disparity measurement in healthy people 2010 john aberle-grasse, mph national center for health...
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Disparity Measurement in Healthy People 2010
John Aberle-Grasse, MPHNational Center for Health Statistics
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Healthy People 2010 goalsIncrease quality and years of healthy life
2. Eliminate health disparities
No method for measuring disparity initially specified
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Healthy People 2000 goalsIncrease the span of healthy lifeReduce health disparity in special populationsAddress the problems that represent the greatest needSeparate targets set for special and total populationsAchieve access to preventive services
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Chose: Percent change over time or Ratio of percent change(RPl-RPb)/RPb (SPl-SPb)/SPb
special population reference populationBaseline (b)Last data point (l)NOTE: Imaginary data
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Reference target4040
Special target6060
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Healthy People 2010 2nd goalEliminate Health Disparities
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.
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Healthy People 2010 2nd goalEliminate Health Disparities
Implement a vision for the nations healthA single target for all population groupsStandard set of population subgroupsApplies to all population-based objectives (389 of 467 objectives)
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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 disabilityHealthy People 2010 is concerned with: all subpopulationssome worse off and some are better off than the total
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Ratio of percent change compares change over time but not inequality at a given point in timePercent change = 0.66Percent change = 0.66
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Healthy People 2010 2nd goalEliminate Health Disparities
Policy and statistical questions specific to Healthy People 2010
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Situations for measuring disparity in Healthy People 2010Single group across a set of objectivesRace/ethnicity Socioeconomic status(eg. How are Hispanics doing compared to the total population on diabetes objectives)Two groupsSexUrban compared to ruralMultiple groups Race/ethnicitySocioeconomic status
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Two groups
Sheet1
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between females and males
AbsoluteRelative
Simple differencePercent differenceRatioSimple dif./ target
Gender
TotalFemaleMaleF-M(F-M)/M*100F/M(F-M)/T
1997404336719.41.1940.35
1998404337616.21.1620.30
1999394237513.51.1350.25
2000394135617.11.1710.30
Percent change 1997-2000-2.5-4.7-2.8-14.3-11.8-11.8-14.3
2010202020
This percent has been changed for illustrative purposes. The correct estimate
is 36 percent.
Sheet1 (10)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Black non-Hispanics and the White non-Hispanics
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnHWnHF-M(F-M)/M*100F/M(F-M)/T
199752361644.41.4440.80
199852361644.41.4440.80
199951351645.71.4570.80
200052351748.61.4860.85
Percent change 1997-20000.0-2.86.39.39.36.2
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Hispanics and White non-Hispanics
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
HWnHF-M(F-M)/M*100F/M(F-M)/T
199754361850.01.5000.90
199855361952.81.5280.95
199956352160.01.6001.05
200054351954.31.5430.95
Percent change 1997-20000.0-2.85.68.68.65.6
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between American Indians or Alaska Natives and White non-Hispanics
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
AIANWnHF-M(F-M)/M*100F/M(F-M)/T
199746361027.81.2780.50
199848361233.31.3330.60
19994335822.91.2290.40
200048351337.11.3710.65
Percent change 1997-20004.3-2.830.033.733.730.0
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Asian or Pacific Islanders and White non-Hispanics
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
APIWnHF-M(F-M)/M*100F/M(F-M)/T
19974236616.71.1670.30
19984036411.11.1110.20
1999373525.71.0570.10
2000353500.01.0000.00
Percent change 1997-2000-16.7-2.8-100.0-100.0-100.0-100.0
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20102020
Sheet1 (6)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Black non-Hispanics and the "best" group (White non-Hispanics)
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnH"best" WnHF-M(F-M)/M*100F/M(F-M)/T
199752361644.41.4440.80
199852361644.41.4440.80
199951351645.71.4570.80
200052351748.61.4860.85
Percent change 1997-20000.0-2.86.39.39.36.2
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Hispanics and the "best" group (White non-Hispanics)
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
H"best" WnHF-M(F-M)/M*100F/M(F-M)/T
199754361850.01.5000.90
199855361952.81.5280.95
199956352160.01.6001.05
200054351954.31.5430.95
Percent change 1997-20000.0-2.85.68.68.65.6
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.
.
20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between American Indians or Alaska Natives and the "best" group (White non-Hispanics)
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
AIAN"best" WnHF-M(F-M)/M*100F/M(F-M)/T
199746361027.81.2780.50
199848361233.31.3330.60
19994335822.91.2290.40
200048351337.11.3710.65
Percent change 1997-20004.3-2.830.033.733.730.0
.
.
.
20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Asian or Pacific Islanders and the "best" group (White non-Hispanics)
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
API"best" WnHF-M(F-M)/M*100F/M(F-M)/T
19974236616.71.1670.30
19984036411.11.1110.20
1999373525.71.0570.10
2000353500.01.0000.00
Percent change 1997-2000-16.7-2.8-100.0-100.0-100.0-100.0
.
.
.
20102020
Sheet1 (7)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Black non-Hispanics and the Average of the race/origin group rates
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnHAvg.F-M(F-M)/M*100F/M(F-M)/T
19975246613.01.1300.30
19985246.25.812.61.1260.29
19995144.46.614.91.1490.33
20005244.87.216.11.1610.36
Percent change 1997-20000.0-2.620.023.223.220.0
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201020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between White non-Hispanics and the Average of the race/origin group rates
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
WnHAvg.F-M(F-M)/M*100F/M(F-M)/T
19973646-10-21.70.783-0.50
19983646.2-10.2-22.10.779-0.51
19993544.4-9.4-21.20.788-0.47
20003544.8-9.8-21.90.781-0.49
Percent change 1997-2000-2.8-2.6-2.00.60.6-2.0
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201020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Hispanics and the Average of the race/origin group rates
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
HAvg.F-M(F-M)/M*100F/M(F-M)/T
19975446817.41.1740.40
19985546.28.819.01.1900.44
19995644.411.626.11.2610.58
20005444.89.220.51.2050.46
Percent change 1997-20000.0-2.615.018.118.115.0
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201020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between American Indians or Alaska Natives and the Average of the race/origin group rates
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
AIANAvg.F-M(F-M)/M*100F/M(F-M)/T
1997464600.01.0000.00
19984846.21.83.91.0390.09
19994344.4-1.4-3.20.968-0.07
20004844.83.27.11.0710.16
Percent change 1997-20004.3-2.60.00.00.00.0
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201020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Asian or Pacific Islanders and the Average of the race/origin group rates
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
APIAvg.F-M(F-M)/M*100F/M(F-M)/T
19974246-4-8.70.913-0.20
19984046.2-6.2-13.40.866-0.31
19993744.4-7.4-16.70.833-0.37
20003544.8-9.8-21.90.781-0.49
Percent change 1997-2000-16.7-2.6145.0151.6151.6145.0
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201020
Sheet1 (8)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Black non-Hispanics and the Total population rate
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnHTotalF-M(F-M)/M*100F/M(F-M)/T
199752401230.01.3000.60
199852401230.01.3000.60
199951391230.81.3080.60
200052391333.31.3330.65
Percent change 1997-20000.0-2.58.311.111.18.3
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between White non-Hispanics and the Total population rate
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
WnHTotalF-M(F-M)/M*100F/M(F-M)/T
19973640-4-10.00.900-0.20
19983640-4-10.00.900-0.20
19993539-4-10.30.897-0.20
20003539-4-10.30.897-0.20
Percent change 1997-2000-2.8-2.50.02.62.60.0
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.
.
20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Hispanics and the Total population rate
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
HTotalF-M(F-M)/M*100F/M(F-M)/T
199754401435.01.3500.70
199855401537.51.3750.75
199956391743.61.4360.85
200054391538.51.3850.75
Percent change 1997-20000.0-2.57.19.99.97.1
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between American Indians or Alaska Natives and the Total population rate
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnHTotalF-M(F-M)/M*100F/M(F-M)/T
19974640615.01.1500.30
19984840820.01.2000.40
19994339410.31.1030.20
20004839923.11.2310.45
Percent change 1997-20004.3-2.550.053.853.850.0
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Asian or Pacific Islanders and the Total population rate
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
APITotalF-M(F-M)/M*100F/M(F-M)/T
1997424025.01.0500.10
1998404000.01.0000.00
19993739-2-5.10.949-0.10
20003539-4-10.30.897-0.20
Percent change 1997-2000-16.7-2.5100.0105.1105.1100.0
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20102020
Sheet1 (9)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Black non-Hispanics and the Healthy People 2010 target
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
BnHTargetF-M(F-M)/M*100F/M(F-M)/T
1997522032160.02.6001.60
1998522032160.02.6001.60
1999512031155.02.5501.55
2000522032160.02.6001.60
Percent change 1997-20000.00.00.00.00.00.0
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between White non-Hispanics and the Healthy People 2010 target
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
WnHTargetF-M(F-M)/M*100F/M(F-M)/T
199736201680.01.8000.80
199836201680.01.8000.80
199935201575.01.7500.75
200035201575.01.7500.75
Percent change 1997-2000-2.80.0-6.3-6.3-6.3-6.3
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Hispanics and the Healthy People 2010 target
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
HTargetF-M(F-M)/M*100F/M(F-M)/T
1997542034170.02.7001.70
1998552035175.02.7501.75
1999562036180.02.8001.80
2000542034170.02.7001.70
Percent change 1997-20000.00.00.00.00.00.0
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between American Indian or Alaska Native and the Healthy People 2010 target
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
AIANTargetF-M(F-M)/M*100F/M(F-M)/T
1997462026130.02.3001.30
1998482028140.02.4001.40
1999432023115.02.1501.15
2000482028140.02.4001.40
Percent change 1997-20004.30.07.77.77.77.7
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20102020
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Measures of disparity between Asian or Pacific Islanders and the Healthy People 2010 target
AbsoluteRelative
SimplePercentRatioSimple dif.
Race/origindifferencedifferencetarget
APITargetF-M(F-M)/M*100F/M(F-M)/T
1997422022110.02.1001.10
1998402020100.02.0001.00
199937201785.01.8500.85
200035201575.01.7500.75
Percent change 1997-2000-16.70.0-31.8-31.8-31.8-31.8
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20102020
Sheet1 (2)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Absolute measures of disparity among race and Hispanic origin groups
Absolute
RangeMean deviation
Race and Hispanic originfromfromfromfromfrom
TotalWnHBnHHAIANAPIHi-LoWnH"best" (WnH)Avg.TotalTarget
19974036525446421812.512.55.6467.626.0
19984036525548401912.812.86.646.27.826.2
19993935515643372111.811.87.344.47.824.4
20003935525448351912.312.37.844.89.024.8
Percent change 1997-2000-2.5-2.80.00.04.3-16.75.6-2.0-2.040.0-2.618.4-4.6
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2010202020202020
Sheet1 (3)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Disparity among race and Hispanic origin groups, Mean deviation/reference point
Relative
Mean deviation/reference point
Race and Hispanic originfromfromfromfromfrom
TotalWnHBnHHAIANAPIWnH"best" WnHAvg.TotalTarget
19974036525446420.350.350.12460.191.30
19984036525548400.350.350.1446.20.201.31
19993935515643370.340.340.1644.40.201.22
20003935525448350.350.350.1844.80.231.24
Percent change 1997-2000-2.5-2.80.00.04.3-16.70.80.843.8-2.621.5-4.6
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2010202020202020
Sheet1 (4)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Disparity among race and Hispanic origin groups, Mean deviation/target
Relative
Mean deviation/target
Race and Hispanic originfromfromfromfromfrom
TotalWnHBnHHAIANAPIWnH"best" WnHAvg.TotalTarget
19974036525446420.630.630.28460.381.30
19984036525548400.640.640.3346.20.391.31
19993935515643370.590.590.3644.40.391.22
20003935525448350.610.610.3944.80.451.24
Percent change 1997-2000-2.5-2.80.00.04.3-16.7-2.0-2.040.0-2.618.4-4.6
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2010202020202020
Sheet1 (5)
Healthy People 2010 objective 22-01: Percent with no leisure-time physical activity, (age adjusted, ages 18 and over) Disparity among race and Hispanic origin groups, Average of ratios
Relative
Average of ratios
Race and Hispanic origintoto
TotalWnHBnHHAIANAPI"best" WnHTarget
19974036525446421.352.30
19984036525548401.352.31
19993935515643371.342.22
20003935525448351.352.24
Percent change 1997-2000-2.5-2.80.00.04.3-16.70.8-4.6
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2010202020202020
Sheet2
Sheet3
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Questions common to each of the three situationsWhat are the contexts for measuring disparity?Cross sectionalOver timeAcross objectivesBetween types of subpopulationsAcross geographic areas
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Questions common to each of the three situationsMeasure 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?
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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 ownMeasuring the two dimensions allows each of the goals to be tracked separately
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Log scale
Target not attained, disparities persist
NOTE: Imaginary dataSOURCE: CDC/NCHS
Target = 5
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Log scale
Target attained, disparities persist
Target = 5
NOTE: Imaginary dataSOURCE: CDC/NCHS
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Log scale
Target not attained, disparities eliminated
Target = 5
NOTE: Imaginary dataSOURCE: CDC/NCHS
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Log scale
Target attained, disparities eliminated
Target = 5
NOTE: Imaginary dataSOURCE: CDC/NCHS
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A three part approach to measuring progress in Healthy People 2010 is suggestedMeasure progress towards targetsOverallParticular groupsMeasure disparityOverallParticular groupsExplore and indicate any particular issuesParticular groups
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Log scale
Target not attained, disparities persist
Target = 5
NOTE: Imaginary dataSOURCE: CDC/NCHS
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Best rate- may change Average rate- does not consider population distributionTotal rate- is relatively stable Target rate- is a constant reference over timeNot all objectives use better than best as target setting method
Is there a particular reference group suggested by HP2010?
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Is there a particular reference group suggested by HP2010?Healthy People 2000 used total populationNIH minority health disparity charge seems to compare disparate race/ethnicity subpopulations to the total populationDoes 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?
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Absolute or relative measure?Absolute measures provide information about the number of excess eventsRelative measures allow comparisons without regard to magnitudeAbsolute and relative measures may lead to the same conclusions when applied to the same objective at a given timeAbsolute and relative measures may lead to different conclusions in comparisons over time or between objectives
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Which statistic should be used?
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Objectives measure positive or negative outcomes?Positive (success) Increase health insurance coverageNegative (failure)Reduce deaths caused by motor vehicle crashesMeasuring all disparities in same terms allows comparison of relative measures of disparity across objectives
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80207525Percent with health insurancePercent without health insurance020406080100Percent Health insurance coverage in two groupsNOTE: Imaginary data
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Objectives measure positive or negative outcomes?Some objectives cannot usefully be measured as successesNIH Strategic Plan to Reduce and Ultimately Eliminate Health Disparities defines disparity in terms of adverse health conditions, failuresThe HP2000 Health Status Indicators all used negative outcomes to be reduced (failures) so they could be compared
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Several common questions for each of these situationsMeasure 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 sectionalOver timeAcross objectivesBetween types of subpopulationsAcross geographic areas
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ResourcesDHHS Healthy People: www.health.gov/healthypeople
NCHS Healthy People: www.cdc.gov/nchs/healthypeople
DATA2010: www.wonder.cdc.gov/data2010