For a population to be healthy, it must minimize health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education, income, disability, geographic location, or sexual orientation.
The statewide measures used in America’s Health Rankings® reflect the condition of the “average” resident and can mask differences within the state. When the measures are examined by race, gender, geographic location and/or economic status, startling differences can exist within a state.
The National Healthcare Disparities Report (http://www.ahrq.gov/qual/nhdr11/nhdr11.pdf), released each year by the Agency for Healthcare Research and Quality, highlights disparities in healthcare delivery at a national level.[1] The report analyzes numerous measures and indicates that disparities exist for many groups, including women, children, the elderly, rural residents, and among racial and socio-economic groups. The report also indicates that such disparities affect all aspects of health and health care delivery, including preventive care, acute care, and chronic disease management. They also affect many health care delivery locations including primary care, home health care, hospice, emergency care, hospitals, and nursing homes.
The report highlights several key themes this year.
All eight national priority areas — (1) Palliative and End-of-Life Care, (2) Patient and Family Engagement, (3) Population Health, (4) Safety, (5) Access, (6) Care Coordination, (7) Overuse, and (8) Health System Infrastructure — showed disparities related to race, ethnicity, and socioeconomic status. While each state has unique issues that contribute to disparities, states that have been successful in reducing disparities in health indicators while retaining high overall health can serve as models for other states.
Life expectancy has been shown to vary by both race and educational level, and these differences are expanding over time. This has led to at least “two Americas” in terms of life expectancy defined by racial-group membership and education level.[2]
Kulkarni et al.[3] further highlight the disparities that exist by calculating the extensive differences in life expectancy by race and gender in counties throughout the United States. They showed that while overall U.S. life expectancy for men and women averaged 75.6 and 80.8 years respectively in 2007, county-by-county life expectancy ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women. If viewed from a racial disparity perspective, life expectancy at birth ranges from 59.4 to 77.2 years for black men and 69.6 to 82.6 years for black women.
For both men and women, life expectancies for whites consistently exceed life expectancies for blacks. Policies and programs to address this disparity should look at both the magnitude of disparity at the state level and the number of people affected.[4]
America’s Health Rankings® contains an explicit metric for disparities—Geographic Disparity. This indicator reflects the range of age-adjusted mortality rates that exist within a state at the county level. State data is available here. This overall disparity metric provides a broad view of the challenges facing a state.
Disparity is also present among the behavior of the race/ethnic groups within states. The tabs below show variations in the prevalence of smoking, sedentary lifestyle, and obesity by race/ethnicity and state. These tables, based upon 2009 and 2010 BRFSS data, illustrate that disparities differ by state. In some states there are large differences between racial/ethnic groups, whereas in other states, the differences are much less pronounced.
The tabs also show the variation in infant mortality rate by race group. Infant mortality varies greatly by race group and state.
This type of analysis, especially when expanded to encompass a broader range of social, economic, and health indicators, allows communities, their organizations, and public health officials to target programs to address the biggest areas of concern.
These tables show the disparity in recent data. Each state profile, available at www.americashealthrankings.org/Reports, shows the trends in smoking, sedentary lifestyle, obesity, and infant mortality rate over the past 8 years. A file containing this data is also available at this web address.
[1] AHRQ. National Healthcare Disparities Report, 2011, AHRQ publication no. 12-0006. March 2012.
[2] Olshansky SJ, Antonucci T, Berkman L, et al. Differences in life expectancy due to race and educational differences are widening, and many may not catch up [disparities] Health Aff. 2012;31(8):1803-1813. http://content.healthaffairs.org. doi: 10.1377/hlthaff.2011.0746.
[3] Kulkarni SC, Levin-Rector A, Ezzati M, Murray CJL. Falling behind: life expectancy in US counties from 2000-2007 in an international context. Population Health Metrics. 2011, 9:16, http://www.pophealthmetrics.com/content/9/1/16.
[4] Bharmal N, Tseng C, Kaplan R, Wong MD. State-level variations in racial disparities in life expectancy. Health Services Research. 2011;46(5). http://dx.doi.org/10.1111%2F%28ISSN%291475-6773. doi: 10.1111/j.1475-6773.2011.01345.x.
Prevalence of Smoking
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|
Non-Hispanic White |
Non-Hispanic Black |
Hispanic |
Non-Hispanic Asian |
Non-Hispanic Hawaiian / Pacific Islander |
Non-Hispanic American Indian or Alaskan Native |
|
Alabama |
22.0% |
21.7% |
31.9% |
|
|
35.0% |
|
Alaska |
17.5% |
|
26.1% |
|
|
37.9% |
|
Arizona |
15.5% |
13.6% |
16.1% |
9.0% |
|
16.5% |
|
Arkansas |
21.9% |
22.7% |
16.8% |
|
|
|
|
California |
12.6% |
17.8% |
12.2% |
6.5% |
18.0% |
27.5% |
|
Colorado |
15.7% |
17.1% |
18.7% |
12.4% |
|
23.9% |
|
Connecticut |
14.1% |
16.9% |
14.2% |
11.6% |
|
|
|
Delaware |
18.3% |
15.5% |
23.3% |
1.7% |
|
|
|
Florida |
18.5% |
15.8% |
11.5% |
6.5% |
|
37.3% |
|
Georgia |
18.8% |
15.7% |
13.6% |
7.6% |
|
|
|
Hawaii |
14.1% |
|
21.4% |
10.1% |
23.1% |
|
|
Idaho |
15.9% |
|
14.2% |
|
|
31.7% |
|
Illinois |
17.0% |
22.2% |
17.8% |
7.8% |
|
|
|
Indiana |
21.4% |
30.8% |
20.1% |
|
|
42.3% |
|
Iowa |
16.4% |
27.1% |
15.4% |
|
|
|
|
Kansas |
16.9% |
23.6% |
17.1% |
7.8% |
|
43.4% |
|
Kentucky |
24.9% |
27.3% |
25.2% |
|
|
45.5% |
|
Louisiana |
22.4% |
21.1% |
19.1% |
|
|
27.6% |
|
Maine |
17.4% |
|
25.1% |
|
|
46.6% |
|
Maryland |
15.2% |
17.1% |
10.4% |
7.7% |
|
|
|
Massachusetts |
14.4% |
16.8% |
14.7% |
6.1% |
|
37.1% |
|
Michigan |
18.7% |
21.1% |
21.6% |
10.6% |
|
28.6% |
|
Minnesota |
15.4% |
21.2% |
17.1% |
2.9% |
|
50.7% |
|
Mississippi |
22.7% |
24.1% |
18.8% |
|
|
|
|
Missouri |
21.5% |
25.2% |
20.5% |
|
|
|
|
Montana |
15.5% |
|
29.4% |
|
|
45.8% |
|
Nebraska |
16.3% |
22.6% |
16.5% |
|
|
48.4% |
|
Nevada |
21.7% |
22.3% |
19.0% |
20.9% |
|
24.1% |
|
New Hampshire |
15.9% |
|
17.4% |
|
|
|
|
New Jersey |
16.0% |
17.0% |
13.7% |
7.3% |
|
10.5% |
|
New Mexico |
15.9% |
23.6% |
20.0% |
14.9% |
|
20.9% |
|
New York |
17.0% |
16.9% |
16.3% |
9.9% |
|
|
|
North Carolina |
20.0% |
20.9% |
13.9% |
16.0% |
|
34.0% |
|
North Dakota |
16.1% |
|
32.8% |
|
|
47.2% |
|
Ohio |
21.2% |
22.8% |
25.0% |
4.4% |
|
52.5% |
|
Oklahoma |
23.3% |
31.9% |
20.7% |
9.1% |
|
31.6% |
|
Oregon |
15.3% |
|
16.3% |
|
|
|
|
Pennsylvania |
18.6% |
27.3% |
16.1% |
7.2% |
|
|
|
Rhode Island |
15.4% |
13.5% |
11.6% |
5.7% |
|
|
|
South Carolina |
20.6% |
19.5% |
17.2% |
|
|
45.4% |
|
South Dakota |
14.4% |
|
17.7% |
|
|
50.5% |
|
Tennessee |
21.7% |
19.8% |
16.4% |
|
|
|
|
Texas |
17.8% |
16.9% |
15.5% |
9.9% |
|
32.3% |
|
Utah |
9.2% |
|
11.2% |
7.7% |
|
20.3% |
|
Vermont |
15.7% |
|
17.8% |
|
|
|
|
Virginia |
17.9% |
18.0% |
27.4% |
11.4% |
|
|
|
Washington |
14.9% |
20.7% |
11.7% |
4.9% |
18.6% |
29.2% |
|
West Virginia |
26.3% |
21.1% |
22.8% |
|
|
|
|
Wisconsin |
17.9% |
25.5% |
29.6% |
|
|
30.3% |
|
Wyoming |
18.6% |
|
24.2% |
|
|
50.6% |
|
United States |
17.8% |
19.6% |
14.4% |
8.5% |
20.7% |
33.0% |
|
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance Survey Data, Atlanta, GA. 2009-2010. Blank indicates data is not available for this subgroup.
Note: Differences between groups may be more or less than shown because the reliability of self-report data varies by ethnic and racial groups. |
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