Trends in Disparity by Sex and Race/Ethnicity for the Leading Causes of Death in the United States-1999-2010

CONTEXT

Temporal trends in disparities in the leading causes of death within and between US demographic subgroups indicate the need for and success of interventions to prevent premature death in vulnerable populations. Studies that report recent trends are limited and outdated.

OBJECTIVE

To describe temporal trends in disparities in death rates by sex and race/ethnicity for the 10 leading causes of death in the United States during 1999-2010.

DESIGN

We used underlying cause of death data and population estimates from the National Vital Statistics System to calculate age-adjusted death rates for the 10 leading causes of death during 1999-2010. We measured absolute and relative disparities by sex and race/ethnicity for each cause and year of death; we used weighted linear regression to test for significance of trends over time.

RESULTS

Of the 10 leading causes of death, age-adjusted death rates by sex and race/ethnicity declined during 1999-2010 for 6 causes and increased for 4 causes. But sex and racial/ethnic disparities between groups persisted for each year and cause of death. In the US population, the decreasing trend during 1999-2010 was greatest for cerebrovascular disease (-36.5%) and the increasing trend was greatest for Alzheimer disease (52.4%). For each sex and year, the disparity in death rates between Asian/Pacific Islanders (API) and other groups varied significantly by cause of death. In 2010, the API-non-Hispanic black disparity was largest for heart disease, malignant neoplasms, cerebrovascular diseases, and nephritis; the API-American Indian/Alaska Native disparity was largest for unintentional injury, diabetes mellitus, influenza and pneumonia, and suicide; and the API-non-Hispanic white disparity was largest for chronic lower respiratory diseases and Alzheimer disease.

CONCLUSIONS

Public health practitioners can use these findings to improve policies and practices and to evaluate progress in eliminating disparities and their social determinants in vulnerable populations.

Absolute and relative educational inequalities in depression in Europe

OBJECTIVES

To investigate (1) the size of absolute and relative educational inequalities in depression, (2) their variation between European countries, and (3) their relationship with underlying prevalence rates.

METHODS

Analyses are based on the European Social Survey, rounds three and six (N = 57,419). Depression is measured using the shortened Centre of Epidemiologic Studies Depression Scale. Education is coded by use of the International Standard Classification of Education. Country-specific logistic regressions are applied.

RESULTS

Results point to an elevated risk of depressive symptoms among the lower educated. The cross-national patterns differ between absolute and relative measurements. For men, large relative inequalities are found for countries including Denmark and Sweden, but are accompanied by small absolute inequalities. For women, large relative and absolute inequalities are found in Belgium, Bulgaria, and Hungary. Results point to an empirical association between inequalities and the underlying prevalence rates. However, the strength of the association is only moderate.

DISCUSSIONS

This research stresses the importance of including both measurements for comparative research and suggests the inclusion of the level of population health in research into inequalities in health.

Measuring health disparities: a comparison of absolute and relative disparities

Monitoring national trends in disparities in different diseases could provide measures to evaluate the impact of intervention programs designed to reduce health disparities. In the US, most of the reports that track health disparities provided either relative or absolute disparities or both. However, these two measures of disparities are not only different in scale and magnitude but also the temporal changes in the magnitudes of these measures can occur in opposite directions. The trends for absolute disparity and relative disparity could move in opposite directions when the prevalence of disease in the two populations being compared either increase or decline simultaneously. If the absolute disparity increases but relative disparity declines for consecutive time periods, the absolute disparity increases but relative disparity declines for the combined time periods even with a larger increase in absolute disparity during the combined time periods. Based on random increases or decreases in prevalence of disease for two population groups, there is a higher chance the trends of these two measures could move in opposite directions when the prevalence of disease for the more advantaged group is very small relative to the prevalence of disease for the more disadvantaged group. When prevalence of disease increase or decrease simultaneously for two populations, the increase or decrease in absolute disparity has to be sufficiently large enough to warrant a corresponding increase or decrease in relative disparity. When absolute disparity declines but relative disparity increases, there is some progress in reducing disparities, but the reduction in absolute disparity is not large enough to also reduce relative disparity. When evaluating interventions to reduce health disparities using these two measures, it is important to consider both absolute and relative disparities and consider all the scenarios discussed in this paper to assess the progress towards reducing or eliminating health disparities.

Racial disparity in U.S. diagnoses of acquired immune deficiency syndrome, 2000-2009

BACKGROUND

Increased attention has been focused on health disparities among racial/ethnic groups in the U.S.

PURPOSE

To assess the extent of progress toward meeting the targets of Healthy People 2010 objectives and eliminating disparities.

METHODS

All diagnoses of AIDS during 2000-2009 among people aged ≥ 13 years in the 50 states and District of Columbia, reported to national HIV surveillance through June 2010, together with census population data were used in this analysis (conducted in March 2011). This study assesses the trend in racial/ethnic disparities in rates of AIDS diagnoses both between particular groups using rate difference (RD) and rate ratio (RR) and across the entire range of racial/ethnic subgroups using three summary measures of disparity: between-group variance (BGV); Theil index (TI); and mean log deviation (MLD).

RESULTS

The overall racial/ethnic disparity, black-white disparity, and Hispanic-white disparity in rates of AIDS diagnoses decreased for those aged 25-64 years from 2000 to 2009. The black-white and Hispanic-white disparity in rates of AIDS diagnoses also decreased among men aged ≥ 65 years; however, the black-white disparity increased among young men aged 13-24 years (BGV: p<0.001, black-white RD: p<0.01) from 2000 to 2009.

CONCLUSIONS

Findings indicate overall decreases in racial/ethnic disparities in AIDS diagnoses except in young men, particularly young black men aged 13-24 years where the burden of AIDS is increasing. HIV testing, prevention, treatment and policy-making should be a priority for this group.

A symmetrized Theil index measure of health disparities: An example using dental caries in U.S. children and adolescents

While the health status of Americans has generally improved over time, health disparities among groups of the population have been pervasive. Designing a measure that tracks the resulting disparities remains a challenge. In this paper, we propose a new measure of health disparities the Symmetrized Theil Index (STI), and derive its design-based sampling variance in grouped survey data. Because STI is symmetric, it circumvents the drawback of the Theil Index in how groups are weighted: indeed, the latter is mostly influenced by groups with high disease frequencies. Moreover, STI is related to Pearson's chi-square test of independence for binary data, and to the F-test in one-way analysis-of-variance for continuous data. We illustrate our approach using data on dental caries for children and adolescents from the third National Health and Nutrition Examination Surveys (NHANES III; 1988-1994) and NHANES 1999-2004. Tooth decay remains the most common chronic disease in U.S. children and adolescents. Although their oral health has generally improved, we find no change in the prevalence or severity of untreated tooth decay in U.S. children and adolescents between surveys. These findings are consistently observed for both the overall STI and its between-group component across gender, race/ethnicity, country of birth, survey respondent's education, income and poverty-income ratio.

Health inequality: what does it mean and how can we measure it?

Reducing socioeconomic inequalities in health has become an important government objective. International organizations, such as the WHO, have played an important role providing the principles to encourage action in many countries. Evidence of socioeconomic inequalities in health is widespread. National and cross-national research has led to the development of a new set of methodological tools to address the challenges that the available data present. Several methods have been used in the literature to measure inequalities in health; the concentration index approach is becoming widely used. In the future, the research agenda will continue to shift away from documenting health inequalities toward efforts to support the development of policies to improve the health of the most deprived populations and to reduce inequalities in health.

Major reduction in AIDS-mortality inequalities after HAART: the importance of absolute differences in evaluating interventions

This study estimates the magnitude of inequalities in AIDS mortality in the period when highly active antiretroviral therapy (HAART) was introduced and after its widespread dissemination in the Region of Madrid, Spain. Two population cohorts were constructed by linking records from 1996 and 2001 population censuses with mortality registry records after initial and full implementation of HAART, respectively. Absolute and relative differences in AIDS mortality in people aged 20-49 years were estimated in each population cohort according to neighbourhood and individual socioeconomic position. The absolute difference in mortality between neighbourhoods with highest and lowest socioeconomic position (unemployment rate, per capita income) declined from about 30/100,000 person-years in the 1996 population cohort to 8/100,000 person-years in the 2001 population cohort. The absolute difference in mortality between individuals with the highest and lowest socioeconomic position fell from about 60/100,000 person-years in the first cohort to about 20/100,000 in the second. Relative differences in mortality by neighbourhood socioeconomic position and by individual education level also decreased in the 2001 cohort with respect to the 1996 cohort. Although relative differences by individual occupation increased, there was no evidence of a significant change. These findings show major reduction in absolute socioeconomic differences in AIDS mortality after HAART and indicate that the use of relative differences alone may be inadequate to fully evaluate the results of health interventions.