Health Statistics
- Centers for Disease Control and Prevention

##   Overview

- Healthy People 2010’s second goal is to eliminate health disparities among population groups
- The Midcourse Review will assess progress toward this goal for all population-based objectives
- This presentation demonstrates the application of the statistical measures we will use to assess disparity for the Midcourse Review
- Racial and ethnic disparities are examined for 17 Healthy People 2010 measures related to health care access

##   Presentation Outline

**Access to Care Measures (5)**

**Screening Measures (5)**

**Vaccination Measures (5)**

_**Highlighted Measure**_**:**
**Population Data and Sample Calculations**

_**Summary Tables**_**:              **
**Disparity Assessment at the **
**Most Recent Data Point**
**Change in Disparity from **
**Baseline Data Point**

**  ****Presentation Outline**

##   Selection of Measures

- Criteria:
-     Related to health care access
-     Drawn from a variety of HP2010 Focus Areas
-     Focus on a variety of life stages
-     Race/ethnic subgroup data available
-     Standard errors available
-     At least two data points available

##   Access to Care Measures

**1-1****	****Health insurance coverage**,
- 		persons < 65 years
**1-4c****	****Specific source of ongoing care**,
- 		persons _>_ 18 years
***(Suppl.)*****	****Healthcare visits in the past 12 months,**
**	****	**all ages
**16-16a****	****Prenatal care in the first trimester,**
**	****	**all ages
**21-10****	****Dental visits in the past year**, 			persons _>_ 2 years

##   Access to Care Measures

**1-1****	****Health insurance coverage**,
- 		persons < 65 years
**1-4c****	****Specific source of ongoing care**,
- 		persons _>_ 18 years
***(Suppl.)*****	****Healthcare visits in the past 12 months,**
**	****	**all ages
**16-16a****	****Prenatal care in the first trimester,**
**	****	**all ages
**21-10****	****Dental visits in the past year**, 			persons _>_ 2 years

## 1-1.  No health insurance coverage, persons under 65 years, 2002

| Race/Hispanic Origin | Age-Adjusted Percent | Absolute difference from "best" | Percent difference from "best" |
| --- | --- | --- | --- |
| American Indian or Alaska Native only | 38.7 | 26.1* | 207.1 |
| Asian only | 17.2 |   4.6* |   36.5 |
| Native Hawaiian or Other Pacific Islander only | 24.0 | 11.4* |    90.5 |
| 2 or more races | 19.2 |   6.6* |   52.4 |
| Hispanic | 33.8 | 21.2* | 168.3 |
| Not Hispanic, Black or African American only | 19.2 |   6.6* |   52.4 |
| Not Hispanic, White only  (“best” group) | 12.6 |   Reference |   Reference |
|  |  |  |  |
| Index of disparity: 101.2 |  |  |  |

- *  The difference between the rate for this group and the “best” group rate is statistically significant (a=0.05).
- Index of Disparity: The average percent difference of the other group rates from the “best” group rate.
- SOURCE: National Health Interview Survey, NCHS, CDC.

## Racial/Ethnic Disparities for the Access to Care Measures at the Most Recent Data Point

**Racial/Ethnic Disparities for the Access to Care Measures at the Most Recent Data Point**

- “Best” group

- No statistically significant disparity from the “best” group (a=0.05)

- Data not available or suppressed

- Statistically significant disparity from the “best” group (a=0.05)

## 1-1.  No health insurance coverage, persons under 65 years, 1997 and 2002

- SOURCE: National Health Interview Survey, NCHS, CDC.

- * Based on a Z test, a=0.05.

- Percent difference increased significantly (a _<_ 0.05).

## Summary for Access to Care Measures

**B**

- “Best” group

- Percent difference is < 10% *or *
- Percent difference is _>_ 10% and not  statistically significant (a > 0.05)

- Data not available or suppressed

- Percent difference is _>_ 10% and statistically significant (a _<_ 0.05)

_**Disparity at the most recent data point:**_

_**Change in disparity from the baseline to the most recent data point:**_

**Summary for Access to Care Measures**

- No arrow indicates no significant change

- Statistically significant increase

- Statistically significant decrease

##        Screening Measures

**3-11b****	****Pap test in the past 3 years,**
- 		women _>_ 18 years
**3-12a**	**Fecal occult blood test in the past 2 years**,
- 		persons _>_ 50 years
**3-12b**	**Sigmoidoscopy ever received**, 			persons _>_ 50 years
**3-13**	**Mammogram in the past 2 years**,
- 		women _>_ 40 years
**12-12**	**Blood pressure measured in the past 2 years ****	****and can state level**,
- 		persons _>_ 18 years

## Summary for Screening Measures

**B**

- “Best” group

- Percent difference is < 10% *or *
- Percent difference is _>_ 10% and not  statistically significant (a > 0.05)

- Data not available or suppressed

- Percent difference is _>_ 10% and statistically significant (a _<_ 0.05)

_**Disparity at the most recent data point:**_

_**Change in disparity from the baseline to the most recent data point:**_

**Summary for Screening Measures**

- * Cannot assess change in disparity for this
-   measure.  Only one year of data available.

- Statistically significant increase

- Statistically significant decrease

##   Vaccination Measures

*Children ages 19-35 months*
- 	14-22a	4 doses DtaP vaccine
- 	14-22b	3 doses Hib vaccine
- 	14-22c	3 doses hepatitis B vaccine
- 	14-22d	1 dose MMR vaccine
- 	14-22e	3 doses polio vaccine
*Non-institutionalized adults ages 65+*
- 	14-29a	Influenza vaccine in the past year
- 	14-29b	Pneumococcal vaccine ever received

## Summary for Childhood Vaccination Measures

**B**

- “Best” group

- Percent difference is < 10% *or *
- Percent difference is _>_ 10% and not  statistically significant (a > 0.05)

- Data not available

- Percent difference is _>_ 10% and statistically significant (a _<_ 0.05)

_**Disparity at the most recent data point:**_

_**Change in disparity from the baseline to the most recent data point:**_

**Summary for Childhood Vaccination Measures**

- No arrow indicates no significant change

- Statistically significant increase

- Statistically significant decrease

## Summary for Adult Vaccination Measures

**B**

- “Best” group

- Percent difference is < 10% *or *
- Percent difference is _>_ 10% and not  statistically significant (a _>_ 0.05)

- Data not available

- Percent difference is _>_ 10% and statistically significant (a < 0.05)

_**Disparity at the most recent data point:**_

_**Change in disparity from the baseline to the most recent data point:**_

- Statistically significant increase

- Statistically significant decrease

**Summary for Adult Vaccination Measures**

- No arrow indicates no significant change

## Data Sources

- Access to Care Measures:
- 1-1. National Health Interview Survey, NCHS, CDC.
- 1-4c. National Health Interview Survey, NCHS, CDC.
- 16-16a. National Vital Statistics System – Natality, NCHS, CDC.
- 21-10. Medical Expenditure Panel Survey, AHRQ.
- Supplemental (No health care visits in the past 12 months). National Health Interview Survey, NCHS, CDC.

## Data Sources

- Screening Measures:
- 3-11b. National Health Interview Survey, NCHS, CDC.
- 3-12a. National Health Interview Survey, NCHS, CDC.
- 3-12b. National Health Interview Survey, NCHS, CDC.
- 3-13. National Health Interview Survey, NCHS, CDC.
- 12-12. National Health Interview Survey, NCHS, CDC.

## Data Sources

- Vaccination Measures:
- 14-22a. National Immunization Survey, NIP and NCHS, CDC.
- 14-22b. National Immunization Survey, NIP and NCHS, CDC.
- 14-22c. National Immunization Survey, NIP and NCHS, CDC.
- 14-22d. National Immunization Survey, NIP and NCHS, CDC.
- 14-22e. National Immunization Survey, NIP and NCHS, CDC.
- 14-29a. National Health Interview Survey, NCHS, CDC.
- 14-29b. National Health Interview Survey, NCHS, CDC.

##   Contact Information

- Suzanne Proctor
- National Center for Health Statistics, CDC
- 3311 Toledo Road
- Room 6307
- Hyattsville, MD  20782
- _[SProctor@cdc.gov](mailto:SProctor@cdc.gov)_