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 24-2), which displays information about disparities among select populations for which data were available for assessment.

In a comparison of respiratory disease disparities among racial and ethnic populations, the white non-Hispanic population had the best group rates for asthma deaths of persons aged 15 to 34 years (24-1c), asthma deaths among persons aged 35 to 64 years (24-1d), asthma deaths among persons aged 65 years and older (24-1e), activity limitations among persons with asthma (24-4), patient education among persons with asthma (24-6), appropriate medication regimens for asthma care (24-7d), assistance in reducing environmental risk factors for asthma (24-7f), and activity limitations due to chronic lung disease (24-9). The black non-Hispanic population was most likely to report receiving education about the early signs of asthma (24-7c). The white population had the better rates for hospitalization for asthma among persons aged 5 to 64 years (24-2b) and hospital emergency department visits for asthma among persons aged 5 to 64 years (24-3b). Persons of two or more races were more likely to report having an asthma management plan (24-7a). The Asian or Pacific Islander population had the lowest death rate for COPD (24-10). The black population experienced the lowest rate for vehicular crash deaths related to excessive sleepiness (24-12).

In a comparison of respiratory disease disparities among females and males, females aged 15 to 34 years had a lower asthma mortality rate (24-1c) than males in that age range. They were also more likely to report receiving asthma education (24-6), having written asthma management plans (24-7a), being instructed in the identification of early signs of an asthma attack (24-7c), making appropriate limited use of rescue medication (24-7d), and receiving assistance in reducing environmental risks (24-7f). Females had a better COPD death rate (24-10) than males. Conversely, males aged 35 to 64 years and aged 65 years and older had better asthma death rates (24-1d and e, respectively) than females in those age groups. Males aged 5 to 64 years also had a better asthma hospitalization rate (24-2b) and a better emergency department visit rate (24-3b). Males had a higher rate than females for vehicular crash deaths related to excessive sleepiness (24-12).

Data needed to evaluate the respiratory disease objectives by education level were available only for a limited number of populations. For persons aged 35 to 64 years, those with at least some college had the lowest rate of asthma deaths (24-1d). For persons aged 45 years and older, those with at least some college had the lowest rate of COPD deaths (24-10). For both these objectives, persons with less than a high school education and high school graduates had rates several times the rates for persons with at least some college.

Income level disparities were evident for several asthma objectives. The middle/high-income population was most likely to report having written asthma management plans (24-7a), receiving education in the early signs of an asthma attack (24-7c), appropriate use of rescue medication (24-7d), and assistance in reducing environmental risks (24-7f). The middle/high-income population also had less activity limitation due to chronic lung disease (24-9). Among persons aged 45 years and older, more than twice as many poor and near-poor persons reported activity limitations from chronic lung and breathing problems than did those of middle/high income.

The relative size of the disparity between populations has also changed over time. For example, in 1999, the black non-Hispanic population aged 15 to 34 years had an asthma death rate 4.7 times the rate of the white non-Hispanic population aged 15 to 34 years. By 2002, the asthma death rate for the black non-Hispanic population aged 15 to 34 years was only 3.6 times the rate for the white non-Hispanic population aged 15 to 34 years. Similarly, in 1999, women aged 35 to 64 years had an asthma death rate 1.7 times the rate for men aged 35 to 64 years. By 2002, the asthma death rate for women was 1.5 times that of men. Declines in asthma deaths among persons 65 years and older (24-1e) from 1999 to 2002 were greater among the Asian or Pacific Islander, black non-Hispanic, and Hispanic populations, compared with the white non-Hispanic population, and contributed to significant progress toward eliminating disparities among all racial and ethnic populations.

Progress toward a target for one or more populations does not always cause a decrease in disparity. Despite declines in COPD deaths (24-10) among all racial and ethnic populations except the American Indian or Alaska Native population, there was no change in the observed disparities from 1999 to 2002. A decline in COPD deaths (24-10) among males did reduce the disparity between males and females. Between 1998 and 2003, increases in the proportion of persons aged 18 years and older who received asthma patient education (24-6) occurred in the white non-Hispanic population, in the middle/high-income population, and in both males and females. However, none of these increases affected the observed disparities among the populations. The proportion of females and males who reported receiving assistance in reducing exposure to asthma environmental risk factors (24-7f) increased between 2002 and 2003. However, the disparity between females and males increased because the increase for females was much greater than for males.

In 2002, the black population group aged 5 to 64 years had an asthma hospitalization rate (24-2b) and emergency department visit rate (24-3b) almost three times or greater than the rate for the white population aged 5 to 64 years. No changes in disparities between racial groups were noted for either hospitalizations or emergency department visits since the baseline years. Females aged 5 to 64 years had higher asthma hospitalizations and higher asthma deaths among persons aged 65 years and older (24-1e) than males.

Research initiatives are under way to better understand the causes of persistent asthma disparities among different populations. For example, NIH supports the Centers for Reducing Asthma Disparities to accelerate research aimed at understanding why select racial, ethnic, and socioeconomic populations are more severely affected than others.¹¹ The centers are examining ways to overcome barriers to quality asthma care that confront minorities and persons living in poverty. For example, pilot studies in the centers are developing tools to promote better communication between patients and their clinicians about their asthma; improving asthma care for inner-city pregnant women with asthma; and promoting the use of best clinical practices among clinicians serving minorities and improving adherence among their asthma patients.

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