Findings From the National Healthcare Quality and Disparities Reports, 2008
Fact Sheet
Since 2003, the Agency for Healthcare Research and Quality has produced the National Healthcare Quality Report and the National Healthcare Disparities Report. Despite improvements, differences persist in health care quality among racial and ethnic minority groups. People in low-income families also experience poorer quality care. This fact sheet discusses differences between groups in terms of relative rates, which is the ratio of the comparison group (e.g., Black) to a baseline group (e.g., White).
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Contents
Introduction
Disparities Persist in Health Care Quality and Access
Magnitude and Patterns of Disparities Differ Among Various Populations
Some Disparities Exist Across Multiple Priority Populations
Limited English Proficiency Is a Barrier to Quality Health Care
Poverty Is a Barrier to High-Quality Care
Disparities Reports Charts Related to Racial and Ethnic Minorities
For More Information
Introduction
Since 2003, the Agency for
Healthcare Research and Quality
(AHRQ) has produced the National
Healthcare Quality Report (NHQR)
and the National Healthcare
Disparities Report (NHDR). Although
improvements have been seen in
health care quality and some
disparities have been reduced or
eliminated, differences persist in
health care quality among members of
various racial and ethnic minority
groups.
Three key themes emerge in the 2008
NHDR:
- Disparities persist in health care
quality and access.
- Magnitude and patterns of
disparities are different within
subpopulations.
- Some disparities exist across
multiple priority populations.
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Disparities Persist in Health Care Quality and Access
All population groups should receive
equally high quality of care. Getting
into the health care system (access to
care) and receiving appropriate health
care in time for the services to be
effective (quality of care) are key
factors in ensuring good health
outcomes. Both categories of
measures, quality of care and access
to care, show that disparities persist
for all populations. Measures of
quality include effectiveness (the
percentage of patients with a disease
or condition who get recommended
care), patient safety, and timeliness.
Below are figures that illustrate for
each population how disparities in
quality and access have changed in the
past 5 years. In each figure, "n"
indicates the number of core
measures. Figure 1 shows that for
Blacks, Asians, American
Indians/Alaska Natives (AI/ANs), and
Hispanics, at least 70% of measures
of quality of care are not improving
(either stayed the same or worsened).
Many Americans have access to
primary and hospital care. For many
populations, however, barriers exist to
getting needed health care, such as
lack of health insurance or trouble
getting appointments. Reducing
disparities in access to health care is
an important step to improving
overall quality. Figure 2 is a summary
of trends in the core measures of
access.
Figure 1. Change over time in racial and ethnic disparities for selected core quality measures, 2000-2001 to 2005-2006
Figure 2. Change over time in racial and ethnic disparities for selected core access measures, 2000-2001 to 2005-2006
Key: AI/AN = American Indian or Alaska
Native.
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Magnitude and Patterns of Disparities Differ Among Various Populations
Improvements in preventive care,
chronic care, and access to care have
led to the elimination of disparities
for some priority populations in areas
such as mammograms, smoking
cessation counseling, and appropriate
timing of antibiotics. At the same
time, many of the largest disparities
have not changed significantly. The
NHDR can be used to identify the
most important gaps in care as well
as improvements for priority
populations. The complete picture of
disparities is different for each
population. An analysis of each
population allows targeting of
resources and efforts to improve care
and narrow the gaps in care for racial
and ethnic minorities.
In 2005, the NHDR reported on the
biggest gaps that existed in health
care quality in America for several
priority populations, including
Blacks, Asians, AI/ANs, and
Hispanics. Some of the largest gaps
reported in 2005 remain the largest
gaps in the 2008 NHDR.
- For Blacks, large disparities
remain in new AIDS cases
despite significant decreases.
The proportion of new AIDS
cases was 9.4 times as high for
Blacks as for Whites. Hospital
admissions for lower extremity
amputations in patients with
diabetes and lack of prenatal
care for pregnant women in the
first trimester are the largest
disparities for Blacks observed
in the 2008 NHDR.
- For Asians, disparities remain in
timeliness of care. Asians were
more likely than Whites to not
get care for illness or injury as
soon as wanted.
- For AI/ANs, disparities remain
in prenatal care. AI/AN women
were twice as likely to lack
prenatal care as White women.
Also, AI/AN adults were less
likely than Whites to receive
colorectal cancer screening.
- For Hispanics, large disparities
also remain in new AIDS cases
despite significant decreases.
The rate of new AIDS cases was
more than three times as high
for Hispanics as for non-
Hispanic Whites.
The "biggest gaps" are defined as
those quality measures with the
largest relative rates between Whites
and racial and ethnic minorities. For
example, a relative rate of 4.0 means
that this population was four times as
likely as the White population to be
hospitalized for pediatric asthma.
This analysis is presented in Table 1.
Table 1. Three largest disparities in quality of health care for selected groups: Measure and rate relative to reference group, 2005 NHDR versus 2008 NHDR (Measures that have the largest gaps in both the 2005 and 2008 NHDR are in italics.)
2005 NHDR |
2008 NHDR |
Group |
Measure |
Relative rate |
Measure |
Relative rate |
Black compared with White |
New AIDS cases per 100,000 population age 13 and over |
10.4 |
New AIDS cases per 100,000 population age 13 and over |
9.4 |
Hospital admissions for pediatric asthma per 100,000 population ages 2-17 |
4.0 |
Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population |
2.3 |
Emergency department visits in which patients left without being seen |
1.9 |
Pregnant women who did not receive prenatal care in the first trimester |
1.6 |
Asian compared with White |
People age 18 and over with serious mental illness who did not receive mental health treatment or counseling in the past year |
1.6 |
Adults who can sometimes or never get care for illness or injury as soon as wanted |
2.1 |
Adults who can sometimes or never get care for illness or injury as soon as wanted |
1.6 |
Children ages 2-17 who did not receive advice about physical activity |
1.2 |
Adults age 65 and over who did not ever receive pneumococcal vaccination |
1.5 |
Adults age 65 and over who did not ever receive pneumococcal vaccination |
1.6 |
AI/AN compared with White |
Pregnant women who did not receive prenatal care in the first trimester |
2.1 |
Pregnant women who did not receive prenatal care in the first trimester |
2.1 |
Composite: Adults who reported poor communication with health providers |
1.8 |
Adults age 50 and over who received colorectal cancer screening |
1.4 |
Children ages 2-17 who did not receive advice about physical activity |
1.3 |
Home health care patients who were admitted to the hospital |
1.3 |
Hispanic compared with non-Hispanic White |
New AIDS cases per 100,000 population age 13 and over |
3.7 |
New AIDS cases per 100,000 population age 13 and over |
3.3 |
Adults who can sometimes or never get care for illness or injury as soon as wanted |
2.0 |
Composite: Children whose parents reported poor communication with health providers |
2.0 |
Composite: Children whose parents reported poor communication with health providers |
1.8 |
Pregnant women who did not receive prenatal care in the first trimester |
2.0 |
Poor compared with high income |
Composite: Children whose parents reported poor communication with health providers |
3.3 |
Composite: Children whose parents reported poor communication with health providers |
3.7 |
Adults who can sometimes or never get care for illness or injury as soon as wanted |
2.3 |
Adults who can sometimes or never get care for illness or injury as soon as wanted |
2.5 |
Children ages 2-17 who did not have a dental visit |
2.0 |
Women age 40 and over who reported they did not have a mammogram in the last 2 years |
2.1 |
Note: Relative rate is used to compare one group with its reference group. It is calculated by dividing the group's estimate by the reference group's estimate. For example, the relative rate of new AIDS cases for Blacks compared with Whites is 9.4 in the 2008 NHDR. This means that Blacks have a rate that is 9.4 times as high as Whites for this measure.
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Some Disparities Exist Across Multiple Priority Populations
In addition to the variable distribution
of disparities evident across priority
populations, in some cases several
different populations experience the
same gaps in care as other populations
due to poor quality overall or
populations experiencing similar
barriers. The following measures
included in the NHDR illustrate
disparities for two or more
populations:
- Blacks, Asians, AI/ANs, and
Hispanics all experienced
disparities in the percentage of
adults age 50 and over who
received a colonoscopy,
sigmoidoscopy, proctoscopy, or
fecal occult blood test. For this
measure, between 1999 and 2006,
the disparity increased in all four
groups (Table 2).
- For Blacks and Hispanics, disparities grew larger in the percentage of adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months.
- Blacks and Asians both had worsened disparities in the receipt of pneumococcal vaccination for adults age 65 and over.
- Blacks and Asians both had worsened disparities in a patient centeredness measure of patient and provider communication.
Table 2. Core measures that are getting worse for more than one racial and ethnic group compared with reference group
Topic |
Measure |
Blacks |
Asians |
AI/ANs |
Hispanics |
Cancer |
Adults age 50 and over who received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test |
* |
* |
* |
* |
Mental health and substance abuse |
Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months |
* |
|
|
* |
Respiratory diseases |
Adults age 65 and over who ever received pneumococcal vaccination |
* |
* |
|
|
Patient centeredness |
Adults with poor provider-patient communication |
* |
* |
|
|
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Limited English Proficiency Is a Barrier to Quality Health Care
Limited English proficiency is a
barrier to quality health care for many
Americans. About 52 million
Americans, or 19.4% of the
population, spoke a language other
than English at home in 2000, up from
32 million in 1990. Of the 52 million:
- 32 million (about 12% of the
population) spoke Spanish.
- 10 million (about 4% of the
population) spoke another Indo-
European language.
- 7.8 million (about 3% of the
population) spoke an Asian or
Pacific Islander language, and
- 2 million spoke other languages
at home.
Many of these people lack health
insurance. Figure 3 shows the
percentage of adults under age 65 who
were uninsured all year, stratified by
language spoken at home.
Figure 3. Adults under age 65 who were uninsured all year, by race and ethnicity, stratified by language spoken at home, 2005
Clear communication is an important
component of effective health care
delivery. It is vital for providers to
understand patients' health care needs
and for patients to understand
providers' diagnoses and treatment
recommendations. Communication
barriers can relate to language, culture,
and health literacy.
For people with limited English
proficiency, having language
assistance is of particular importance.
People with limited English
proficiency may choose a usual source
of care in part based on language
concordance. Not having a language concordant
provider may limit or
discourage some patients from
establishing a usual source of care.
Figure 4 shows the percentage of
adults with limited English
proficiency who had a usual source of
care with language assistance.
Figure 4. Adults with limited English proficiency, by whether they had a usual source of care with or without language assistance, 2003-2005
Key: USC = usual source of care.
Note: Language assistance includes
bilingual clinicians, trained medical
interpreters, and informal interpreters (e.g.,
bilingual receptionists).
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Poverty Is a Barrier to High-Quality Care
In general, poor populations have
reduced access to high-quality care
and are more likely to be uninsured.
Figure 5 shows that poor populations
have worse care and less access to
care than high-income populations.
Figure 5. Poor compared with high-income individuals on measures of quality and access
Key: CRM = core report measures.
Although some disparities between
poor people and high-income people
in access to care are lessening, most
measures of quality that could be
tracked over time show no
improvement. Figure 6 shows changes
in poor-high-income disparities over
time.
Figure 6. Change in poor-high-income disparities over time
Key: CRM = core report measures.
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Disparities Reports Charts Related to Racial and Ethnic Minorities
The measures in the NHDR are
presented by clinical condition or
area (e.g., cancer, diabetes, maternal
and child health) in Chapter 2 and by
priority population (e.g., Blacks,
Hispanics) in Chapter 4. The NHDR
highlights findings on a selected
number of measures each year.
Additional data on measures relevant
to racial and ethnic minorities can be
found in the online data tables for the
report.
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For More Information
The 2008 National Healthcare Disparities Report (AHRQ Pub. No. 09-0002) is available online at http://www.ahrq.gov/qual/qrdr08.htm.
Printed copies of the report can be ordered from the AHRQ Publications Clearinghouse by calling 800-358-9295 or by sending an e-mail to AHRQPubs@ahrq.hhs.gov.
Additional information on programs and activities related to minority health at the Agency for Healthcare Research and Quality is available on the AHRQ Web site at http://www.ahrq.gov/research/minorix.htm or by contacting:
Cecilia Rivera Casale, Ph.D.
Senior Advisor for Minority Health
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Phone: (301) 427-1547
Fax: (301) 427-1562
E-mail: Cecilia.Casale@ahrq.hhs.gov
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AHRQ Publication No. 09-0092
Current as of September 2009
Internet Citation:
Disparities in Health Care Quality Among Racial and Ethnic Minority Groups: Findings From the National Healthcare Quality and Disparities Reports, 2008. Fact Sheet. AHRQ Publication No. 09-0092, September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqrdr08/nhqrdrminority08.htm