In 2000, about 30% of the U.S. population identified themselves as members of racial or ethnic minority groups. By 2050, it is projected that these groups will account for almost half of the U.S. population. Census 2000 counted over 36 million Blacks or African Americans (12.9% of the U.S. population); over 35 million Hispanics or Latinos who live in the United States (12.5%) and another 3.8 million who live in the Commonwealth of Puerto Rico1; almost 12 million Asians (4.2%)2; 874,000 Native Hawaiians and Other Pacific Islanders (0.3%)3; and over 2 million American Indians and Alaska Natives (0.7%), of whom 38% reside on Federal trust lands.4 Racial and ethnic minorities are more likely than non-Hispanic Whites to be poor or near poor.5 In addition, Hispanics, Blacks, and some Asian subgroups are less likely than non-Hispanic Whites to have a high school education.6 In general, racial and ethnic minorities often experience poorer access to care and lower quality of preventive, primary, and specialty care.5,6
In previous chapters of this report, health care differences by raciali and ethnicii categories as defined by the Office of Management and Budget7 and used by the U.S. Census Bureau are described.8 In this section, quality of and access to health care for each minority group is summarized. Criteria for importance are that the difference is statistically significant at the alpha=0.05 level, two-tailed test and that the relative difference is at least 10% different from the reference group when framed positively as a favorable outcome or negatively as an adverse outcome. Access measures focus on facilitators and barriers to health care and exclude health care utilization measures.
In addition, changes in differences related to race and ethnicity over time are examined in this section. Both absolute and relative differences are compared in current data and historical data. Core report measures for which both the absolute differences and the relative differences are becoming smaller over time are identified as improving disparities. Core report measures for which both the absolute differences and the relative differences are becoming larger over time are identified as worsening disparities. Uncommonly, absolute and relative differences do not agree on direction of change. In these cases, direction of change is unclear and results for these measures are not presented.
As in previous NHDRs, this section includes information on programs and issues that may affect racial and ethnic disparities. The assessment of disparities faced by American Indians and Alaska Natives includes information on the approximately 60% of American Indians and Alaska Natives who obtain care from Indian Health Service (IHS) facilities.
New in this year's report is a special focus on the effects of language barriers and country of birth on quality of and access to care. Data from the Medical Expenditure Panel Survey are used to present findings on speaking a language other than English and being born in a foreign country.
i Races include: Black or African American, Asian, Native Hawaiian or Other Pacific Islander, American Indian and Alaska Native, White, and persons of multiple races.
ii Ethnicity differentiates Hispanics and non-Hispanics. This report also distinguishes non-Hispanic Whites and non-Hispanic Blacks.