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 28-2), which displays information about disparities among select populations for which data were available for assessment.

For those vision-related objectives that had significant differences among racial and ethnic populations, the white non-Hispanic population showed the best rates for regular dilated eye examinations (28-1) and for vision impairment rates due to refractive errors (28-3) and glaucoma (28-6). In contrast, the black non-Hispanic population aged 45 years and older had a rate for glaucoma-related vision impairment more than three times the rate of the white non-Hispanic population. The black non-Hispanic population and the Mexican American population also had higher rates for impairment due to refractive error (28-3). The population identifying with two or more races had the best rate for vision screening in children 6 years of age and under (28-2).

Initiatives are under way to counteract these known disparities. For example, the Healthy Vision Community Awards Program provides seed money to organizations that are actively involved in addressing the Healthy People 2010 vision objectives.¹⁴ The program, launched in 2002, has supported 130 community-based programs in more than 35 States and Puerto Rico and has served diverse audiences, including the black non-Hispanic, Hispanic, American Indian, and Alaska Native populations, as well as preschool children through adults over age 65 years, and economically disadvantaged and medically underserved persons.

Males had better rates for the following objectives with significant gender differences: visual impairment due to refractive errors (28-3) and cataracts (28-7), and adult use of protective eyewear (28-9b). Females had better rates for obtaining dilated eye exams at appropriate intervals (28-1) and for reducing occupational eye injuries resulting in emergency department visits (28-8b). Most of these disparities between genders were between 10 percent and 49 percent, with one notable exception: Males had a rate for occupational eye injuries (28-8b) that was more than three times the rate for females.

Among objectives with significant disparities in education level, persons with at least some college had the best group rate for dilated eye exams (28-1). High school graduates had the best rate for impairment due to cataracts among persons aged 65 years and older (28-7).

Among income levels, persons with middle/high incomes had the best rates for uncorrected vision impairment due to refractive errors (28-3); the rates for the poor and near-poor populations were more than 50 percent higher than the best group rate. Limited data were available to examine disparities between persons with and without disabilities. The population without disabilities had a better rate for visual impairment among persons aged 17 years and under (28-4) than the population with disabilities. Although the overall disparity between these two populations remained high (the rate for persons with disabilities was three times that for those without disabilities), the gap narrowed. Between 1997 and 2003, disparity declined by almost 200 percentage points.

For objectives related to hearing, the white non-Hispanic population had the best rate for adults aged 70 years and older who had had a hearing examination in the past 5 years (28-14b). The black non-Hispanic population had the best rate for adults aged 20 to 69 years who had had a hearing examination in the past 5 years (28-14a). Hispanic outreach meetings, Spanish-language public service announcements, and health information fact sheets may have played a role in the increase in the use of hearing aids, wearing protective devices, and having hearing exams in the Hispanic population.^{15, 16}

Males had better rates for two objectives with significant gender differences: recent hearing exams (28-14a and b) and the use of hearing protection devices by noise-exposed persons (28-16a). Females had better rates for obtaining cochlear implants (28-13b). All of these gender disparities were less than 99 percent.

Among objectives with significant disparities in education level, high school graduates had the best rate for hearing aid use by persons aged 20 to 69 years (28-13a). Persons with middle/high incomes also demonstrated the best group rates for recent hearing exams among persons aged 20 years and older (28-14a and b) and for the use of hearing protective devices among noise-exposed persons aged 20 to 69 years (28-16a). Between 1999–2000 and 2001–02, the disparity in receiving hearing exams between the near-poor population and the middle/high-income population increased more than 10 percentage points (28-14a).

Limited data were available to examine disparities between persons with and without disabilities. Persons with disabilities had a better rate for hearing aid use among persons aged 20 to 69 years (28-13a) than among persons without disabilities. The disparity between these two populations was substantial; the rate for persons with disabilities was about six times that of persons without disabilities.

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