Addressing disparities

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Addressing disparities

• Bruce Behringer
• Co-Chair
• Tennessee Comprehensive Cancer Control Coalition
• Assistant Vice President, Division of Health
  Sciences
• East Tennessee State University

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Defining Disparities

• understanding differences in incidence,
  prevalence, mortality and burden of disease and
  other adverse conditions in a population group

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Ranked 44 in age-adjusted all cancer
incidence, 2000-4

• Ranked 20 in age adjusted
• all cancer incidence, 2005

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Ranked 6 in age-adjusted all cancer mortality,
2000-4

• Ranked 3 in age adjusted
• all cancer mortality, 2005

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Tennessee Males, 2005
13 new cases 5 deaths TN 17.5
higher than US
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Tennessee Females, 2005
27 new cases 4 deaths TN 10.5 higher
than US
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Tennessee Black Cancer Mortality Disparities are
Dramatic and Devastating

• 29.1 higher than white Tennessee female
  mortality, 2005
• 43.3 higher than white Tennessee male mortality,
  2005

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Tennessees national cancer rankings by type of
cancer, 2005
New cases Deaths
All cancers 20 3
Lung 4 3
Breast 17 8
Colorectal 12 10
Prostate 36 15
Cervix 6 6
Melanoma 14 14
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Why did incidence rate change so radically from
2000-4 to 2005?
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Why is there such a large difference in state
ranking between incidence and mortality?
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Why did state mortality rankingworsen from
2000-4 to 2005?
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The eternal community questions

• Why is there so much cancer?
• Is here any worse than other places?

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How to define health disparity issues the
product of multiple factors
Population Health Outcomes
Characteristics of health delivery system Characteristics of population at risk
Aday LA. At Risk in America, 2nd ed. San
Francisco, CA Jossey-Bass, 2001.
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Is it time to acknowledge Tennessee as a
statewide disparities population?
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Types of issues raised in
disparity research

• Is it patient/ population health literacy
• OR
• Provider/health system cultural competence?
• Is it lack of access to care in health services
• OR
• Patient underuse of services, even when
  barriers are removed?

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Types of issues raised in
disparity research

• Is it low use of cancer screening services
• OR
• Lack of a direct provider recommendation for
  screening?
• Is it cultural sense of fatalism about cancer
  that resists acceptance of aggressive treatment
• OR
• Family experience, lack of navigational skills
  and community history of poor cancer outcomes?

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Types of issues raised in
disparity research

• How do population socio-economic factors
• INTERACT WITH
• Environmental factors as causes of cancer?
• How do health care policies that guide
  investments, services reimbursement, research and
  quality improvement
• DIFFUSE EQUALLY
• For the benefit of all providers, populations
  and communities?

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Amazing amount of cancer control activity in
Tennessee

• Community education and screening programs
• High percent of public insurance coverage
• State public health activities
• 33 cancer centers
• Cancer advocacy organizations
• Fundraising, events and benefits to help
  families, friends and neighbors
• Support through local prayer calls and donations

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Do we have sufficient resources to address cancer
disparity?

• How to target investments?
• How to use programs that work?
• How to promote collaboration?

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Its not the effort

• What will help us to be more effective?

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What can we learn from ourselves about
doing things better?

• What can we learn from others states that get
  better rankings?

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What can we learn now from our certified cancer
registry to help us target our efforts to reduce
disparities?

• Which counties?
• What cancers?
• Which genders, ages and races?

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Cancer is a health disparity for all of Tennessee

• We need the framework to work together to target
  and use effective cancer education, risk
  reduction, prevention, screening, and
  treatment strategies

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That is the function of the Tennessee
Comprehensive Cancer Control Coalition and State
Comprehensive Cancer Plan
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The TCCCC Challenge

• Who has cancer?
• Which people?
• What places?
• What are the reasons?
• Which types of cancer?
• At what steps in cancer continuum?
• How can we make progress in the fight?
• What intervention effectively address the issues?
• How do gather the resources needed to make a
  difference?

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44 age adjusted all cancer incidence, 2000-4
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20 age adjusted all cancer incidence, 2005
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3 age adjusted all cancer mortality, 2005
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6 age adjusted all cancer mortality, 2000-4
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17.5 higher

• Tennessee Male Mortality, 2005

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10.5 higher

• Tennessee Female Mortality, 2005

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43.3 higher

• Tennessee Black male mortality, 2005

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Rate differences for all genders, ages and races,
2005
United States Tennessee
458.4 Incidence 468.9 2.2 higher
184.1 Mortality 209.6 13.9 higher
Age adjusted mortality rates per 100,000
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Rate differences by genders, 2005
United States Tennessee
533.8 Incidence Males 560.8 5.0 higher
405.9 Incidence, Females 406.5 Not higher
226.2 Mortality Males 265.9 17.5 higher
155.4 Mortality Females 171.8 10.5 higher
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Tennessee Rate differences by race, 2005
Whites Blacks
543.9 Incidence Males 653.0 20.1 higher
401.1 Incidence Females 365.7 8.8 lower
260.2 Mortality Males 373.0 43.3 higher
165.2 Mortality Females 213.4 29.1 higher