Disparity Measurement in Healthy People 2010

1. Disparity Measurement in Healthy People 2010 John Aberle-Grasse, MPH National Center for Health Statistics

2. Healthy People 2010 goals • Increase quality and years of healthy life 2. Eliminate health disparities • No method for measuring disparity initially specified

3. 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

4. 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

5. Healthy People 2010 2nd 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

6. Healthy People 2010 2nd 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)

7. Minimum population template Additional categories

8. 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

9. 4 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

10. Healthy People 2010 2nd goal • Eliminate Health Disparities • Policy and statistical questions specific to Healthy People 2010

11. Situations for measuring 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

12. Two groups

13. Questions common to each of the three situations • What are the contexts for measuring disparity? • Cross sectional • Over time • Across objectives • Between types of subpopulations • Across geographic areas

14. Questions common to each of the three situations • 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?

15. 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

20. 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

22. Is there a particular reference group suggested by HP2010? • “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

23. Is there a particular reference group suggested by HP2010? • 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”?

24. Absolute or relative measure? • 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

25. Which statistic should be used?

26. Objectives measure positive or 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

27. |80-75| = 5% |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

28. Objectives measure positive or 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

29. Several common questions for each of these situations • 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

30. Resources DHHS Healthy People: www.health.gov/healthypeople NCHS Healthy People: www.cdc.gov/nchs/healthypeople DATA2010: www.wonder.cdc.gov/data2010