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. 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

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



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 U.S. 2010-2070

  • Stage 1 - Pre-modern Stage

  • Stage 2 – Early industrialization and urbanization

  • Stage 3 – Mature industrial stage

  • Stage 4 – Post-industrial stage



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

Accessed February 27, 2006


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

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, 1950-2000http://www.digitalopportunity.org/imagecatalogue/imageview/12898/?RefererURL=/contact/company/view/5130

Source: National Center for Health Statistics (2002)


The 5 th demographic stage
The 5http://www.digitalopportunity.org/imagecatalogue/imageview/12898/?RefererURL=/contact/company/view/5130th demographic stage


The 5 th stage multi culturalism
The 5http://www.digitalopportunity.org/imagecatalogue/imageview/12898/?RefererURL=/contact/company/view/5130th 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 foreign-born U.S. population, 1990-1997

  • 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


Framingham, MA U.S. 2010-2070

Evans County, GA

Washington County, Maryland

Alameda County

Tecumsh, MI


Disentangling race and class
Disentangling Race and Class U.S. 2010-2070

Race

Class


Example
Example U.S. 2010-2070

  • 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 U.S. 2010-2070


Adl regressed on income
ADL regressed on Income U.S. 2010-2070


Adl regressed on race1
ADL regressed on race U.S. 2010-2070











Health Disparities Research is further confounded because of racial segregation

White

Black

Racial Status Determines the way

in which you “experience” America



Racial distribution
Racial Distribution racial segregation


Median income
Median Income racial segregation

Source: US Censes 2000


Percent living below official poverty level
Percent Living Below Official Poverty Level racial segregation

Source: US Censes 2000


Educational status
Educational Status racial segregation

Source: US Censes 2000


Sex racial segregation

Source: US Censes 2000


The study
The Study racial segregation

  • 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%)



Racial distribution of swb sample
Racial Distribution of SWB Sample Sample

Percent

N=841

N=572


Median income by race
Median Income By Race Sample

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


Educational status by race
Educational Status by Race Sample

X2 = 45.96 df=4 p<.0001


Sex Sample

X2 = .22 df 1 p=.312


Local vs national race disparity comparisons
Local vs. National Race Disparity Comparisons* Sample

* Compared with the National Health Interview Survey, 2001




Cancer
Cancer Sample


Stroke
Stroke Sample


Diabetes
Diabetes Sample





Undiagnosed and uncontrolled hypertension systolic
Undiagnosed and Uncontrolled Hypertension (Systolic) Sample

Rates are NOT adjusted for age or education.


Matched sample
Matched Sample Sample

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


Matched sample analysis
Matched Sample Analysis Sample

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


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