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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.

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Racial, Ethnic and Socioeconomic Health Disparities in the US

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  1. Racial, Ethnic and Socioeconomic Health Disparities in the US Richard Lichtenstein Ph.D., MPH University of Michigan School of Public Health June 2007

  2. Fair or Poor Health among Adults18 years and older by family income, race, and Hispanic origin, 2004 Source: Health, United States, 2006 Table 60

  3. Why are Poverty and Race/Ethnicity Related to Health?

  4. What Racial/Ethnic Group Accounts for the Most Poor People in the US?

  5. Number ofPersons Below Poverty Level By Race, 2004 In Thousands Source: Health, United States, 2006, Table 3

  6. Percent ofPersons Below Poverty Level By Race, 2003 Percent below poverty Source: Health, United States, 2006, Table 3

  7. Figure 2.6Percent of Persons with Incomes Below Poverty Level by Age Source: U.S. Bureau of the Census, Census 2000 Supplementary Survey * Primary Metropolitan Statistical Area

  8. What is Race?

  9. What is Race? • “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

  10. What is Race? • “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

  11. What is Race? 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)

  12. Race Varies by Country • “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

  13. 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).

  14. “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).

  15. Some Data on Detroit and Some Neighborhoods in Detroit

  16. Population by RaceCity 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/

  17. Demographic Characteristics of the Eastside of Detroit

  18. 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

  19. 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

  20. Life Expectancy at Birth by Race and Sex, 1970-2003 Source: Health, United States, 2005, Table 27, http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary

  21. Why Do Blacks Have a Shorter Life Expectancy Than Whites?

  22. Age-Adjusted Death RatesDue 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

  23. Years of Potential Life Lostdue 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

  24. Years of Potential Life Lostdue 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.

  25. Years of Potential Life Lostdue 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.

  26. Years of Potential Life Lostdue 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.

  27. Years of Potential Life Lostdue 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.

  28. Years of Potential Life Lostdue 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.

  29. Years of Potential Life Lostdue 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.

  30. 5 Year Relative Survival Rates for Breast Cancer White Female Percent of Patients (%) Black Female Source: Health, United States, 2006, Table 54: http://www.cdc.gov/nchs/data/hus/hus06.pdf#summary

  31. Infant Mortality Rates by Race*United States, 1970-2003 Deaths per 1,000 Live Births Source: Health, United States, 2006, Table 22 *Race of mother

  32. 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

  33. IMR for US in 2004 was 6.37NOTE: 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 )

  34. Infant Mortality Rate* by Country U.S. *IMR: Deaths of infants under 1 year per 1,000 live births Source: Health, United States, 2006, Table 25

  35. International Rankings for Infant Mortality1960 and 2002 1960 2002

  36. IMR - International Rankings 2007 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)

  37. Infant Mortality by Race of Mother, 2005 *=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

  38. Infant Mortality Rates by mother’s education, race, and Hispanic origin, 2000-2003 Source: Health, United States, 2006, Table 20

  39. Activity Limitation among Adults by family income, race, and Hispanic origin, 2004 Source: Health, United States, 2006, Table 58

  40. No Health Insurance Coverage among persons under 65, by race and Hispanic origin, 2004 Source: Health, United States, 2006, Table 135.

  41. Vaccinations among Children 19-35 months old by Poverty Status and Race, 2004 Source: Health, United States, 2006, Table 81.

  42. Percent of Children under 18 with no Usual Source of Care by insurance type, 2003-2004 Source: Health United States, 2006, Table 76.

  43. Children under 6 with no physician contactswithin last year, by Race and Poverty Status, 2003-2004 Source: Health, United States, 2006, Table 79

  44. 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

  45. UNEQUAL TREATMENT

  46. Black/White and SES Differences When Patients Have Same Diagnosis

  47. “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.

  48. Institute of Medicine ReportUnequal 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

  49. Studies have shown this to be true for patients with: • 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

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