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 15-2), which displays information about disparities among select populations for which data were available for assessment.

While every person is at risk for injury, some populations are at increased risk for certain injuries. In general, the white non-Hispanic population, females, and persons with at least some college education had the best group rates within the respective race and ethnicity, gender, and education characteristics for the majority of the objectives. Females had better rates than men for all but one of the objectives with measurable gender disparity. Persons with at least some college had the best rates for almost all of the objectives with education data. Overall, disparities from the best group rates tended to be large―50 percent or greater for most of the objectives with disparity data.

Firearm-related deaths (15-3) demonstrated increases in disparity, while firearm-related injuries (15-5) demonstrated decreases in disparities. The Asian or Pacific Islander population had the best rate for firearm-related deaths. The death rate of the black non-Hispanic population was more than six times as high, and this disparity increased by more than 100 percentage points between 1999 and 2002. Rates for all other racial and ethnic populations were about three times the rate of the Asian or Pacific Islander population. The male firearm death rate was six times the rate for females; the disparity between males and females increased by 10 to 49 percentage points between 1999 and 2002.

The white non-Hispanic population had the best rate for nonfatal firearm-related injuries (15-5), compared with the black non-Hispanic and the Hispanic populations. The nonfatal firearm-related injury rate for the black non-Hispanic population was almost 10 times the rate of the best group. The rate for the Hispanic population decreased sharply between 1997 and 2001, from 39.4 injuries per 100,000 population to 21.8 injuries per 100,000 population. As a result, the disparity between the Hispanic and white non-Hispanic populations declined by more than 100 percentage points. Although the disparity between male and female firearm-related injuries declined by 50 to 99 percentage points, males continued to experience firearm injuries at a rate more than seven times that for females.

The Asian or Pacific Islander population had the lowest rate for poisoning deaths (15-8), while rates for the other racial and ethnic populations were at least three times as high. Between 1999 and 2002, the disparity between the white non-Hispanic population and the Asian or Pacific Islander population increased by more than 100 percentage points, largely due to an increase in poisoning deaths among the white non-Hispanic population. Despite a decline in the gender disparity between 1999 and 2002, males were almost twice as likely as females to die from poisoning. Similarly, persons with a high school education or less were more than twice as likely as individuals with some college to die from poisoning.

Disparities were also observed in unintentional injury deaths (15-13). The Asian or Pacific Islander population had the best rate, while the rate for the American Indian or Alaska Native population was three times as high, and the rates for the white non-Hispanic and black non-Hispanic populations were twice as high. Males were more than twice as likely to die from unintentional injuries than were females. Persons with a high school education or less were more than twice as likely to die from unintentional injuries as persons with at least some college.

Motor vehicle deaths per 100,000 population (15-15a) demonstrated disparities of race and ethnicity, gender, and education level. The Asian or Pacific Islander population had the best group rate for motor vehicle deaths (15-15a). The American Indian or Alaska Native population had the highest motor vehicle death rate, three times the rate for the Asian or Pacific Islander population. The black non-Hispanic and white non-Hispanic populations both had rates 50 percent to 99 percent higher than the Asian or Pacific Islander population. Part of this inequality is likely related to differences in safety belt use and rates for alcohol-impaired driving.⁴⁸ Motor vehicle deaths were more than twice as high in males as in females. By education level, persons with at least some college had the best rate, while persons with a high school education or less had rates at least twice as high. Furthermore, the disparity between these groups increased by at least 10 percentage points between 1999 and 2002.

Residential fire deaths (15-25) showed improvement in disparities by race and ethnicity. The Hispanic population had the best rate for this objective. The rate for the black non-Hispanic population declined by almost 20 percent between 1999 and 2002, resulting in a decrease in disparity of more than 100 percentage points between this group and the Hispanic population. Despite this change, the black non-Hispanic population continued to have the highest rate for residential fire deaths, more than three times that of the Hispanic population.

Violence is another important area of health disparity among populations. The homicide rate (15-32) for the black non-Hispanic population was especially high―more than seven times that of the white non-Hispanic population in 2002. The American Indian or Alaska Native and Hispanic populations had rates that were three times the rate for the white non-Hispanic population. Between 1999 and 2002, the disparity between the black non-Hispanic and white non-Hispanic populations increased by over 50 percentage points. By gender, the disparity between males and females increased by more than 10 percentage points, with males more than three times as likely to be the victim of a homicide. The homicide rates for persons with a high school education or less were more than four times the rate experienced by persons with at least some college.

Physical assaults (15-37) also showed considerable variability among different racial and ethnic populations, with the Asian or Pacific Islander population having the best rate. Other races and ethnicities had rates for physical assault that were at least twice the rates of the Asian or Pacific Islander population. Furthermore, between 1998 and 2001 the Hispanic population had a 100 percentage point or more increase in disparity from the best group rate.The rate for the American Indian or Alaska Native population declined from 99.4 assaults per 1,000 population in 1998 to 39.2 assaults per 1,000 population in 2001, resulting in a more than 100 percentage point decrease in the disparity between this group and the Asian or Pacific Islander population.

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