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Disparity Measurement in Healthy People 2010. John Aberle-Grasse, MPH National Center for Health Statistics. Healthy People 2010 goals. Increase quality and years of healthy life. 2. Eliminate health disparities. No method for measuring disparity initially specified.

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Disparity measurement in healthy people 2010 l.jpg

Disparity Measurement in Healthy People 2010

John Aberle-Grasse, MPH

National Center for Health Statistics


Healthy people 2010 goals l.jpg
Healthy People 2010 goals

  • Increase quality and years of healthy life

2. Eliminate health disparities

  • No method for measuring disparity initially specified


Healthy people 2000 goals l.jpg
Healthy People 2000 goals

  • Increase the span of healthy life

  • Reduce health disparity in special populations

    • Address the problems that represent the greatest need

    • Separate targets set for special and total populations

  • Achieve access to preventive services


Chose percent change over time or ratio of percent change l.jpg
Chose: Percent change over time or Ratio of percent change

(RPl-RPb)/RPb

(SPl-SPb)/SPb

special

population

reference

population

Baseline (b)

Last data point (l)

NOTE: Imaginary data


Healthy people 2010 2 nd goal l.jpg
Healthy People 2010 2 changend goal

“The second goal of Healthy People 2010 is 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.”

  • Eliminate Health Disparities


Healthy people 2010 2 nd goal6 l.jpg
Healthy People 2010 2 changend goal

  • Eliminate Health Disparities

    • Implement a vision for the nation’s health

    • A single target for all population groups

    • Standard set of population subgroups

      • Applies to all population-based objectives (389 of 467 objectives)


Slide7 l.jpg

Minimum population template change

Additional categories


Is ratio of percent change a good option for measuring disparity in healthy people 2010 l.jpg
Is ratio of percent change a good option for measuring disparity in Healthy People 2010?

  • Healthy People 2000 was concerned with:

    • only special populations

    • at particularly high risk for death, disease or disability

  • Healthy People 2010 is concerned with:

    • all subpopulations

    • some worse off and some are better off than the total


Ratio of percent change compares change over time but not inequality at a given point in time l.jpg

4 disparity in Healthy People 2010?

2

2

NOTE: Imaginary data

Ratio of percent change compares change over time but not inequality at a given point in time

Percent change = 0.66

Percent change = 0.66


Healthy people 2010 2 nd goal10 l.jpg
Healthy People 2010 2 disparity in Healthy People 2010?nd goal

  • Eliminate Health Disparities

    • Policy and statistical questions specific to Healthy People 2010


Situations for measuring disparity in healthy people 2010 l.jpg
Situations for measuring disparity in Healthy People 2010 disparity in Healthy People 2010?

  • Single group across a set of objectives

    • Race/ethnicity

    • Socioeconomic status

    • (eg. How are Hispanics doing compared to the total population on diabetes objectives)

  • Two groups

    • Sex

    • Urban compared to rural

  • Multiple groups

    • Race/ethnicity

    • Socioeconomic status


Two groups l.jpg
Two groups disparity in Healthy People 2010?


Questions common to each of the three situations l.jpg
Questions common to each of the three situations disparity in Healthy People 2010?

  • What are the contexts for measuring disparity?

    • Cross sectional

    • Over time

    • Across objectives

    • Between types of subpopulations

    • Across geographic areas


Questions common to each of the three situations14 l.jpg
Questions common to each of the three situations disparity in Healthy People 2010?

  • Measure progress and disparity separately?

  • What is the reference point?

  • Is an absolute or relative comparison of interest?

  • Which statistic should be used?

  • Measure positive or negative outcomes?


Should progress toward targets and elimination of disparity be measured separately l.jpg
Should progress toward targets and elimination of disparity be measured separately?

  • Measuring the two dimensions together introduces confounding

  • The two goals are listed separately; each dimension is of interest on its own

  • Measuring the two dimensions allows each of the goals to be tracked separately


A three part approach to measuring progress in healthy people 2010 is suggested l.jpg
A three part approach to measuring progress in Healthy People 2010 is suggested

  • Measure progress towards targets

    • Overall

    • Particular groups

  • Measure disparity

    • Overall

    • Particular groups

  • Explore and indicate any particular issues

    • Particular groups


Slide22 l.jpg

Is there a particular reference group suggested by HP2010? People 2010 is suggested

  • “Best” rate- may change

  • Average rate- does not consider population distribution

  • Total rate- is relatively stable

  • Target rate- is a constant reference over time

  • Not all objectives use “better than best” as target setting method


Is there a particular reference group suggested by hp2010 l.jpg
Is there a particular reference group suggested by HP2010? People 2010 is suggested

  • Healthy People 2000 used total population

  • NIH minority health disparity charge seems to compare disparate race/ethnicity subpopulations to the total population

  • Does Healthy People 2010 stated goals of eliminating health disparities and improving health for all segments of the population suggest using the “best” or target when it is set as “better than the best”?


Absolute or relative measure l.jpg
Absolute or relative measure? People 2010 is suggested

  • Absolute measures provide information about the number of excess events

  • Relative measures allow comparisons without regard to magnitude

  • Absolute and relative measures may lead to the same conclusions when applied to the same objective at a given time

  • Absolute and relative measures may lead to different conclusions in comparisons over time or between objectives


Which statistic should be used l.jpg
Which statistic should be used? People 2010 is suggested


Objectives measure positive or negative outcomes l.jpg
Objectives measure positive People 2010 is suggestedor negative outcomes?

  • Positive (success)

    • Increase health insurance coverage

  • Negative (failure)

    • Reduce deaths caused by motor vehicle crashes

  • Measuring all disparities in same terms allows comparison of relative measures of disparity across objectives


Slide27 l.jpg

|80-75| = 5% People 2010 is suggested

|80-75/75| = 6.7%

|20-25|=5%

|20-25/25|=20%

Group two

Group one

Health insurance coverage in two groups

100

80

80

75

60

Percent

40

25

20

20

0

Percent with health insurance

Percent without health insurance

NOTE: Imaginary data


Objectives measure positive or negative outcomes28 l.jpg
Objectives measure positive People 2010 is suggestedor negative outcomes?

  • Some objectives cannot usefully be measured as successes

  • NIH Strategic Plan to Reduce and Ultimately Eliminate Health Disparities defines disparity in terms of adverse health conditions, failures

  • The HP2000 Health Status Indicators all used negative outcomes to be reduced (failures) so they could be compared


Several common questions for each of these situations l.jpg
Several common questions for each of these situations People 2010 is suggested

  • Measure progress and disparity separately?

  • What is the reference point?

  • Is an absolute or relative comparison of interest?

  • Which statistic should be used?

  • Measure positive or negative outcomes?

  • What is the context for measuring disparity?

    • Cross sectional

    • Over time

    • Across objectives

    • Between types of subpopulations

    • Across geographic areas


Resources l.jpg
Resources People 2010 is suggested

DHHS Healthy People: www.health.gov/healthypeople

NCHS Healthy People: www.cdc.gov/nchs/healthypeople

DATA2010: www.wonder.cdc.gov/data2010


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