Race, Income, Education Still Account for Health Differences

January 21, 2011

January 21, 2011 — The nation's health has improved collectively on some fronts and worsened on others, but what remains constant are dramatic differences between groups based on race, income, and other factors that reflect social inequalities, according to the first in a series of comprehensive assessments of health disparities from the Centers for Disease Control and Prevention (CDC).

Some of these health gaps have narrowed but are still large enough to vex public health officials. Other gaps have widened.

In the good news category, the percentage of Americans who have their hypertension under control rose over the last decade to 43.7% as of 2005 to 2008. However, Mexican-Americans (31.8%) lagged substantially behind blacks (41.2%) and whites (46.5%) in this measure.

In the bad news category, the age-adjusted prevalence of diagnosed diabetes climbed from 7% in 2004 to 7.7% in 2008 among adults in general. The news was even worse for adults with less than a high school education. Their diabetes rate during that period increased from 9.7% to 11.8%. For individuals with more than a high school education, the rate hardly changed, going from 6% to 6.2%.

Income differences also help explain health disparities, according to the CDC report. The prevalence of diabetes was progressively higher at progressively lower income levels, for example, and reported rates of colorectal cancer screening increased in stair-step fashion with increasing levels of household income and education level.

CDC officials wrote in the report that such differences could widen as the American population ages, ethnically diversifies, and divides more sharply along income lines.

"Because vulnerable populations are more likely than others to be affected adversely by economic recession, the recent downturn in the global economy might worsen health disparities throughout the United States if the coverage and effectiveness of safety-net and targeted programs do not keep pace with needs," CDC officials write.

Infant Mortality Among Blacks 2.4 Times Higher Than Among Whites

Some of the starkest health disparities emerged in the area of childbirth. The birth rate of 62.9 per 1000 for black girls aged 15 to 19 years in 2008 was more than twice the rate of 26.7 for white female teenagers. Although this is cause for concern, this gap represents an improvement over 1991, when it was almost 3-fold. For all girls in this adolescent age group, the birth rate per 1000 declined from 61.8 to 41.5, with a steeper decrease among blacks than whites.

Less racial divergence was seen in preterm births. In 2007, the rate of preterm births per 100 was 11.5 for whites compared with 18.3 for blacks and 12.3 for Hispanics.

Infant deaths tell another story. In 2006, the overall infant mortality rate per 1000 live births stood at 6.68. However, it was 13.35 among blacks compared with 5.58 among whites — 2 figures that were barely below levels seen in 2000. Among broad categories, Asians and Pacific Islanders posted the lowest infant mortality rate in 2006, at 4.55.

Disparities Unacceptable but Correctable, Says CDC Director

The CDC report highlighted a multitude of other examples of how Americans remain divided into haves and have-nots in terms of health:

  • Asthma in 2006 to 2008 was more common among females, children, the poor, Puerto Rican Hispanics, and the multiracial, whose prevalence rate of 14.8% was almost twice as high as the national rate of 7.8%.

  • Among adults aged 65 years and older, seasonal influenza vaccination coverage in 2009 to 2010 for blacks (55.2%) and Hispanics (56.1%) trailed well behind that for whites (71.7%).

  • Men of all ages and races in 2007 (18.4/100,000) were roughly 4 times more likely to commit suicide than women (4.8/100,000).

  • The obesity rate in blacks of 44% for 2005 to 2008 was a third higher than the 33% rate for whites. Black women aged 60 years and older posted the highest rate of all, at 55%.

  • The rate of hospitalizations that could have been prevented by better primary care for blacks was more than double the rate for whites in 2007. Overall, rates of preventable hospitalizations decreased with rising income.

Health disparities such as these are both unacceptable and correctable, writes CDC Director Thomas Frieden, MD, MPH, in a foreword to the CDC report. Success will require "public awareness and understanding of which groups are most vulnerable, which disparities are most correctable through available interventions, and whether disparities are resolved over time."

CDC Health Disparities and Inequalities Report — United States, 2011. Morb Mortal Wkly Rep. January 14, 2011;60(suppl). Full text

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