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Racial, Ethnic and Socioeconomic Health Disparities in the US. Richard Lichtenstein Ph.D., MPH University of Michigan School of Public Health June 2007. Fair or Poor Health among Adults 18 years and older by family income, race, and Hispanic origin, 2004.

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Racial ethnic and socioeconomic health disparities in the us

Racial, Ethnic and Socioeconomic Health Disparities in the US

Richard Lichtenstein Ph.D., MPH

University of Michigan

School of Public Health

June 2007


Fair or poor health among adults 18 years and older by family income race and hispanic origin 2004
Fair or Poor Health among Adults US18 years and older by family income, race, and Hispanic origin, 2004

Source: Health, United States, 2006 Table 60




Number of persons below poverty level by race 2004
Number of in the US?Persons Below Poverty Level By Race, 2004

In Thousands

Source: Health, United States, 2006, Table 3


Percent of persons below poverty level by race 2003
Percent of in the US?Persons Below Poverty Level By Race, 2003

Percent below poverty

Source: Health, United States, 2006, Table 3


Figure 2 6 percent of persons with incomes below poverty level by age
Figure 2.6 in the US?Percent of Persons with Incomes Below Poverty Level by Age

Source: U.S. Bureau of the Census, Census 2000 Supplementary Survey

* Primary Metropolitan Statistical Area


What is race
What is Race? in the US?


What is race1
What is Race? in the US?

  • “Race is a social construct, a social classification based on phenotype, that governs the distribution of risks and opportunities in our race-conscious society.”

  • Race is not a biological determinant.

Camara Phyllis Jones


What is race2
What is Race? in the US?

  • “Although ethnicity reflects cultural heritage, race measures a societally imposed identity and consequent exposure to the societal constraints associated with that particular identity.”

Camara Phyllis Jones


What is race3
What is Race? in the US?

Phenotypically and/or geographically distinctive sub-specific group, composed of individuals inhabiting a defined geographical and/or ecological region, and possessing characteristic phenotypic and gene frequencies that distinguish it from other such groups.

The number of racial groups that one wishes to recognize within a species is usually arbitrary but suitable for the purposes under investigation.

 Dictionary of Genetics (1990)


Race varies by country
Race Varies by Country in the US?

  • “This assigned race varies among countries…In the United States I am clearly labeled Black, while in Brazil I would be just as clearly labeled White and in South Africa I would be clearly labeled "colored." It is likely that, if I stayed long enough in any one of these settings, my health profile would become that of the group to which I had been assigned, even though I would have the same genetic endowment in all three settings.”

Camara Phyllis Jones


Health Disparities or Health Inequalities are inequities that are related to differences in health status or medical treatment that are unfair to disadvantaged people and that are avoidable

Braverman and Tarimo, Soc Sci and Med:54:1621-1635 (2002).


that are related to differences in health status or medical treatment that are Pursuing equity in health care means striving to reduce avoidable disparities in physical and psychological well-being—and in the determinants of that well-being—that are systematically observed between groups of people with different levels of underlying social privilege, i.e., wealth, power or prestige.”

Braverman and Tarimo, Soc Sci and Med:54:1621-1635 (2002).


Some data on detroit and some neighborhoods in detroit
Some Data on Detroit and Some Neighborhoods in Detroit that are related to differences in health status or medical treatment that are


Population by race city of detroit health dept and michigan residents 2003
Population by Race that are related to differences in health status or medical treatment that are City of Detroit Health Dept. and Michigan Residents, 2003

City of Detroit Health Dept.

Michigan

Source: U.S. Bureau of the Census, Census 2000 Supplementary Survey:http://www.census.gov/acs/


Demographic characteristics of the eastside of detroit

Demographic Characteristics of the Eastside of Detroit that are related to differences in health status or medical treatment that are


Table 1: Sociodemographic Characteristics of Eastside and Central Detroit in Comparison to City of Detroit and the National Average

*2000 Census, www.census.gov

Detroit data from www.chimart.org, 1999-2001 data


Table II: Health Status Characteristics of the Eastside in Comparison to the City of Detroit and the U.S. Population

Detroit data from www.chimart.org, 1999-2001 data

*2002 Data from Health, United States, 2005 Table 29

**Infant deaths/1000 live births, Health United States Table 25


Life expectancy at birth by race and sex 1970 2003
Life Expectancy at Birth Comparison to the City of Detroit and the U.S. Populationby Race and Sex, 1970-2003

Source: Health, United States, 2005, Table 27,

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary


Why do blacks have a shorter life expectancy than whites
Why Do Blacks Have a Shorter Life Expectancy Than Whites? Comparison to the City of Detroit and the U.S. Population


Age adjusted death rates due to all causes by race and hispanic origin 2003
Age-Adjusted Death Rates Comparison to the City of Detroit and the U.S. PopulationDue to All Causes, by Race and Hispanic Origin, 2003

Source: Health, United States, 2005, Table 29

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary


Years of potential life lost due to ischemic heart disease by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Ischemic Heart Disease,by race and Hispanic origin, 2003

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary


Years of potential life lost due to cerebrovascular diseases by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Cerebrovascular Diseases,by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


Years of potential life lost due to breast cancer females by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Breast Cancer, Females by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


Years of potential life lost due to prostate cancer males by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Prostate Cancer, Males by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


Years of potential life lost due to diabetes mellitus by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Diabetes Mellitus,by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


Years of potential life lost due to hiv infection by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to HIV Infection,by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


Years of potential life lost due to homicide by race and hispanic origin 2003
Years of Potential Life Lost Comparison to the City of Detroit and the U.S. Populationdue to Homicide,by race and Hispanic origin, 2003

Source: Health, United States, 2005, Table 30

http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

* Age-adjusted years lost before age 75 per 100,000 population under 75 years of age.


5 year relative survival rates for breast cancer
5 Year Relative Survival Rates for Breast Cancer Comparison to the City of Detroit and the U.S. Population

White Female

Percent of Patients (%)

Black Female

Source: Health, United States, 2006, Table 54: http://www.cdc.gov/nchs/data/hus/hus06.pdf#summary


Infant mortality rates by race united states 1970 2003
Infant Mortality Rates by Race* Comparison to the City of Detroit and the U.S. PopulationUnited States, 1970-2003

Deaths per 1,000 Live Births

Source: Health, United States, 2006, Table 22

*Race of mother


Figure 24. Infant mortality rates by detailed race and Hispanic origin of mother: United States, 1999-2001

White, not Hispanic

Black, not Hispanic

Hispanic (total)

Puerto Rican

Other Hispanic

Mexican

Central and South American

Cuban

Asian or Pacific Islander (total)

Hawaiian

Filipino

Other Asian or Pacific Islander

Japanese

Chinese

American Indian or Alaska Native

Infant per 1,000 live births

NOTES: Infant is defined as under 1 year of age. Persons of Hispanic origin may be of any race. The race groups, Asian or Pacific Islander and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. See Data Table for data points graphed and additional notes.

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Linked Birth/Infant Death Data Sets.

Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2004


Imr for us in 2004 was 6 37 note the us placed 180 out of 221 countries higher is better

IMR for US in 2004 was 6.37 Hispanic origin of mother: United States, 1999-2001NOTE: The US placed 180 out of 221 countries (higher is better)

Source: CIA World Factbook:https://www.cia.gov/cia/publications/factbook/geos/us.html#People (accessed May 06, 2007 )


Infant mortality rate by country
Infant Mortality Rate* by Country Hispanic origin of mother: United States, 1999-2001

U.S.

*IMR: Deaths of infants under 1 year per 1,000 live births

Source: Health, United States, 2006, Table 25


International rankings for infant mortality 1960 and 2002
International Rankings for Infant Mortality Hispanic origin of mother: United States, 1999-20011960 and 2002

1960 2002


IMR - International Rankings 2007 Hispanic origin of mother: United States, 1999-2001

Country Infant mortality rate Rank (deaths/1,000 live births)

Angola 184.44 1

Sierra Leone 158.27 2

Afghanistan 157.43 3

Liberia 149.73 4

Niger 116.83 5

-

-

-

United States 6.37 180

-

-

-

Norway 3.64 214

Finland 3.52 215

France 3.41 216

Iceland 3.27 217

Hong Kong 2.94 218

Japan 2.80 219

Sweden 2.76 220

Singapore 2.30 221

Source: CIA – The World Factbook: https://www.cia.gov/cia/publications/factbook/rankorder/2091rank.html (accessed May 06, 2007)


Infant mortality by race of mother 2005
Infant Mortality by Race of Mother, 2005 Hispanic origin of mother: United States, 1999-2001

*=excludes Detroit

Source: Division for Vital Records and Health Statistics, Michigan Department of Community Health, 2007

http://www.mdch.state.mi.us/pha/osr/InDxMain/Infsum05.asp


Infant mortality rates by mother s education race and hispanic origin 2000 2003
Infant Mortality Rates by mother’s education, race, Hispanic origin of mother: United States, 1999-2001and Hispanic origin, 2000-2003

Source: Health, United States, 2006, Table 20


Activity limitation among adults by family income race and hispanic origin 2004
Activity Limitation among Adults Hispanic origin of mother: United States, 1999-2001 by family income, race, and Hispanic origin, 2004

Source: Health, United States, 2006, Table 58


No health insurance coverage among persons under 65 by race and hispanic origin 2004
No Health Insurance Coverage among persons under 65, by race and Hispanic origin, 2004

Source: Health, United States, 2006, Table 135.


Vaccinations among children 19 35 months old by poverty status and race 2004
Vaccinations among Children 19-35 and Hispanic origin, 2004months old by Poverty Status and Race, 2004

Source: Health, United States, 2006, Table 81.


Percent of children under 18 with no usual source of care by insurance type 2003 2004
Percent of Children under 18 with and Hispanic origin, 2004no Usual Source of Care by insurance type, 2003-2004

Source: Health United States, 2006, Table 76.


Children under 6 with no physician contacts within last year by race and poverty status 2003 2004
Children under 6 with no physician contacts and Hispanic origin, 2004within last year, by Race and Poverty Status, 2003-2004

Source: Health, United States, 2006, Table 79


Asthma hospitalizations children 1 14 yrs of age by household income and race 1989 1991
Asthma Hospitalizations - Children 1-14 yrs of age by household income* and race, 1989-1991

*Median household income in Zip code of residence

Source: Health, United States, 1998, Table 21


Unequal treatment
UNEQUAL TREATMENT household income* and race, 1989-1991



“The health system is less responsive to black patients then to white patients.” (Epstein and Ayanian, 2001)The same is true for low vs. high income patients.


Institute of Medicine Report then to white patients.” Unequal Treatment“Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.”

IOM, Unequal Treatment, 2002


Studies have shown this to be true for patients with
Studies have shown this to be true for patients with: then to white patients.”

  • Heart attacks and heart disease (PTCA and CABGS)

  • Peripheral vascular disease of the lower extremities (amputation vs. re-vascularization)

  • ESRD (transplants vs. dialysis)

  • Small-cell carcinoma of the lungs

  • Psychiatric problems

  • Many more diagnoses


Racial disparities in early stage lung cancer treatment
Racial Disparities In Early Stage Lung Cancer Treatment then to white patients.”

Source: Bach et. al,. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999 Oct 14;341(16):1198-205.


Racial disparities in re perfusion therapy after acute myocardial infarction odds ratio
Racial Disparities In Re-Perfusion Therapy after Acute Myocardial Infarction (odds ratio)

Source: Weitzman et. al,. Gender, racial, and geographic differences in the performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol. 1997 Mar 15;79(6):722-6.


Racial disparities in rehabilitation services after hip fracture odds ratio
Racial Disparities In Rehabilitation Services after Hip Fracture (odds ratio)

Source: Harada et. al,. Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities. Med Care. 2000 Nov;38(11):1119-30.


Inadequate analgesic administration
Inadequate Analgesic Administration Fracture (odds ratio)

  • Black patients with isolated long-bone fractures were less likely to receive analgesics than whites, despite similar pain complaints, in an urban ED in Atlanta.

    • Study controlled for multiple confounders, including time since injury, total time in ED, need for fracture reduction.

  • Author previously found that Hispanic ethnicity was a risk factor for inadequate analgesia.

Source: Todd et al. (2000) “Ethnicity and Analgesic Practice” Annals of

Emergency Medicine, vol. 35(1), pp.11-16.



Percentage with access problems
Percentage With Access Problems Fracture (odds ratio)


The uninsured by race and income non elderly calendar year 2003
The Uninsured by Race and Income Fracture (odds ratio)Non-Elderly, Calendar Year 2003*

Source: ERIU tabulation of 2004 CPS data. *Data may represent more of a “point in time”

estimate than a true full-year estimate.


For Want of a Dentist Fracture (odds ratio)

Pr. George's Boy Dies After Bacteria From Tooth Spread to Brain

By Mary Otto

Washington Post Staff WriterWednesday, February 28, 2007; Page B01

Twelve-year-old Deamonte Driver died of a toothache

Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.


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