1 / 39

DHHS Office of Civil Rights Title VI Training Conference Philadelphia, PA August 13, 2002

Using Data to Identify Disparities: Issues, Limitations, Cautions. DHHS Office of Civil Rights Title VI Training Conference Philadelphia, PA August 13, 2002. Richard J. Klein, MPH National Center for Health Statistics Centers for Disease Control and Prevention. D.C.

micheal
Download Presentation

DHHS Office of Civil Rights Title VI Training Conference Philadelphia, PA August 13, 2002

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Using Data to Identify Disparities: Issues, Limitations, Cautions DHHS Office of Civil RightsTitle VI Training ConferencePhiladelphia, PAAugust 13, 2002 Richard J. Klein, MPH National Center for Health Statistics Centers for Disease Control and Prevention

  2. D.C. Public Health Service Region IV Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

  3. Data sources • Population-based sample surveys • Encounter-based sample surveys • Self-reported race/ethnicity • Subject to sampling error • Administrative records • Proxy-reported race/ethnicity (observation?) • Subject to sampling error

  4. Data sources (cont.) • Complete counts • Proxy race/ethnicity • Complete counts • "Self"-reported race/ethnicity • Complete counts/sample surveys • "Self"-reported race/ethnicity • Vital records – deaths • Vital records – births/infant deaths (linked) • Census data

  5. Modes of data collection • Personal interview • Examination • Administrative / Vital records • Telephone • Mail / Internet / Other

  6. Data issues • Age adjustment • Cause of death classification • Data reliability • Race/ethnicity misclassification • Revision of OMB standards for race/ethnicity • Telephone coverage

  7. Age adjustment

  8. Comparison of diabetes prevalence*:United States, by specified race, 1999 Rate per 100,000 population American Indian/ Alaska Native** Black/African American, not-Hispanic Hispanic*** Asian/Pacific Islander** White, not-Hispanic *Diabetes that has been diagnosed by a physician. **Includes persons of Hispanic and non-Hispanic origin. ***Persons of Hispanic origin may be any race. Age-adjusted rates are adjusted to the year 2000 standard population. Source: National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS.

  9. Comparison of diabetes prevalence*:United States, by specified race, 1999 Crude rate Age-adjusted rate Rate per 100,000 population American Indian/ Alaska Native** Black/African American, not-Hispanic Hispanic*** Asian/Pacific Islander** White, not-Hispanic *Diabetes that has been diagnosed by a physician. **Includes persons of Hispanic and non-Hispanic origin. ***Persons of Hispanic origin may be any race. Age-adjusted rates are adjusted to the year 2000 standard population. Source: National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS.

  10. 15 Leading causes of death, 1999 *Rank based on number of deaths. **Cause-of-death definitions may differ for those used in Healthy People 2010 and the Leading Health Indicators. ***Age-adjusted rates per 100,000 standard population based on year 2000 standard. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  11. 2010 target (US) Diabetes death* rates: United States andRegion IV, by specified race, 1999 Region IV United States Age-adjusted rate per 100,000 standard population American Indian/ Alaska Native** Black/African American, not-Hispanic Hispanic*** Asian/Pacific Islander** White, not-Hispanic *Diabetes deaths are classified by ICD-10 codes: E10-E14 and may be the underlying or contributing cause of death. **Includes persons of Hispanic and non-Hispanic origin. ***Persons of Hispanic origin may be any race. Rates are age-adjusted to the year 2000 standard population. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  12. 2010 target (US) Diabetes death* rates: United States andRegion IV States, by race, 1999 Total population Black/African American Age-adjusted rate per 100,000 standard population Florida Georgia Alabama Kentucky Mississippi Tennessee United States North Carolina South Carolina Region IV *Diabetes deaths are classified by ICD-10 codes: E10-E14 and may be the underlying or contributing cause of death. Rates are age-adjusted to the year 2000 standard population. Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  13. Cause of death classification

  14. 2010 target (US) Cerebrovascular disease (stroke)* death rates:United States and Region IV, by specified race, 1999 United States Region IV Age-adjusted rate per 100,000 standard population American Indian/ Alaska Native** Black/African American, not-Hispanic Hispanic*** Asian/Pacific Islander** White, not-Hispanic *Stroke deaths are classified by ICD-10 codes: I60-I69. **Includes persons of Hispanic and non-Hispanic origin. ***Persons of Hispanic origin may be any race. Rates are age-adjusted to the year 2000 standard population. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  15. 2010 target (US) Cerebrovascular disease (stroke)* death rates:United States and Region IV States, by race, 1999 Total population Black/African American Age-adjusted rate per 100,000 standard population Florida Georgia Alabama Kentucky Mississippi Tennessee United States North Carolina South Carolina Region IV *Stroke deaths are classified by ICD-10 codes: I60-I69. Rates are age-adjusted to the year 2000 standard population. Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  16. 2010 target (US) Human immunodeficiency virus (HIV)* death rates:United States and Region IV, by specified race, 1999 United States Region IV Age-adjusted rate per 100,000 standard population Black/African American, not-Hispanic Hispanic*** White, not-Hispanic *HIV deaths are classified by ICD-10 codes: I11, I20-I25. Rates are age-adjusted to the year 2000 standard population. American Indian/Alaska Native and Asian/Pacific Islander death rates from HIV are unreliable in Region IV. Information on these populations have been suppressed. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  17. 2010 target (US) Human immunodeficiency virus (HIV)* death rates:United States and Region IV States, by race, 1999 Total population Black/African American Age-adjusted rate per 100,000 standard population Florida Georgia Alabama Kentucky Mississippi Tennessee United States North Carolina South Carolina Region IV *HIV deaths are classified by ICD-10 codes: I11, I20-I25. Rates are age-adjusted to the year 2000 standard population. Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  18. Data reliability

  19. Percent of people under 65 years with health insurancecoverage: United States and Region IV, by specified race, 2000 United States Region IV 2010 target (US) Age-adjusted percent American Indian/ Alaska Native* Black/African American, not-Hispanic Hispanic** Asian/Pacific Islander* White, not-Hispanic I = 95% confidence interval. *Includes persons of Hispanic and non-Hispanic origin. **Persons of Hispanic origin may be any race. Percents are age-adjusted to the year 2000 standard population. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS.

  20. Percent of people under 65 years with health insurancecoverage: United States and Region IV States, by race, 2000 Total population Black/African American 2010 target (US) Age-adjusted percent Florida Georgia Alabama Kentucky Mississippi Tennessee United States North Carolina South Carolina Region IV I = 95% confidence interval. Percents are age-adjusted to the year 2000 standard population. Source: National/Regional - National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS; State – Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention, NCCDPHP.

  21. 2010 target (US) Percent of women 40 and older who have received a mammogram within the past 2 years: United States andRegion IV, by specified race, 2000 Region IV United States Age-adjusted percent Black/African American, not-Hispanic White, not-Hispanic Hispanic* I = 95% confidence interval. *Persons of Hispanic origin may be any race. Percents are age-adjusted to the year 2000 standard population. American Indian/Alaska Native and Asian/Pacific Islander mammogram rates are unreliable for Region IV. Information for these populations have been suppressed. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS.

  22. Percent of women 40 and older who have received a mammogram within the past 2 years: United States andRegion IV States, by race, 2000 2010 target (US) Total population Black/African American Age-adjusted percent Florida Georgia Alabama Kentucky Mississippi Tennessee United States North Carolina South Carolina Region IV I = 95% confidence interval. Percents are age-adjusted to the year 2000 standard population. Source: National/Regional - National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS; State – Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention, NCCDPHP.

  23. Race/ethnicity classification

  24. Race/Ethnicity classification • Census • Birth certificate- self-reported by mother • Death certificate • Underestimation of deaths and death rates • Hospital reporting method sometimes unclear • Self-reported- considered most reliable • Report by observation or proxy- may reflect misclassification

  25. Percent distribution of the population by specified race/ethnicity: United States and Region IV, 2000 United States Region IV Percent American Indian/ Alaska Native* Black/African American, not-Hispanic Hispanic** Asian/Pacific Islander* White, not-Hispanic *Includes persons of Hispanic and non-Hispanic origin. **Persons of Hispanic origin may be any race. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: Census 2000 Summary File 1, US Bureau of the Census.

  26. Percent of mothers who began prenatal care in the first trimester of pregnancy: United States and Region IV,by specified race, 2000 United States Region IV 2010 target (US) Percent American Indian/ Alaska Native* Black/African American, not-Hispanic Hispanic** Asian/Pacific Islander* White, not-Hispanic *Includes persons of Hispanic and non-Hispanic origin. **Persons of Hispanic origin may be any race. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee. Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  27. Chronic lower respiratory disease* death rates for people 45 years and older: United States and Region IV,by specified race, 1999 United States Region IV Age-adjusted rate per 100,000 standard population 2010 target (US) American Indian/ Alaska Native** Black/African American, not-Hispanic Hispanic*** Asian/Pacific Islander** White, not-Hispanic *Chronic lower respiratory disease deaths are classified by ICD-10 codes: J40-J47. **Includes persons of Hispanic and non-Hispanic origin. ***Persons of Hispanic origin may be any race. Rates are age-adjusted to the year 2000 standard population. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee Source: National Vital Statistics System (NVSS), Centers for Disease Control and Prevention, NCHS.

  28. Revision of OMB standardsfor race/ethnicity

  29. any mention!

  30. Percent of children 19 to 35 months who are fully immunized*: United States and Region IV, By specified race, 2000 2010 target (US) Percent Asian, not-Hispanic Black/African American, not-Hispanic White, not-Hispanic Hispanic** I = 95% confidence interval. *Four or more doses of DTP, three or more doses of poliovirus, one or more doses of MCV, three or more doses of Hib, and three or more doses of HepB. **Persons of Hispanic origin may be any race. American Indian/Alaska Native immunization rates are unreliable for Region IV. Information on this population has been suppressed. Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee. Source: National Immunization Survey (NIS), Centers for Disease Control and Prevention, NIP and NCHS.

  31. Telephone coverage

  32. Limitations of telephone surveys • Surveys only capture persons with telephones • Possible biased response due to cell phones • Accuracy of responses • Low response rate due to answering machines, Caller ID, etc.

  33. Obesity* in adults 20 years and older:United States, 1999 Age-adjusted percent BRFSS NHIS NHANES** I = 95% confidence interval. *Obesity is defined as BMI > 30 **NHANES data are for adults 20 –74 years and for years 1999-2000 combined. Percents are age-adjusted to the year 2000 standard population. Source: Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention, NCCDPHP; National Health Interview Survey (NHIS), Centers for Disease Control and Prevention, NCHS; National Health and Nutrition Examination Survey (NHANES), Centers for Disease Control and Prevention, NCHS.

  34. For more information: National Center for Health Statistics www.cdc.gov/nchs DATA2010 wonder.cdc.gov/data2010 Healthy People 2010 www.health.gov/healthypeople

More Related