Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 14-2), which displays information about disparities among select populations for which data were available for assessment.

The relative lack of disparities in childhood vaccination coverage has been a successful outcome of the Childhood Immunization Initiative.²³ Since the beginning of the decade, substantial progress was made in eliminating racial and ethnic disparities for new cases of congenital rubella syndrome, measles, rubella, and mumps.^{4, 24, 25, 26}

However, disparities still exist. The white non-Hispanic population had the best immunization rates of children aged 19 to 35 months for five of the seven antigens tracked (14-22), as well as the best rate for completed series (14-24a). The best rate for varicella immunization was observed in Hispanic children (14-22f), while Asian children had the best rate for PCV immunization (14-22g). Near-poor children aged 19 to 35 months had better immunization rates than poor children for the four subobjectives with significant disparities by income. Middle/high-income children had the best rate for completed immunization series (14-24a). Between 2002 and 2003, increases in disparity were seen for PCV immunization between American Indian or Alaska Native children and black non-Hispanic children and Asian children (14-22g).

Disparities between population rates for hepatitis A infections decreased (14-6). Rates for hepatitis A declined substantially between 1997 and 2003 for racial and ethnic populations, all of which achieved the 2010 target of 4.3 new cases per 100,000 population. The decline among the American Indian or Alaska Native population, which historically has had rates five or more times those of other racial and ethnic populations, was the largest. The rate for this population, which was more than 100 cases per 100,000 population in 1994,²⁷ had already declined to 22.7 new cases per 100,000 population by the 1997 baseline and then continued to decline, reaching a rate of 1.2 new cases per 100,000 population in 2003. Rates for the Hispanic population also declined, substantially dropping from 23.4 new cases per 100,000 population in 1997 to 2.7 per 100,000 population in 2003. Nonetheless, the Hispanic population still had a rate more than twice that of the American Indian or Alaska Native (best) population. Reasons for this disparity are not certain, but a reduction through nationwide implementation of routine vaccination of all children aged 12 to 23 months of age is likely.

Hepatitis B rates for adults (aged 19 to 24 years, 25 to 39 years, and 40 years and older [14-3a, b, and c]) declined in most racial and ethnic populations. Among persons 19 to 39 years of age (14-3a and b), the Hispanic or Latino population had the best rates, while among persons aged 40 years and older (14-3c), the best rate was for the white non-Hispanic population. Substantial progress was made in reducing the disparity between the Asian and Pacific Islander population and the best group; the rate of the Asian and Pacific Islander population approached that of the best group for all three age categories. The black non-Hispanic and American Indian or Alaska Native populations continued to have rates that were generally at least twice that of the best population. Higher rates for the black non-Hispanic population and the American Indian or Alaska Native population may reflect the rate for high-risk behaviors, such as drug use in the context of communities where the underlying rate for infection is high.

The national Vaccines for Children program and Section 317 grants which provide hepatitis A²⁸ and hepatitis B²⁹ vaccinations for children and adolescents have been helpful in eliminating disparities.^{10, 30, 31} While universal vaccination of infants and young children against hepatitis A and hepatitis B will ultimately reduce the remaining disparities, targeted vaccination of adults in risk populations may help achieve the targets sooner.

The black population also continued to have persistent disparities for several other infectious disease objectives. Rates for invasive pneumococcal infections (14-5) demonstrated disparity gaps ranging from 20 percent to greater than 100 percent from the best group rates. While the reasons behind the disparities in disease rates are unclear, introduction of a new pneumococcal vaccine for children in 2000 is helping to reduce the disparity in invasive pneumococcal infections among children under 5 years of age. However, during the period of 1997 to 2002, disparities between the black population and the best group increased for invasive pneumococcal infections in the population aged 65 years and older (14-5b) and penicillin-resistant pneumococcal infections in children under 5 years of age (14-5c). ³² Cases of invasive early onset group B streptococcal disease (14-16) also showed a disparity of more than 100 percent between the black and white (best) populations. While rates for both populations declined between 1996 and 2002, the disparity gap widened.

TB (14-11) was another area where large disparities continued to exist across multiple racial and ethnic populations. The rates for other racial and ethnic populations were more than 100 percent higher than the white non-Hispanic (best) population rate, and disparities increased for the Hispanic and black non-Hispanic populations. Understanding and eliminating racial and ethnic disparities in TB will require identifying and targeting populations at high risk for TB; remaining actively involved in global efforts against TB; maintaining adequate resources; and developing new diagnostic tests, new treatments, and an effective vaccine. ³³

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