Trivedi A, Gibbs B, Nsiah-Jefferson L, Ayanian J, Prothrow-Stith D; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1189.
Harvard Medical School, Health Care Policy, 180 Longwood Avenue, Boston, MA 02115 Tel. 617.432.3138 Fax
RESEARCH OBJECTIVE: A state minority health report card may provide an important tool to evaluate and promote state policies to reduce health disparities. We analyzed state performance on four measures of minority health: rates of uninsurance for minorities compared to whites, physician diversity, creation of an Office of Minority Health (OMH), and reporting of health data using detailed race/ethnicity categories. STUDY DESIGN: We used data from the Current Population Survey to determine the relative risk of being uninsured for minorities compared to Whites among non-elderly, low-income individuals. Using data from the AMA Physician Masterfile and U.S. Census, we calculated the degree to which underrepresented minority physicians (URM) in the state must be increased in order to reflect the states underlying demographic population. We contacted all state OMHs recognized by the federal government to conduct a telephone survey on their funding, staffing, history and activities. We determined the number of racial and ethnic categories states used in reporting all-cause mortality data in their most recent vital statistics publication. Finally we conducted secondary analyses of the data to explore three potential predictors of state performance in minority health - region of the country (East, Midwest, South, and West), per capita government spending, and proportion of minorities within the state. POPULATION STUDIED: Non-elderly, low-income U.S. residents; U.S. physicians; representatives of state Offices of Minority Health. PRINCIPAL FINDINGS: Top-quartile states had minimal insurance disparities between minorities and whites; however, minorities who live in bottom-quartile states are 50-100% more likely to be uninsured than Whites. While six states had a proportion of URM physicians that reflected their demographic composition, eighteen states would need to raise their number of URM physicians by a factor of 4.5 to 11 to reach proportional representation. Thirty of fifty states have an office of minority health; however, of these thirty, 6 had no budget and 10 had only one employee. Nearly 50% of states report mortality data using three or fewer racial or ethnic categories, including 30% that report mortality data using a White-Other, Black-White, or Black-White-Other racial breakdown. There was a striking geographic clustering of high and low-performing states with region a significant predictor on all four measures (p<0.05). Percentage of minorities in the state and state fiscal capacity were not significant predictors of performance. CONCLUSIONS: States vary tremendously in their capacity to address racial and ethnic health disparities. High and low performing states tend to cluster geographically. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Future research should be conducted on these and other potential predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.
Publication Types:
Keywords:
- African Americans
- African Continental Ancestry Group
- Aged
- Continental Population Groups
- Data Collection
- Ethnic Groups
- European Continental Ancestry Group
- Evaluation Studies
- Health Policy
- Health Services Needs and Demand
- Humans
- Minority Groups
- Physicians
- methods
- organization & administration
- hsrmtgs
UI: 103624223
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