Racial Disparities in US Healthcare

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1 Racial Disparities in US Healthcare Paul H. Johnson, Jr. Ph.D. Candidate University of Wisconsin Madison School of Business Research partially funded by the National Institute of Mental Health: Ruth L. Kirschstein National Research Service Award No. T32 MH Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

2 Outline Outline 1 Introduction/Definitions 2 Examples of Racial Disparities 3 Mechanisms Underlying Racial Disparities 4 Methodology for Analyzing Racial Disparities 5 Policy Interventions to Mitigate Racial Disparities Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

3 Introduction/Definitions Introduction Recent comprehensive studies have found pervasive evidence of racial disparities in health outcomes and healthcare treatments Institute of Medicine s Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2003 (IOM2003) Racial disparities typically result in worse health outcomes and healthcare treatments for racial minorities Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

4 Introduction/Definitions Race Federal Standards for Classifying Race/Ethnicity, Office of Management and Budget, 2001 Racial Categories: White, Black or African American, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander Ethnic Categories: Hispanic or Latino, non-hispanic or Latino Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

5 Introduction/Definitions Race (Cont.) Table 1a. Projected Population of the United States, by Race and Hispanic Origin: 2000 to 2050 (In thousands except as indicated. As of July 1. Resident population.) (Leading dots indicate sub-parts.) Population or percent and race or Hispanic origin POPULATION.TOTAL 282, , , , , ,854.White alone 228, , , , , ,626.Black alone 35,818 40,454 45,365 50,442 55,876 61,361.Asian Alone 10,684 14,241 17,988 22,580 27,992 33,430.All other races 1/ 7,075 9,246 11,822 14,831 18,388 22,437.Hispanic (of any race) 35,622 47,756 59,756 73,055 87, ,560.White alone, not Hispanic 195, , , , , ,283 PERCENT OF TOTAL POPULATION.TOTAL White alone Black alone Asian Alone All other races 1/ Hispanic (of any race) White alone, not Hispanic Footnotes: 1/ Includes American Indian and Alaska Native alone, Native Hawaiian and Other Pacific Islander alone, and Two or More Races Source: U.S. Census Bureau, 2004, "U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin," <http://www.census.gov/ipc/www/usinterimproj/> Internet Release Date: March 18, 2004 Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

6 Introduction/Definitions Racial Disparities IOM2003 Definition: Differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention Other Definitions (including mine): include access-related factors Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

7 Examples of Racial Disparities Overall Mortality (p. 10 of Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care, January 2007) Mortality Ratio Figure 10 Mortality Ratios by Age, Gender, and Race/Ethnicity, 2003 African American, Non-Hispanic American Indian/Alaska Native White, Non-Hispanic Hispanic Asian or Native Hawaiian/Pacific Islander On average, Hispanics, Africa Americans, American Indians/ Alaska Natives and Whites have higher mortality rates than Asia and Native Hawaiians/Pacific Islanders at each stage of the lifespan. However, aggregated data mask the higher mortality rates of particular Asian and Pa Islander subpopulations, such Vietnamese and Native Hawaiia Age NOTE: The chart compares death rate of each racial/ethnic group to that of Asian/Pacific Islander, the group with the lowest death rates at each age. DATA: National Center for Health Statistics, National Vital Statistics System. SOURCE: National Vital Statistics Report, 54(13): April Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

8 NOTE: The Examples chart compares ofdeath Racial rate of each Disparities racial/ethnic group to that of Asian/Pacific Islander, the group with the lowest death rates at each age. DATA: National Center for Health Statistics, National Vital Statistics System. SOURCE: National Vital Statistics Report, 54(13): April Cardiovascular Care (p. 10 of Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care, January 2007) Deaths per 100,000 population: Figure 11 Death Rate due to Heart Disease by Race/Ethnicity, In 2003, the death rate due to h disease for men was higher tha death rate for women. Regardle of gender, the death rate for Afr Americans was the highest of a groups, while the death rate wa lowest among Asian and Pacific Islanders. The death rate for Hispanics and American Indians Alaska Natives was lower than t of Whites. White, Hispanic African Asian American Non- American and Indian/ Hispanic Pacific Alaska Islander Native Men White, Hispanic African Asian American Non- American and Indian/ Hispanic Pacific Alaska Islander Native Women NOTE: Rates are age-adjusted. DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. SOURCE: Health US, 2005, Table Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

9 Examples of Racial Disparities Diabetes (www.health.gov, January 2004) Prevalence of Diabetes By Race and Ethnicity Race and Ethnicity Age-Adjusted Prevalence Rate (per 100,000 population) American Indian/Native American 106 Asian or Pacific Islander 37 Black or African American 77 White 44 Hispanic or Latino 69 Not Hispanic or Latino 47 Not Hispanic or Latino, Black or African American 78 Not Hispanic or Latino, White 42 Source: CDC Wonder. DATA the Healthy People 2010 Database. Centers for Disease Control and Prevention, January 2004 Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

10 NOTE: Diabetes prevalence includes physician-diagnosed (self-reported) and undiagnosed diabetes Examples (fasting blood glucose of Racial of at least Disparities 126 mg/dl). SOURCE: Health, United States, 2006, Table 55. Overweight/Obesity (p. 12 of Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care, January 2007) DATA: National Center for Health Statistics, National Health and Nutrition Examination Survey. Figure 15 Overweight and Obesity Rate Among Adults by Race/Ethnicity, 2005 Percent overweight or obese: 37.1% 57.8% 59.6% 65.5% 67.9% 58.2% Obesity is a contributing facto to numerous diseases. People who are overweight or obese te to have higher rates of diabetes and cardiovascular problems. More African Americans and American Indians/Alaska Native are overweight or obese than non-hispanic Whites and Asian and Pacific Islanders. Asians a Pacific Islanders are least likely all racial and ethnic groups to b overweight or obese. Asian and Pacific Islander White, Non-Hispanic Hispanic American Indian/Alaska Native African American, Non-Hispanic Other NOTE: Overweight or obese is defined as having a body mass index greater than or equal to 25.0 kg/meters squared. DATA: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Survey Data, SOURCE: Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

11 Examples of Racial Disparities Other Examples of Racial Disparities Asthma Cancer HIV/AIDS Children s Health Services Mental Health Services Rehabilitative Services Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

12 Mechanisms Underlying Racial Disparities Access: Income (p. 25 of National Center for Health Statistics, Health, United States, 2006 with Chartbook on Trends in the Health of Americans, 2006) Population NOTES: Percent of poverty level is based on family SOURCE: U.S. Census Bureau, Current income and family size and composition using Population Survey. U.S. Census Bureau poverty thresholds. Persons of Hispanic origin may be of any race. Black and Asian races include persons of Hispanic and non-hispanic origin. See data table for data points graphed and additional notes. Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

13 Mechanisms Underlying Racial Disparities Access: Health Insurance (p. 14 of Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care, January 2007) 13% 12% 6% 69% White, Non-Hispanic million 34% 23% 40% Hispanic 40.8 million Figure 16 Health Insurance Coverage of the Nonelderly by Race/Ethnicity, % 21% 19% 28% 48% 3% African American, Non-Hispanic 32.6 million 10% 7% 63% Asian and Pacific Islander 11.8 million 32% 23% 43% 2% American Indian/Alaska Native 1.5 million 14% 26% 5% 55% Two or More Races 4.2 million Uninsured Medicaid or Other Public Individual Employer Among the nonelderly, Whites the group most likely to have he insurance. They are also more likely than other racial and ethn groups to receive coverage from their employer. Hispanics have largest percentage of uninsured and the lowest percentage of pe with employer coverage. Asian and Pacific Islanders are least li to receive coverage from Medic or other public insurance, while African Americans are most like receive coverage from Medicaid other public insurance. NOTE: Nonelderly includes individuals up to age 65. Other public includes Medicare and military-related coverage; SCHIP is included in Medicaid. DATA: March 2005 Current Population Survey. SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates. Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

14 Mechanisms Underlying Racial Disparities Usual Source of Care (p. 22 of Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care, January 2007) 40% Figure 26 No Usual Source of Health Care: Adults by Race/Ethnicity, and % 30.9% 28.8% 24.0% 20.8% 18.9% 19.2% 19.1% 17.9% 17.7% In , Hispanics, Afric Americans, Asians and America Indian/Alaska Natives were less likely to have a usual source of health care than were Whites. S , rates have improve or remained unchanged among all racial/ethnic groups except Hispanics and American Indians Alaska Natives. 14.6% N/A 0% White, Non-Hispanic Hispanic African American, Non-Hispanic Asian Only* American Indian/Alaska Native Two or More Races NOTE: *The sample size for Native Hawaiian/Pacific Islander was not large enough for reliable estimates. DATA: National Center for Health Statistics, National Health Interview Survey, and SOURCE: Health, United States, 2006, Table 77. Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

15 Mechanisms Underlying Racial Disparities Other Mechanisms for Racial Disparities (IOM2003) Patients: preferences, treatment refusal/mistrust Providers: minority bias, stereotyping, clinical uncertainty Healthcare System: language barriers, geographic variation, fragmented health plans (by socio-economic status) Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

16 Methodology for Analyzing Racial Disparities Data Federal, state, and private databases Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services Centers for Disease Control and Prevention US Census Bureau Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

17 Methods Methodology for Analyzing Racial Disparities Descriptive Analysis Regression Analysis Single-Level Regression Analyses Multi-Level Regression Analyses Report Cards Health Accountability 36 Data can be both cross-sectional and longitudinal Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

18 Policy Interventions to Mitigate Racial Disparities Policy Interventions (IOM2003) Avoid fragmentation of health plans along socioeconomic lines Strengthen the stability of patient-provider relationships Increase the proportion of racial minority health professionals Provide greater resources to enforce civil rights laws Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

19 Policy Interventions to Mitigate Racial Disparities Policy Interventions (IOM2003) (Cont.) Promote consistency and equity of care through the use of evidence-based guidelines Structure payment systems to ensure an adequate supply of services to minorities Support the use of interpretation services Increase patient and provider cultural awareness/education Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

20 Policy Interventions to Mitigate Racial Disparities Thank You! Questions and/or Comments??? Paul H. Johnson, Jr. (UW-Madison) SOA Health Spring Meeting May 30, / 20

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