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The Emerging Minority-Majority: Problems and Prospects for Health Disparities Research. Thomas A. LaVeist, PhD Professor of Health Policy and Management and Sociology Director, Center for Health Disparities Solutions Johns Hopkins Bloomberg School of Public Health. A New American Revolution.

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The Emerging Minority-Majority: Problems and Prospects for Health Disparities Research

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The emerging minority majority problems and prospects for health disparities research

The Emerging Minority-Majority:Problems and Prospects for Health Disparities Research

Thomas A. LaVeist, PhD

Professor of Health Policy and Management and Sociology

Director, Center for Health Disparities Solutions

Johns Hopkins Bloomberg School of Public Health


A new american revolution

A New American Revolution


Percentage resident population by race ethnicity u s 1950 2000

Percentage Resident Population by race/ethnicity, U.S. 1950-2000

Source: National Center for Health Statistics (2002)


Projected percentage resident population by race ethnicity u s 2010 2070

Projected Percentage Resident Population by race/ethnicity, U.S. 2010-2070

Source: U.S. Bureau of the Census:(NP-T5) Projections of the Resident

Population by Race, Hispanic Origin, and Nativity: Middle Series, 1999 to 2100


The demographic transition

The Demographic Transition

  • Stage 1 - Pre-modern Stage

  • Stage 2 – Early industrialization and urbanization

  • Stage 3 – Mature industrial stage

  • Stage 4 – Post-industrial stage


The emerging minority majority problems and prospects for health disparities research

Source: Time Magazine January 11, 1960


The emerging minority majority problems and prospects for health disparities research

http://www.digitalopportunity.org/imagecatalogue/imageview/12898/?RefererURL=/contact/company/view/5130

Accessed February 27, 2006


Population implosion

Population Implosion

Low Fertility and Population Ageing: Causes, Consequences, and Policy Options, by Jonathan Grant, Stijn Hoorens, Suja Sivadasan, Mirjam van het Loo, Julie DaVanzo, Lauren Hale, Shawna Gibson, and William Butz, MG-206-EC, 2004, 172 pp. Rand Research Brief


Us fertility rate 1950 2000

US Fertility Rate, 1950-2000

Source: National Center for Health Statistics (2002)


The 5 th demographic stage

The 5th demographic stage


The 5 th stage multi culturalism

The 5th Stage – Multi-Culturalism

  • Stage 4 countries attract immigration from pre-Stage 4 countries

  • The immigrant population will have a larger percentage in the childbearing ages range

  • The immigrant population will have a higher birth rate


Stage 4 and pre stage 4 status of country of birth for foreign born u s population 1990 1997

Stage 4 and Pre-stage 4 status of country of birth for foreign-born U.S. population, 1990-1997


The minority majority

The Minority-Majority

  • Accelerate globalization

  • Competitive advantage in the global economy

  • Well adapted business will have advantage in domestic marketplace


Projected percentage resident population by race ethnicity u s 2010 20701

Projected Percentage Resident Population by race/ethnicity, U.S. 2010-2070

Source: U.S. Bureau of the Census:(NP-T5) Projections of the Resident

Population by Race, Hispanic Origin, and Nativity: Middle Series, 1999 to 2100


The emerging minority majority problems and prospects for health disparities research

Framingham, MA

Evans County, GA

Washington County, Maryland

Alameda County

Tecumsh, MI


Disentangling race and class

Disentangling Race and Class

Race

Class


Example

Example

  • 2002 National Health Interview Survey (NHIS), n=93,386

  • N=33,148 adults age 40+ with complete data on income, race and ADL

  • African Americans, n=4473 (12%)

  • Income, <$20K=6813; $20K-$75K=19,504; >$75K=6831

  • At least 1 ADL = 1043 (2.8%)


Adl regressed on race

ADL regressed on race


Adl regressed on income

ADL regressed on Income


Adl regressed on race1

ADL regressed on race


Cross tabulation of race and adl within income groupings

Cross tabulation of race and ADL within income groupings


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

A Baltimore Area High School


The emerging minority majority problems and prospects for health disparities research

Health Disparities Research is further confounded because of racial segregation

White

Black

Racial Status Determines the way

in which you “experience” America


Community census profile of the community

Community Census Profile of the Community


Racial distribution

Racial Distribution


Median income

Median Income

Source: US Censes 2000


Percent living below official poverty level

Percent Living Below Official Poverty Level

Source: US Censes 2000


Educational status

Educational Status

Source: US Censes 2000


The emerging minority majority problems and prospects for health disparities research

Sex

Source: US Censes 2000


The study

The Study

  • Adult Residents of the 2 census tracts

  • 40 Minute Interview

  • Interviews In-person at home or at health fair

  • 3 Blood pressure measurements

  • Cuffs calibrated at Johns Hopkins Hospital

  • 35 Interviewers

  • Interviewer Incentives

  • Respondent Incentives

  • Successfully Interviewed N=1498 (42.14%)


Representativeness of the sample and race differences in the sample

Representativeness of the Sample and Race Differences in the Sample


Racial distribution of swb sample

Racial Distribution of SWB Sample

Percent

N=841

N=572


Median income by race

Median Income By Race

T = -1.942 df=1284 95%CI(-.464,.002)


Educational status by race

Educational Status by Race

X2 = 45.96 df=4 p<.0001


The emerging minority majority problems and prospects for health disparities research

Sex

X2 = .22 df 1 p=.312


Local vs national race disparity comparisons

Local vs. National Race Disparity Comparisons*

* Compared with the National Health Interview Survey, 2001


High blood pressure

High Blood Pressure


Heart disease

Heart Disease


Cancer

Cancer


Stroke

Stroke


Diabetes

Diabetes


Asthma or emphysema

Asthma or Emphysema


Life time smoking

Life-time Smoking


Current smoker

Current Smoker


Undiagnosed and uncontrolled hypertension systolic

Undiagnosed and Uncontrolled Hypertension (Systolic)

Rates are NOT adjusted for age or education.


Matched sample

Matched Sample

Adjusted for age, gender, smoking, BMI, education, income & Insurance


Matched sample analysis

Matched Sample Analysis

Adjusted for income, BMI, education, health insurance, sex, and age


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