racial and spatial health disparities in the delta arthur g. cosby professor & director social...
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Racial and Spatial Health Racial and Spatial Health Disparities in the DeltaDisparities in the Delta
Arthur G. CosbyProfessor & Director
Social Science Research CenterMississippi State University
Public Health Systems Research-Creating the Evidence for Policy-
February 7-9th, 2006
““The South is a place, the The South is a place, the North is a directionNorth is a direction””
““The Most Southern Place on The Most Southern Place on Earth” Earth”
The Mississippi Delta and the The Mississippi Delta and the Roots of Regional Identity Roots of Regional Identity
James C. CobbB. Phinizy Spalding Distinguished
Professor of HistoryUniversity of Georgia
The Urbanization of AmericaThe Urbanization of America
The demographic history of the United States is a transition from a primarily rural agrarian society to an urban one. There is a tendency for us to view geography in terms of these categories.
Rural Population as a Percentage of Total US Rural Population as a Percentage of Total US Population Population (1790-2000)(1790-2000)
2000 US Census (www.census.gov) Year
Percent
Rural America
Urban America
The Great Rural-Urban The Great Rural-Urban TransitionTransition
-Helped shape the way in which we think and respond to place and, in this case, health and place in America
-Rural health has become an important policy concept
Examples: National Rural Health Association
Office of Rural Health Policy
The Journal of Rural Health
etc.
Rural HealthVersus
Healthy and Unhealthy Places
A Different A Different Conceptualization of Conceptualization of
Health and PlaceHealth and Place
“Rural Health” (9,250,000 Google hits)
“Unhealthy Places” (16,600 Google hits)
A Brief Comparison of the Search for Rural Health and Unhealthy Places
557 times more likely to find the concept
Rural Health than
the concept
Unhealthy Places
If you have seen one rural place, you If you have seen one rural place, you have seen one rural placehave seen one rural place
At this point in history, it At this point in history, it may be substantially more may be substantially more
important to consider important to consider healthy and unhealthy healthy and unhealthy
places as a policy conceptplaces as a policy concept
Advances in Spatial Advances in Spatial TechnologiesTechnologies
allow us to think differently allow us to think differently about space and healthabout space and health• Geographic Information Systems
• Global Positioning Systems
• Remote Sensing
• Spatial Statistics
Healthy and Unhealthy Places in America:Healthy and Unhealthy Places in America:Average Years of Lost Life
(80 – Average Life Expectancy, 1990)
Produced by:The Monitor LabSocial Science Research CenterMississippi State University
Source: U.S. Department of Health and Human Services, HRSA Community Health Status Indicator Project
• Clusters of Healthy and Unhealthy Places
• Some of the Healthiest Places were Rural
• Some of the Unhealthiest Places were Rural
• Several of the Unhealthiest Places had regional and cultural identity (The Delta, The Southern Black Belt, and Appalachia)
• Most Importantly, differences in Life Expectancy Most Importantly, differences in Life Expectancy were Profoundwere Profound
““Healthy and Unhealthy Healthy and Unhealthy Places”Places”
Cossman, R.E., Cosby, A.G.Cossman, R.E., Cosby, A.G.• Defined by powerful and undebatable index –
life expectancy
• Clearly discernable clusters
• Profound health disparities
• Statistically significant clusters
• Persistent over time
Figure 8: SpaceStat MapFigure 8: SpaceStat Map
The DRA Delta: A The DRA Delta: A Congressionally Derived Congressionally Derived
RegionRegion
240 county Delta Regional Authority definition
Age-adjusted Circulatory Death Age-adjusted Circulatory Death RatesRates
Deaths/100,000
62.8 – 332.4 332.5 – 368.5 368.6 – 401.0 401.1 – 440.9 441.0 – 1135.1
Source: 1994-1998 Centers for Disease Control and Prevention
Age-adjusted Circulatory Death Age-adjusted Circulatory Death RatesRates
Deaths/100,000
62.8 – 332.4 332.5 – 368.5 368.6 – 401.0 401.1 – 440.9 441.0 – 1135.1
59% of the Delta Counties are in the highest circulatory deaths quintile.
Source: 1994-1998 Centers for Disease Control and Prevention
Age-adjusted Neoplasm Death Age-adjusted Neoplasm Death RatesRates
Deaths/100,000
0.0 – 185.7 185.8 – 202.4 202.5 – 215.3 215.4 – 231.7 231.8 – 423.7
Source: 1994-1998 Centers for Disease Control and Prevention
54% of the Delta Counties are in the highest neoplasm deaths quintile.
Age-adjusted Neoplasm Death Age-adjusted Neoplasm Death RatesRates
Deaths/100,000
0.0 – 185.7 185.8 – 202.4 202.5 – 215.3 215.4 – 231.7 231.8 – 423.7
Source: 1994-1998 Centers for Disease Control and Prevention
Age-adjusted Accidental Death Age-adjusted Accidental Death RatesRates
Deaths/100,000
0.0 – 34.7 34.8 – 43.1 43.2 – 51.7 51.8 – 62.9 63.0 – 298.3
Source: 1994-1998 Centers for Disease Control and Prevention
Age-adjusted Accidental Death Age-adjusted Accidental Death RatesRates
Deaths/100,000
0.0 – 34.7 34.8 – 43.1 43.2 – 51.7 51.8 – 62.9 63.0 – 298.3
42% of the Delta Counties are in the highest accidental deaths quintile.
Source: 1994-1998 Centers for Disease Control and Prevention
Disabilities per 100 PersonsDisabilities per 100 Persons
Disabilities/100
10.9 – 27.3 27.3 – 31.6 31.6 – 36.3 36.3 – 42.9 42.9 – 85.0
Source: 2000 Census SF3
1990 Average Life Expectancy1990 Average Life Expectancy
Years of Life
65.6 – 73.7 73.8 – 75.1 75.2 – 76.0 76.1 – 76.9 77.0 – 79.9
Source: 2000 Community Health Status Report (HRSA)
1990 Average Life Expectancy1990 Average Life Expectancy
63% of the Delta Counties are in the lowest life expectancy quintile.
Years of Life
65.6 – 73.7 73.8 – 75.1 75.2 – 76.0 76.1 – 76.9 77.0 – 79.9
Source: 2000 Community Health Status Report (HRSA)
What if We were What if We were Equal?Equal?
800
900
1000
1100
1200
1300
1400
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Metro Nation
Age Adjusted Mortality RatesAge Adjusted Mortality Rates3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ag
e A
dju
ste
d D
eath
Rate
Ag
e A
dju
ste
d D
eath
Rate
Per
100,0
00 P
op
ula
tion
Per
100,0
00 P
op
ula
tion
70
80
90
100
110
120
130
140
150
160
170
180
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Metro Minus Nation
Difference in Age Adjusted Difference in Age Adjusted Mortality RatesMortality Rates3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ag
e A
dju
ste
d D
eath
Rate
Ag
e A
dju
ste
d D
eath
Rate
Per
100,0
00 P
op
ula
tion
Per
100,0
00 P
op
ula
tion
3,752
3,214
4,244 4,204
5,1784,856 4,855
5,745
6,477
7,026
7,351
3,000
3,500
4,000
4,500
5,000
5,500
6,000
6,500
7,000
7,500
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Metro Minus Nation / 100,000 * Population
Additional Deaths in Delta Metro Additional Deaths in Delta Metro AreaArea3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ad
dit
ion
al N
um
ber
of
Ad
dit
ion
al N
um
ber
of
Death
sD
eath
s
800
900
1000
1100
1200
1300
1400
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Non-Metro Nation
Age Adjusted Mortality RatesAge Adjusted Mortality Rates3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ag
e A
dju
ste
d D
eath
Rate
Ag
e A
dju
ste
d D
eath
Rate
Per
100,0
00 P
op
ula
tion
Per
100,0
00 P
op
ula
tion
70
80
90
100
110
120
130
140
150
160
170
180
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Non-Metro Minus Nation
Difference in Age Adjusted Difference in Age Adjusted Mortality RatesMortality Rates3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ag
e A
dju
ste
d D
eath
Rate
Ag
e A
dju
ste
d D
eath
Rate
Per
100,0
00 P
op
ula
tion
Per
100,0
00 P
op
ula
tion
3,7213,887
4,0953,712
3,382
3,8324,228
5,618
6,473
7,673
8,321
3,000
3,500
4,000
4,500
5,000
5,500
6,000
6,500
7,000
7,500
8,000
8,500
68-7
071
-73
74-7
677
-79
80-8
283
-85
86-8
990
-92
93-9
596
-98
99-0
1
Delta Non-Metro Minus Nation / 100,000 * Population
Additional Deaths in Delta Non-Additional Deaths in Delta Non-Metro AreaMetro Area3-Year Averages 3-Year Averages
1968 – 2001 1968 – 2001
Ad
dit
ion
al N
um
ber
of
Ad
dit
ion
al N
um
ber
of
Death
sD
eath
s
Additional DeathsAdditional Deaths
Delta Metro 7351
Delta Rural 8321
Total 15,672
The Implications for PublicThe Implications for PublicHealth SystemsHealth Systems
• There are clearly regional clusters that can be defined by health outcomes
• These regional clusters appear to be associated with a distinct history, subculture, etc.
• The health outcomes are profoundly different between these regions
• Large spatial disparities
• In the Delta region, there is evidence that health improvement may have leveled
• Health disparities between the Delta and the rest of the nation appear to be increasing
• These patterns transcend state and community boundaries
• Should we redefine our approaches to addressing the spatial aspects of health from one based on demographic history to one based on health conditions and outcomes
The Implications for PublicThe Implications for PublicHealth SystemsHealth Systems
MS Black MalesUS White MalesMS White Males
1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
600
700
800
900
1000
1100
1200
Racial Disparity Trends in Cardiovascular Mortality for MS Males
Age-Adjusted Cardiovascular Mortality Rates (Ages 35 Years and Over) utilizing Compressed Mortality File and CDC Wonder.
MS WM vs. BM
1972 1976 1980 1984 19881968 1992 1996 2000
1970 1974 1978 1982 1986 1990 1994 1998 2002
Difference Between White and Black Male Heart Disease Mortality: Mississippi
-50
0
50
100
150
200
-200
-150
-100
-250
Note: Numbers are calculated as the yearly MS Black rate minus the yearly MS White rate. Positive numbers indicate years where the black heart disease rate is higher, negative numbers indicate years where the white heart disease rate is higher. The Y-axis indicates the difference in the number of deaths per 100,000.
MS Black FemalesUS White FemalesMS White Females
1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
400
500
600
700
800
900
Racial Disparity Trends in Cardiovascular Mortality for MS Females
Age-Adjusted Cardiovascular Mortality Rates (Ages 35 Years and Over) utilizing Compressed Mortality File and CDC Wonder.
MS WF vs. BF
50
100
150
200
250
1972 1976 1980 1984 19881968 1992 1996 20001970 1974 1978 1982 1986 1990 1994 1998 2002
Difference Between White and Black Female Heart Disease Mortality: Mississippi
Note: Numbers are calculated as the yearly MS Black rate minus the yearly MS White rate. Each number is positive, meaning that the black rate is greater than the white rate in each year. The Y-axis indicates the difference in the number of deaths per 100,000.
BM MS vs. WM US
WM MS vs. WM US
BF MS vs. WF US
WF MS vs. WF US
400
300
200
100
0
-100
-200
-300
19701972
1974 19781976 1980
19821984 19881968
1986 19901992
1994 19981996 2000
2002
Note: Numbers are calculated as the yearly MS Black or White (Male and Female) rate minus the yearly US White (Male and Female) rate. Positive numbers indicate years where the MS rate is higher than the US rate, negative numbers indicate years where the US rate is higher than the MS rate. The Y-axis indicates the difference in the number of deaths per 100,000.
Magnitude of CVD Magnitude of CVD DisparitiesDisparities