Selected Findings From the 2010 National
Healthcare Quality and Disparities Reports
Fact Sheet
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
Racial and Ethnic Minorities
Summary
Additional Information
Introduction
Each year since 2003, the Agency for Healthcare Research and
Quality (AHRQ) has reported on progress and opportunities for improving health
care quality and reducing health care disparities. As mandated by the U.S.
Congress, the National Healthcare Quality Report (NHQR) focuses on "national
trends in the quality of health care provided to the American people" while the
National Healthcare Disparities Report (NHDR) focuses on "prevailing
disparities in health care delivery as it relates to racial factors and
socioeconomic factors in priority populations." Priority populations include racial
and ethnic minorities, low-income groups, women, children, older adults,
residents of rural areas and inner cities, and individuals with disabilities
and special health care needs.
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Racial and Ethnic Minorities
In 2000, about 33% of the U.S. population identified
themselves as members of racial or ethnic minority groups. By 2050, it is
projected that these groups will account for almost half of the U.S.
population. For 2007, the U.S. Census Bureau estimated that the United States
had almost 38.8 million Blacks or African Americans (12.9% of the U.S.
population); more than 45.5 million Hispanics or Latinos (15.1%); almost 13.4
million Asians (4.4%); more than 0.5 million Native Hawaiians and Other Pacific
Islanders (NHOPIs) (0.2%); and more than 2.9 million American Indians and
Alaska Natives (AI/Ans) (1.0%), of whom 57% reside on Federal trust lands.
Racial and ethnic minorities are more likely than non-Hispanic Whites to be
poor or near poor. In addition, Hispanics, Blacks, and some Asian subgroups are
less likely than non-Hispanic Whites to have a high school education.
Disparities in quality of care are common:
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Blacks and AI/ANs received worse care than Whites for about 40%
of measures.
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Asians received worse care than Whites for about 20% of measures.
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Hispanics received worse care than non-Hispanic Whites for about
60% of core measures.
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Poor people received worse care than high-income people for about
80% of core measures.
Disparities in access are also common, especially among Hispanics and poor
people:
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Blacks had worse access to care than Whites for one-third of core
measures.
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Asians and AI/ANs had worse access to care than Whites for 1 of 5
core measures.
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Hispanics had worse access to care than non-Hispanic Whites for 5
of 6 core measures.
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Poor people had worse access to care than high-income people for
all 6 core measures.
Few disparities in quality of care are getting better:
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Fewer than 20% of disparities faced by Blacks, AI/ANs, Hispanics,
and poor people showed evidence of narrowing.
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The Asian-White gap was narrowing for about 30% of core measures,
the largest proportion of any group, but most disparities were not changing.
Select for a table of the largest racial, ethnic, and socioeconomic disparities that are not
improving.
Barriers to Access
and Quality Healthcare
Access to care measures include facilitators and barriers to
care and health care utilization experiences of subgroups defined by race and
ethnicity, income, education, availability of health insurance, limited English
proficiency, and availability of a usual source of care.
Health Insurance
Status
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Overall, there was no significant change from 1999 to 2008. In
2008, about 83.2% of people under age 65 had health insurance.
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In 2008, Asians under age 65 were more likely than Whites to have
health insurance (86.1% compared with 83.3%). AI/ANs under age 65 were less
likely than Whites to have health insurance (71.6% compared with 83.3%). There
were no statistically significant differences for other racial groups.
-
In 2008, Hispanics under age 65 were less likely than
non-Hispanic Whites to have health insurance (66.7% compared with 87.5%).
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From 1999 to 2008, while the percentage of people with health
insurance increased for poor people (from 66.2% to 71.0%), the percentage
worsened for middle-income people (from 86.4% to 83.4%). In 2008, the
percentage of people with health insurance was significantly lower for poor,
near-poor, and middle-income people than for high-income people (71.0%, 69.4%,
and 83.4% respectively, compared with 93.8%).
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In 2008, the percentage of people with health insurance was about
one-third lower for people with less than a high school education than for
people with at least some college education (56.9% compared with 89.0%).
Specific Source of
Ongoing Care
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Overall, 86.1% percent of people had a specific source of ongoing
care in 2008.
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In 2008, the percentage of people with a specific source of
ongoing care was lower for Blacks than Whites (84.7% compared with 86.3%) and
significantly lower for Hispanics than for non-Hispanic Whites (77.1% compared
with 88.6%).
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In 2008, the percentage of people with a specific source of
ongoing care was significantly lower for poor people than for high-income
people (77.5% compared with 92.1%).
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The percentage of people with a specific source of ongoing care
was lower for people with less than a high school education and for people with
a high school education than for people with at least some college education
(74.2% and 82.2%, respectively, compared with 88.9%).
Quality and Access to
Care for Populations With Limited English Proficiency
Limited English proficiency is a barrier to quality health
care for many Americans. Of the 281 million people age 5 and over in the United
States in 2007, 55.4 million individuals (20%) reported speaking a language
other than English at home. Many of these people lack health insurance.
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Compared with patients who speak English at home, patients who
speak Spanish at home were more likely to report poor communication with nurses
while patients who speak some other language at home were more likely to report
poor communication with both nurses and doctors.
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In 2007, Hispanic adults were significantly more likely than
non-Hispanic adults to have a usual source of care with language assistance.
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In 2007, White adults with limited English proficiency were
significantly more likely than Asians to have a usual source of care with
language assistance.
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In 2007, non-Hispanic White patients in California were
significantly less likely than Hispanic patients to need a translator during
their last doctor visit. Non-Hispanic Whites were also less likely than
Mexicans and Central Americans to need a translator. Asians were significantly
more likely than non-Hispanic Whites to need a translator during their last
doctor visit (4.1% compared with 0.7%). There were, however, no statistically
significant differences between the overall Asian population and Chinese or
Vietnamese patients. There were also no significant differences between Chinese
and Vietnamese patients.
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In California, patients under age 65 with public insurance and
uninsured patients were less likely than patients with private insurance to
find it easy to read the instructions on a prescription bottle.
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Summary
The 2010 NHQR and 2010 NHDR emphasize the need to accelerate
progress if the Nation is to achieve higher quality and more equitable health
care for all Americans in the near future. Among the themes that emerge from
the reports are:
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Health care quality and access are suboptimal, especially for
minority and low-income groups.
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Quality is improving; access and disparities are not improving.
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Urgent attention is warranted to ensure improvements in quality
and progress on reducing disparities with respect to certain services,
geographic areas, and populations, including:
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Cancer screening and management of diabetes.
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States in the central part of the country.
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Residents of inner-city and rural areas.
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Disparities in preventive services and access to care.
- Progress is uneven with respect to eight national priority areas:
-
Two are improving in quality: (1) Palliative and End-of-Life Care
and (2) Patient and Family Engagement.
-
Three are lagging: (3) Population Health, (4) Safety, and (5)
Access.
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Three require more data to assess: (6) Care Coordination, (7)
Overuse, and (8) Health System Infrastructure.
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All eight priority areas showed disparities related to race,
ethnicity, and socioeconomic status.
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Additional Information
The 2010 National Healthcare Disparities Report is available
online at http://www.ahrq.gov/qual/qrdr10.htm.
Additional information on programs and activities related to
minority health at the Agency 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
E-mail: Cecilia.Casale@ahrq.hhs.gov
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AHRQ Publication No. 11-0005-3-EF
Current as of March 2011
Internet Citation:
Disparities in Healthcare Quality Among Racial and Ethnic Minority Groups: Selected Findings from the 2010 National Healthcare Quality and Disparities Reports. Fact Sheet. AHRQ Publication No. 11-0005-3-EF, March 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqrdr10/nhqrdrminority10.htm