health disparities in ma council for the elimination of racial and ethnic disparities

Health Disparities in MA

Council for the Elimination of Racial and Ethnic Disparities

2

Racial and Ethnic Disparities in Health Outcomes Are Seen Consistently in

Massachusetts

• Such disparities are particularly apparent in premature or excessive death rates for cancer, HIV, diabetes and asthma and in higher hospitalizations rates for many diseases and conditions

• Disparities are seen across the Commonwealth – in all corners of the State

• The causes of these disparities are multiple, including poverty, lack of acess to care and racism, discrimination and the legacy of slavery

3

Race and Ethnic Breakdown of PopulationCentral Region and Massachusetts: 2005

Central Region Massachusetts

White*

86.0%

Black*

3.2%

Hispanic

7.3%

Asian*

3.3%

* Non-Hispanics

White*

81.0%

Black*

6.0%

Hispanic

7.9%

Asian*

4.9%

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

American Indian*

0.3%

American Indian*

0.2%

Population Total = 806,015 Population Total = 6,349,097

4

Black*6.0%

Hispanic7.9%

Asian*4.9%

White*81.0%

American Indian*0.2%

Race and Ethnic Breakdown of PopulationWorcester and Massachusetts: 2005

White*, 66.7

Black*, 8.6

Hispanic, 17.4

Asian*, 7.0

American Indian*,

0.4

Worcester

* Non-Hispanics


Massachusetts

Population Total = 6,349,097Population Total = 172,648

5

WORCESTER 13%

FITCHBURG 13%

SOUTHBRIDGE 17%

HARVARD 7%

LANCASTER 8%

LEOMINSTER 10%

SHIRLEY 8%

WEST BOYLSTON 6%

CLINTON 10%

Spanish LanguageSpoken at Home (%)

Cities/Towns in Central Region

10.0% - 55.3%

5.0% - 9.9%

0.2% - 4.9%

Central Region

5

Miles

Spanish Spoken at Home

Central Region: 2000


Examples of Racial and Ethnic Disparities

8

Diabetes

9

32

123 121

54 64

0

25

50

75

100

125

150

175

200

225

2005

Age a

dju

sted r

ate

per

1000

Asian Hispanic Black (NH) White Total

Prevalence of Diabetes in Massachusetts Varies Significantly by Race/Ethnicity

Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program

10

Diabetes Hospital Discharges, 2003-2005

133114

368

242

45

0

50

100

150

200

250

300

350

400

Hospital discharge rate

Ra

te p

er

10

0,0

00

MA White Black Hispanic Asian

Source: Division of Health Care Finance and Policy, Inpatient Hospital Discharge Database

11

Mortality Rates for Diabetes as the Primary Cause of Death, by Race, 1994 - 2004

47.8 43.9 43.0

54.546.1 42.9

34.3

44.6 42.6 45.7

34.7

16.723.8 20.5

26.8 25.9

36.142.4

25.8

41.0

30.7 26.8

12.7

23.515.1

19.7 19.211.7 11.3

22.216.7 19.7 17.9

0

1020

30

4050

60

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Years

Rate

per

100,0

00

White, NH Black, NH Hispanic Asian/Pacific Islander, NH


Mortality Rates are Much Higher for Blacks and Hispanics

12

Diabetes Mortality Rates, 2003-2005

18 17

38

29

14

0

50

Age-Adjusted Death Rate

Ra

te p

er

10

0,0

00

MA White Black Hispanic Asian


13

3.5 3.6

4.3

6.7

2.5

3.7

3.0

5.2

0

2

4

6

8

White Non-Hispanic

Hispanic Black Non-Hispanic

Asian

%G

DM

2000 2006

GDM by Race and Hispanic EthnicityMassachusetts: 2000 vs. 2006

* Statistically higher than 2000 rate (p<0.05)

N=

1,8

30

N=

1,4

85

N=

211

N=

277

N=

238

N=

379

N=

274 N

=3

68

*

*

14

Asthma

15

Age-Adjusted Asthma ED Visits and Hospitalizations by Race/Ethnicity

2003-2005

676

1564 1524

235

783

227

2080

841

2276

1038

0

500

1000

1500

2000

White Black Hispanic Asian MA

Rat

e p

er 1

00,0

00

ED Visits Hospitalizations


16

Age-Adjusted Asthma Mortality, 2003-2005

1.0

2.72.5

1.31.1

0

1

2

3

White Black Hispanic Asian MA Total

Rat

e p

er 1

00,0

00


17

Cancer

18

Age-Adjusted Cancer Incidence, MA Males, 2000-2004

87 89

49 5070

54 49 47

244

301

135121

272

171184

78

0

50

100

150

200

250

300

White Black Hispanic Asian

Rat

e p

er 1

00,0

00

Prostate Lung Colon All CA Deaths

Source: MDPH, MA Cancer Registry

19

Age-Adjusted Cancer Incidence, MA Females, 2000-2004

64

48

27 30

50 4636 34

173 176

92 91103

140

93

69

0

50

100

150

200

White Black Hispanic Asian

Rat

e p

er 1

00,0

00

Breast Lung Colon All CA Deaths

Source: MDPH, MA Cancer Registry

20

Birth outcomes

21

4.2

5.8

11.1

0

2

4

6

8

10

12

14

16

18

20

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

IMR

(#

de

ath

s/1

,00

0 li

ve

bir

ths

)IMR by Race & Hispanic Ethnicity

Massachusetts: 1990-2006

White Non-Hispanic

Black Non-Hispanic

Hispanic


22

HIV

23

People Diagnosed with HIV Infection by Gender and Race/Ethnicity: Massachusetts, 2004-2006

48%

18%

25%

50%

25%29%

3% 3%

0%

10%

20%

30%

40%

50%

60%

Male FemaleRace/Ethnicity

Pe

rce

nt

of

To

tal H

IV D

iag

no

se

s

White (non-Hispanic) Black (non-Hispanic)Hispanic Other

Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07

24

Females Diagnosed with HIV Infection by Race/Ethnicity and Place of Birth:

Massachusetts,2004-2006

88%

35% 37%

36%

11%

65%

27%1%

0%

0%

20%

40%

60%

80%

100%

White NH, N=130 Black NH, N=354 Hispanic, N=204

Race/Ethnicity

Pe

rce

nt

of

To

tal D

iag

no

se

s

US Puerto Rico/US Dependency Non-US1 97% of people diagnosed with HIV infection from 2004-2006 that were born in a US Dependency were born in Puerto Rico; NH=Non-Hispanic; Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 11/1/07

1

25

Percentage of HIV Cases Among 13-24 Year Olds, by Race/Ethnicity: 1999–20061

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004 2005 2006

Year of Diagnosis

Percent

White Black Hispanic Other

White NH

Black NH

Hispanic

Other

1

2006 Data are preliminary; Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 11/1/07

26

People Diagnosed with HIV Infection by Age at Diagnosis & Race/Ethnicity: Massachusetts, 2003-2005

26%

40%44%

32%

26% 25%

3% 3%

0%

10%

20%

30%

40%

50%

60%

13-24 years, N=201 25+ years, N=2461

Pe

rce

nt

of

To

tal H

IV D

iag

no

se

s

White Black Hispanic Other

Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 7/06

Violence in Massachusetts

28

550521

355

445

416

356

245

133

167 154 162

222

179 177

268

341

616

100

200

300

400

500

600

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Gun Violence in Boston Homicides & Non-Fatal Shootings

(1990 - PRESENT)

DATA SOURCE: Councilor Ross (5.06 Presentation)

# o

f S

ho

oti

ng

s

Year

29

Nonfatal Gunshot Injuries by Race/Ethnicity Boston, 2003-2005 Combined

White, 4.5%

Other/Unknown 6.0%

Latino, 12.9%

Cape Verdean, 2.2%

Asian/Pac Isl, 1.0%

Black, 73.5%

DATA SOURCE: Weapon-related injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office

Black Bostonians are 24% of total population and 74% of victims of gunshots

Disparities Are Seen Across the

Commonwealth

31

Diabetes Hospital Discharge Rate by Race/Ethnicity

Western Region and Massachusetts: 2003-2005

368

114118

452

396

242

4536

0

50

100

150

200

250

300

350

400

450

500

Western Region Massachusetts

Dis

char

ges

p

er 1

00,0

00

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

*

*

Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better than state

32

Diabetes Death Rate by Race/EthnicityCentral Region and Massachusetts: 2003-2005

17

37 39

49

29

37

14

22

0

10

20

30

40

50

60

Central Region Massachusetts

De

ath

s p

er

10

0,0

00



Age-adjusted to the 2000 US standard population. Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

*

33

Diabetes Hospital Discharge Rate by Race/Ethnicity

Berkshires, Pittsfield & Massachusetts: 2003-2005

114

368242

45181122

1,584

975

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Berkshires Pittsfield Massachusetts

Dis

char

ges

p

er 1

00,0

00



Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

*


*

NA NA NA NA

*

34

Infant Mortality Rates by Race/Ethnicity Western Region and Massachusetts: 2002-2005

NA= Calculations based on less than 5 events are excluded

4.1*4.5

11.3 *

15.1*

8.0*7.0 *

3.0*

0

2

4

6

8

10

12

14

16


De

ath

s p

er

10

00

liv

e b

irth

s

White^ Black^ Hispanic Asian^

NA

(*) Statistically different from State (p ≤.05)

Source: MDPH, Bureau of Health Information, Statistics, Research, & Evaluation Bureau, Division of Research & Epidemiology

State Overall:

4.9

^ = Non-Hispanic

35

HIV/AIDS Death Rate by Race/EthnicityWestern Region and Massachusetts: 2003-2005

1 2

1916

13

1

29

0

5

10

15

20

25

30

35


De

ath

s p

er

10

0,0

00

White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

NA

*


Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

36

Asthma Emergency Department Visit Rates Children Ages 0-14

Western Region and Massachusetts: 2005

2,096

238

569 516

1,683

2,196

1,573

356

0

500

1,000

1,500

2,000

2,500


Vis

its

per

100

,000



**

*

Age-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Department Visits

Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

The Health Profiles of Each Racial and Ethnic Group and Sub-group

are Different

41

Brazilian 45.3%

Nigerian 42.9%

Haitian 41.0%

Filipino 39.8%

Asian Indian 37.7%

European 35.2%

MA 33.4%

Chinese 29.7%

African-American 29.4%

Puerto Rican 27.6%

Vietnamese 27.4%

Japanese 26.1%

Colombian 24.1%

Honduran 23.0%

Salvadoran 22.7%

Guatemalan 21.7%

Cambodian 17.4%

0% 10% 20% 30% 40% 50% 60% 70%

Cesarean Rate by Maternal Ethnicity1,Massachusetts 2006

1 Only ethnic groups statistically different from the state rate are included

**

**

**

****

**

* Statistically higher than state rate (p ≤.05)** Statistically lower than state rate (p<.05)

****

********

**

What are the contributing factors?

Social and economic determinants of health matter

46Source: NEHI/Boston Foundation: Boston Paradox

3+ fold variatio

n

$75,000 +

<$25,000

Substantial Variation in Diabetes Rates by Household Income

47

Diabetes by Education, 2006

6.47.9

15.6

5.44.4

0

5

10

15

20

25

< HS HS grad 1-3 years college 4+ years college MA

Per

cen

t

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state


49

The Experience of Racism and Discrimination

2.9%

18.1%20.8%

0.0%

10.0%

20.0%

30.0%

40.0%

Black Latino White

Pe

rce

nta

ge

o

f re

sp

on

de

nts

8.3%4.0% 1.9%

0.0%

10.0%

20.0%

30.0%

40.0%

Black Latino White

Pe

rce

nta

ge

of

res

po

nd

en

ts

Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity

Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity

Note: Data about Asian residents not shown due to inadequate sample sizeSOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission

health disparities in ma council for the elimination of racial and ethnic disparities

Documents

health disparities

diabetes slide

health survey program

bureau of health information

evaluation bureau

health outcomes

ethnic disparities

legacy of slavery slide