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 5-2), which displays information about disparities among select populations for which data were available for assessment.

Progress was made toward Healthy People 2010's two overarching goals to increase quality and years of healthy life and eliminate health disparities. In general, the white non-Hispanic population, females, and persons with higher education levels were identified as having the best group rates. Exceptions, however, existed; for example, the Asian or Pacific Islander population had the best group rate for diabetes-related deaths among the general population (5-5), and the Hispanic population had the best group rate for cardiovascular deaths in persons with diabetes (5-7).

Large disparities exist in rates of diabetes. The American Indian or Alaska Native population's number of overall cases of diabetes (5-3) was twice that observed in the white non-Hispanic population. Persons with less than a high school education experienced twice the rate for new cases of diabetes (5-2) as did persons with at least some college. Rates for new cases and overall cases of diabetes (5-2 and 5-3) among persons with disabilities were three times the rates among persons without disabilities.

The diabetes-related death rate (5-5) was more than twice as high in the black non-Hispanic population as in the Asian or Pacific Islander population. Similarly, persons with less than a high school education and high school graduates experienced diabetes-related death at more than twice the rate of persons with at least some college. The rate for lower extremity amputation among males with diabetes was twice that observed among females with diabetes (5-10).

Between 1997 and 2003, disparity in overall cases of diabetes (5-3) decreased between persons with a high school education or less and persons with at least some college (best population). Disparity also decreased between the Hispanic and the white non-Hispanic (best) populations. However, between 1997 and 2003, each of these populations had an increase in new cases of diabetes. Thus, the declines in disparity resulted because the best populations moved away from the target at a faster pace than the other populations.

Disparities among various populations were largely unchanged from baseline assessments. A few positive trends were evident: disparities in receiving an annual dilated eye exam (5-13) and disparities between high school graduates and persons with at least some college decreased by 10 percent to 49 percentage points. Diabetes-related deaths (5-5) showed a 10 to 49 percentage point decrease in the disparity gap between the American Indian or Alaska Native and the Asian or Pacific Islander populations. Finally, both the white non-Hispanic population and persons with less than a high school education had reductions in disparities for cardiovascular deaths related to diabetes (5-7).

New cases of diabetes (5-3) demonstrated a 50 to 99 percentage point decrease in disparity between persons with less than a high school education and those with at least some college. For the same objective (5-3), a 10 to 49 percentage point decrease occurred in the disparities between the Hispanic and white non-Hispanic populations and persons with a high school education and those with at least some college.

Of concern were increases in disparities tied to education. The disparities for the proportion of persons diagnosed with diabetes (5-4) (rather than total cases) and the rate for diabetes-related deaths (5-5) increased among persons with a high school education and the best populations. High school graduates also showed an increase in disparity from the best group in obtaining annual dental exams (5-15). Finally, the disparity in cardiovascular deaths in persons with diabetes (5-7) between the black non-Hispanic and Hispanic (best) populations widened by 10 to 49 percentage points. This result was particularly alarming because of the greater rate for co-morbidities, like high blood pressure, among the black non-Hispanic population affected by diabetes mellitus.

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