Race, Ethnicity, and Language Data Standardization for Health Care Quality Improvement (2009) / Chapter Skim
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2 Evidence of Disparities Among Ethnicity Groups
2 Evidence of Disparities Among Ethnicity Groups
Pages 31-60
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From page 31... ...
race and ethnicity categories as the minimum standard by which collected race and ethnicity data should be parsed and reported, the recommendations go further, calling for better data on racial and ethnic populations "to reflect the diversity within racial and ethnic populations (e.g., subgroups of Hispanics, African Americans, Asian Americans, etc.) , particularly at the local level" (IOM, 2003, p.
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From page 32... ...
The U.S. Census captures data on a few discrete ethnic groups both under the Hispanic ethnicity question, by having check-off boxes for some Hispanic groups (e.g., Puerto Ricans, Dominicans)
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From page 33... ...
The subcommittee adopts the term granular ethnicity to describe groups at a more specific level of categorization than the broad OMB categories, such as the ethnic groups that the Census lists as subgroups in its Hispanic ethnicity and race questions. The subcommittee, as will be examined in Chapter 3, believes a separate question on granular ethnicity would complement the OMB categories for race and Hispanic ethnicity without further intermingling the constructs of race and ethnicity.
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From page 34... ...
For the most part, entities use the same categories of race, ethnicity and language whether data are collected for health or health care purposes so the connections between health disparities and health care disparities can be drawn more easily. Illustration of Differences Among Ethnic Groups Within Broad OMB Categories A study by Blendon and colleagues (2007)
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From page 35... ...
These studies are illustrative of how more granular ethnicity data reveal more precise opportunities for targeting health care quality improvement initiatives.3 Notations are made when the studies are controlled for socio-economic factors when comparing health or health care differences among populations. Statistically significant associations and trends are emphasized.
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From page 36... ...
The avail able literature includes studies of health and health care disparities between Hispanic groups by overall self-rated health, access to care, mental health, cancer and cancer screening, low birthweight, asthma, and cardiovascular health. Overall Self-Rated Health In a national study comparing the overall mental and physical health of multiple Hispanic ethnicity groups, the Mexican group tended to have better scores on both components of the SF-12 than Whites and other Hispanic groups, whether those of Mexican ancestry were born in the United States or Mexico (Jerant et al., 2008)
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From page 37... ...
Poverty Rate (%) Mexican 20.9 59.3 7.4 58.5 43.1 54.2 23.5 Puerto Rican 3.4 9.7 1.2 98.6b 26.7 36.7 25.8 Cuban 1.2 3.5 0.4 31.5 45.9 37.1 14.6 Central American 1.8 5.1 0.6 24.5 56.8 54.0 19.9 Costa Ricanc (0.07)
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From page 38... ...
In terms of lifetime prevalence, compared with the comparable Puerto Rican gender group, those of Mexican ethnicity showed lower rates of depressive disorders whether male or female and lower rates of substance abuse disorders for women, and lower overall psychiatric disorders for men. Cuban men were less likely to suffer from anxiety disorders and overall psychiatric disorders.
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From page 39... ...
Foreign-born women with Mexican ethnicity had about a 21 percent reduced risk of low birthweight, but the same phenomenon was not observed for other Latino women who were born outside the continental United States (i.e., Puerto Ricans, Cubans, Central/South Americans) (Acevedo-Garcia et al., 2007)
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From page 40... ...
The authors also comment on how Hispanic populations beyond Mexican, Cuban and Puerto Rican ethnicity are not well characterized, because in surveys their numbers are small resulting in heterogeneous groups being lumped into an "other" Hispanic category. BLACK OR AFRICAN AMERICAN GROUPS In Census 2000, 12.9 percent of the U.S.
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From page 41... ...
Rates of Cancer Mortality Data on differences in cancer mortality rates among Blacks at more granular ethnicity levels are limited. One study, based on New York City death certificates dating from 1988–1992 linked with U.S.
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From page 42... ...
Poverty Rate (%) African-American 24.5 67.0 8.6 99.0 ―c 24.3 23.2 Afro-Caribbean 1.6 4.4 0.6 30.4 ―c 27.6 15.5 African 1.5 4.2 0.5 68.3 34.2c 21.2 22.3 Other or no ancestry 9.0 24.5 3.1 91.0 38.8 29.8 reported Total Black 36.6 100.0 12.8 92.8 36.1c 27.7d 24.3 Total U.S.
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From page 43... ...
. This mirrored the relative risk profile for delivery of moderately low birthweight infants among all mothers in these ethnic groups regardless of whether they themselves were assessed as high or low risk for low birthweight outcomes.
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From page 44... ...
A lack of health coverage can lead to problems in having a usual source of health care. A recent study released by the Kaiser Family Foundation and the Asian and Pacific Islander American Health Forum found that uninsured Asians are more than four times as likely to lack a usual source of care compared with insured Asians (Kaiser Family Foundation and APIAHF, 2008)
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From page 45... ...
Than "Very Well" High School Poverty Rate Asian Groups (in 000s) Population Population Native Born (%)
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From page 46... ...
Health Status Asian Americans tend to rate their health status more highly than do other groups, just 11 percent of Asian Americans rate their health status as fair or poor, compared with 13 percent of non-Hispanic Whites, 18 percent of Hispanics, 22 percent of African Americans, and 23 percent of American Indians/Alaska Natives (Kaiser Family Foundation and APIAHF, 2008)
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From page 47... ...
populations, Asian Americans have the highest incidence rates of liver and stomach cancer for both sexes compared with Hispanic, non-Hispanic Whites, or non-Hispanic Blacks" (CDC, 2008)
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From page 48... ...
, where overall cancer incidence rates were lower for Asians and Pacific Islanders in the sample (i.e., Asian Indians, Chinese, Filipinos, Guamanians, Japanese, Koreans, Native Hawaiians, Samoans, and Vietnamese) compared with White non-Hispanics in the United States; the one exception was Native Hawaiian women.
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From page 49... ...
Poverty Rate (%) Native Hawaiian 400 36.8 0.14 97.8 04.3 16.8 15.6 Samoan 128 22.5 0.05 79.1 19.5 24.2 20.2 Guamanian 91 14.6 0.03 87.6 15.4 22.2 13.7 Tongan 37 7.3 0.01 48.6 32.7 34.7 19.5 Fijian 14 2.7 0.01 22.4 25.2 33.2 10.5 Marshallese 7 1.5 ― 23.9 41.4 32.3 38.3 Other Pacific Islander 209 14.6 0.07 61.7 19.4 23.3 21.4 Tahitiand (3.3)
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From page 50... ...
. Demographic Characteristics The poverty rate among those of White race alone in 2007 was 10.5 percent, nearly the same as the overall average rate for Asian and Pacific Islanders but half the rate among Blacks and Hispanics.
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From page 51... ...
Poverty Rate (%) Whites speaking only English 175.0a 93.7 66.7 97.9 at home Whites speaking Spanish at 2.7a 1.4 1.0 91.5 46.7c 13.6 11.0 home Whites speaking other Indo- 8.6a 4.6 3.3 46.5 32.9c 23.8 11.6 European languages at home Whites speaking Asian and 0.4a 0.2 0.1 59.0 26.7c 12.6 10.0 Pacific Islander languages at home Whites speaking all other 0.1a 0.03 0.02 61.5 29.4c 19.0 16.8 languages at home Total White 186.8a NA 71.2 95.4 41.4 (31.3)
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From page 52... ...
Reliable data on differences among other ethnic groups within the broad White category could not be identified, representing an area that could benefit from more study that would be informed by granular ethnicity data collection. Self-Reported Health Naturalized Middle Eastern immigrants reported worse health compared with their non-naturalized Middle Eastern counterparts in a study based on data from the NHIS.
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From page 53... ...
It remains to be seen which other White subgroups experience considerable differences in care or health outcomes, and collecting granular ethnicity data will make the picture clearer. AMERICAN INDIAN OR ALASKA NATIVE GROUPS The number and proportion of persons in the American Indian or Alaska Native (AIAN)
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From page 54... ...
Graduationb (%) Poverty Rate (%)
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From page 55... ...
Kelly and colleagues (2006) found subgroup differences when comparing the cancer incidence rates of Ameri can Indians from New Mexico and Alaska.14 Between 1993 and 2002, Alaska Indians had a higher incidence rate for all cancer sites combined than either New Mexico Indians or U.S.
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From page 56... ...
The scientific findings in this chapter demonstrate the existence of disparities in health and health care at a level of categorization that is more detailed than the OMB categories of race and Hispanic ethnicity. Therefore, the subcommittee concludes that use of the broad OMB categories alone can mask identification of disparities at the more granular level.
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From page 57... ...
2006. Health brief: Native Hawaiians in the United States.
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From page 58... ...
Health coverage and access to care among Asian Americans, Native Hawaiians and Pacific Islanders. Menlo Park, CA: The Henry J
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From page 59... ...
2008. Metabolic syndrome: Prevalence among American Indian and Alaska Native people living in the Southwestern United States and in Alaska.
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