Disparities in Preventive Health Care: Variations across States

1
Disparities in Preventive Health Care
Variations across States
Ernest Moy, MD, MPH Karen Ho, MHS Academy for
Health Equity June 26, 2008
2
Learning Objectives

• Discuss why examining disparities at the State
  level is important
• Discuss feasibility to assess education, racial,
  and ethnic disparities in preventive health care
  at the State level
• Discuss variation across States in the magnitude
  of disparities in preventive health care

3
States are critical to address disparities in
health care

• States have knowledge of local conditions
• Priority health conditions
• Underserved populations
• Available resources and partners
• States can influence local care delivery
• Regulate providers and insurers
• Purchase care for Medicaid recipients and State
  employees
• Deliver care directly

4
Little is known about variations in disparities
across States

• Previous work has identified variation but has
  been limited in scope
• AHRQ State Snapshots Disparities in Diabetes
  Treatment
• Commonwealth Fund State Scorecards Equity
• Research objectives of this study To assess
• Feasibility of examining disparities in adult
  preventive health care across States
• Variations in the magnitude of disparities
  related to education, race, and ethnicity

5
Methods- Data

• Behavioral Risk Factor Surveillance System
  (BRFSS) 2006
• 50 States, DC, Puerto Rico, Virgin Islands

6
Methods- Measures

• Preventive care
• Mammogram among women age 40
• Pap tests among women age 18-65
• Colorectal cancer screening among adults age 50
• Flu shot among adults age 65
• Pneumococcal shot among adults age 65

7
Methods- Comparisons

• Disparities Absolute differences comparing
• lt High School vs. gt College
• Non-Hispanic Blacks vs. Non-Hispanic Whites
• Hispanics vs. Non-Hispanic Whites

8
Methods- Analyses

• Assessed each disparity for each measure for
• Each State
• All States in aggregate
• Best (top 10) and Worst (bottom 10) States

9
Educational, Racial, Ethnic Disparities for All
States
10
Feasibility of Assessing Disparities at the State
Level
11
Educational Disparity in Colorectal Screening
across All States
12
Racial Disparity in Colorectal Screening across
All States
13
Ethnic Disparity in Colorectal Screening across
All States
14
Limitations

• Preventive health care reported by patients
• Only adult preventive services examined
• Unable to generate estimates for Asians, Native
  Hawaiians and Pacific Islanders, American Indians
  and Alaska Natives, and multiple race individuals
• Information not available on Black and Hispanic
  subpopulations
• Data collection and sampling can vary across
  States

15
Conclusions

• Feasible to examine health care disparities in at
  the State level.
• There is high variation in disparities across
  States.
• Individual States differ type of disparity and
  priority area.
• Examining variations in disparities across States
  may permit better targeting of local disparities
  resources and establish practical benchmarks.

16
Your questions and comments