United States
Health Disparities

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 or income, disability, geographic location, or sexual orientation.

The statewide measures used in America’s Health Rankings® reflect the condition of the “average” resident. However, when those measures are examined more closely and race, gender, geographic location and/or economic status are considered, startling differences can exist within a state.

The National Healthcare Disparities Report, released each year by the Agency for Healthcare Research and Quality, highlights disparities in healthcare delivery at a national level. 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 delivery locations including primary care, home health care, hospice, emergency care, hospitals and nursing homes.

The report highlights several key themes this year, including:

All eight national priority areas

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.

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 at Geographic Disparity . This overall disparity metric provides a broad view of the challenges facing a state, but a few specific behavioral measures shed more light on the extent of the disparity.

Tables 1 and 3 show how the prevalence of smoking, obesity and diabetes vary by race/ethnicity within the states. These tables illustrate that disparities are a local issue; in some states, there is a wide difference among racial/ethnic groups whereas among other types of groups, the difference is much less pronounced. This type of analysis, especially when expanded to encompass a broad 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.

Disparities also exist in the prevalence of diseases, especially chronic disease. Table 2 shows how diabetes affects the various racial/ethnic groups in each state. It is notable that diabetes is consistently higher among non-Hispanic blacks than diabetes among either non-Hispanic whites or Hispanics.

Kalkarni et. al.1 further accent the disparities that exist by calculating the extensive difference in life expectancy  by race and gender in counties throughout the United States. Using their methods, they showed that although the 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.

1Karlarni, Sandeep C., Levin-Rector, Alixon, Ezzati, Majid, and Murray, Chirstopher JL, 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.

 

Table 1 Prevalence of Smoking by Race/Ethnicity and State (percent of adult population)
 
Non-Hispanic White
Non-Hispanic Black
Hispanic
Non-Hispanic Asian
Non-Hispanic Hawaiian / Pacific Islander
Non-Hispanic American Indian or Alaskan Native
Non-Hispanic Multiracial
Alabama
22.4%
21.5%
26.9%
NA
NA
28.6%
16.4%
Alaska
17.6%
NA
20.2%
11.8%
NA
37.6%
36.7%
Arizona
15.0%
16.4%
15.1%
9.5%
NA
17.4%
29.9%
Arkansas
21.7%
24.3%
18.5%
NA
NA
29.4%
43.2%
California
13.3%
20.2%
12.5%
6.4%
17.0%
28.2%
22.3%
Colorado
15.8%
20.6%
19.4%
12.9%
NA
30.4%
26.1%
Connecticut
14.5%
16.1%
17.4%
10.3%
NA
NA
30.3%
Delaware
18.2%
15.9%
22.9%
3.1%
NA
NA
23.9%
Florida
19.0%
14.7%
12.5%
7.1%
NA
37.1%
29.7%
Georgia
19.3%
16.1%
13.8%
11.1%
NA
32.0%
22.4%
Hawaii
13.7%
17.2%
21.4%
10.6%
22.7%
NA
20.3%
Idaho
16.1%
NA
15.9%
NA
NA
29.1%
23.4%
Illinois
17.9%
23.3%
19.9%
8.4%
NA
NA
26.8%
Indiana
22.4%
31.6%
25.9%
9.0%
NA
45.3%
33.6%
Iowa
17.0%
31.6%
17.0%
NA
NA
NA
NA
Kansas
17.0%
23.8%
17.5%
7.6%
NA
39.4%
30.0%
Kentucky
24.9%
27.4%
23.2%
NA
NA
40.6%
35.5%
Louisiana
21.9%
20.7%
22.3%
NA
NA
23.8%
24.4%
Maine
17.6%
NA
23.2%
NA
NA
46.7%
28.2%
Maryland
15.4%
16.8%
9.5%
6.0%
NA
26.2%
21.6%
Massachusetts
15.0%
17.0%
14.8%
5.9%
NA
35.0%
22.9%
Michigan
18.8%
21.1%
24.7%
11.2%
NA
30.4%
31.9%
Minnesota
15.9%
21.3%
20.8%
7.0%
NA
50.4%
NA
Mississippi
22.9%
23.0%
22.4%
NA
NA
37.4%
29.4%
Missouri
22.6%
25.0%
21.9%
NA
NA
29.0%
32.3%
Montana
16.1%
NA
27.9%
NA
NA
44.5%
41.7%
Nebraska
16.8%
24.0%
17.1%
14.0%
NA
44.6%
34.6%
Nevada
21.7%
21.2%
19.6%
22.1%
NA
29.1%
32.0%
New Hampshire
16.2%
NA
16.7%
3.6%
NA
52.0%
34.3%
New Jersey
15.9%
17.0%
13.2%
7.3%
NA
13.5%
21.3%
New Mexico
17.1%
26.1%
19.9%
16.0%
NA
18.5%
29.1%
New York
17.1%
17.3%
16.1%
9.6%
NA
27.3%
30.4%
North Carolina
20.4%
21.3%
13.8%
15.1%
NA
33.8%
31.2%
North Dakota
16.3%
NA
25.4%
NA
NA
46.5%
NA
Ohio
20.4%
23.2%
29.1%
5.4%
NA
51.6%
33.7%
Oklahoma
23.4%
31.5%
21.2%
9.0%
NA
31.5%
29.4%
Oregon
15.5%
NA
14.9%
9.5%
NA
36.6%
26.7%
Pennsylvania
19.1%
27.2%
19.7%
9.5%
NA
46.8%
36.2%
Rhode Island
16.2%
14.4%
12.2%
8.6%
NA
25.7%
30.3%
South Carolina
20.8%
19.1%
15.3%
17.8%
NA
40.1%
32.6%
South Dakota
14.9%
NA
19.2%
NA
NA
48.4%
26.8%
Tennessee
22.3%
20.2%
20.2%
NA
NA
NA
15.4%
Texas
18.3%
18.6%
16.0%
10.0%
NA
30.2%
23.0%
Utah
9.1%
NA
12.2%
6.0%
NA
18.1%
18.3%
Vermont
16.0%
NA
19.4%
NA
NA
43.6%
25.0%
Virginia
17.6%
18.3%
22.0%
8.8%
NA
50.5%
22.5%
Washington
15.1%
21.3%
11.9%
4.8%
15.1%
31.8%
27.3%
West Virginia
26.3%
27.0%
25.0%
NA
NA
NA
31.0%
Wisconsin
18.2%
28.3%
29.4%
NA
NA
34.5%
32.2%
Wyoming
18.5%
NA
24.5%
NA
NA
49.1%
23.2%
United States
18.1%
19.9%
14.8%
8.4%
21.2%
32.6%
27.2%
District of Columbia
9.4%
21.6%
15.1%
5.8%
NA
NA
21.1%
 
 
Table 2: Prevalence of Obesity by Race/Ethnicity and State (percent of adult population)
 
Non-Hispanic White
Non-Hispanic Black
Hispanic
Non-Hispanic Asian
Non-Hispanic Hawaiian / Pacific Islander
Non-Hispanic American Indian or Alaskan Native
Non-Hispanic Multiracial
Alabama
29.0%
42.4%
30.7%
NA
NA
31.5%
24.0%
Alaska
24.3%
NA
28.6%
11.6%
NA
33.9%
30.1%
Arizona
23.3%
35.9%
32.3%
8.2%
NA
40.8%
30.8%
Arkansas
29.8%
41.5%
30.1%
NA
NA
33.0%
31.9%
California
21.8%
35.8%
30.6%
8.4%
21.7%
30.5%
23.7%
Colorado
18.3%
27.9%
24.8%
7.6%
NA
32.7%
28.8%
Connecticut
20.8%
39.5%
29.0%
7.3%
NA
NA
32.5%
Delaware
26.0%
42.5%
31.5%
5.3%
NA
NA
34.3%
Florida
24.1%
38.8%
28.7%
10.8%
NA
26.0%
29.5%
Georgia
25.6%
38.1%
32.7%
7.9%
NA
31.0%
27.1%
Hawaii
19.3%
35.3%
27.0%
13.7%
56.8%
NA
34.6%
Idaho
25.1%
NA
29.6%
NA
NA
41.1%
35.2%
Illinois
25.5%
39.5%
31.5%
10.8%
NA
NA
27.5%
Indiana
28.8%
37.0%
28.4%
8.9%
NA
27.1%
26.8%
Iowa
28.1%
33.0%
29.5%
NA
NA
NA
NA
Kansas
28.4%
41.8%
34.7%
4.9%
NA
31.9%
31.8%
Kentucky
31.0%
43.2%
33.1%
NA
NA
27.8%
32.5%
Louisiana
28.4%
39.5%
29.3%
NA
NA
33.9%
38.5%
Maine
26.7%
NA
21.0%
NA
NA
29.0%
35.8%
Maryland
24.3%
36.3%
27.4%
10.2%
NA
23.8%
31.6%
Massachusetts
21.8%
30.5%
29.1%
8.0%
NA
26.1%
25.3%
Michigan
29.1%
41.1%
32.9%
7.5%
NA
41.5%
38.5%
Minnesota
25.2%
28.2%
27.1%
17.4%
NA
34.8%
NA
Mississippi
30.4%
42.6%
35.4%
NA
NA
32.2%
26.2%
Missouri
29.5%
38.2%
29.0%
NA
NA
36.9%
33.5%
Montana
22.9%
NA
22.9%
NA
NA
42.3%
32.3%
Nebraska
27.0%
39.6%
31.8%
8.4%
NA
43.6%
36.9%
Nevada
24.1%
28.5%
26.5%
17.2%
NA
35.2%
34.1%
New Hampshire
25.8%
NA
24.0%
3.0%
NA
29.1%
27.5%
New Jersey
23.1%
35.9%
26.8%
7.6%
NA
21.9%
26.5%
New Mexico
20.8%
31.7%
30.7%
8.5%
NA
37.0%
22.5%
New York
24.1%
31.4%
27.2%
8.6%
NA
36.4%
27.0%
North Carolina
26.7%
42.4%
26.0%
5.1%
NA
34.5%
39.9%
North Dakota
27.4%
NA
37.7%
NA
NA
43.5%
NA
Ohio
28.7%
40.8%
32.5%
8.2%
NA
34.9%
31.6%
Oklahoma
29.7%
41.3%
30.3%
8.0%
NA
40.0%
35.0%
Oregon
25.3%
NA
25.4%
5.1%
NA
NA
29.3%
Pennsylvania
27.7%
39.4%
34.5%
5.6%
NA
32.7%
29.2%
Rhode Island
23.3%
35.6%
30.9%
13.0%
NA
NA
23.2%
South Carolina
27.4%
40.3%
38.2%
4.4%
NA
38.1%
26.1%
South Dakota
28.1%
NA
29.2%
NA
NA
39.4%
37.6%
Tennessee
30.5%
40.9%
30.3%
NA
NA
NA
31.2%
Texas
26.7%
38.5%
36.0%
9.1%
NA
33.1%
32.0%
Utah
23.0%
NA
27.4%
9.0%
NA
30.2%
22.6%
Vermont
23.6%
NA
20.8%
NA
NA
33.2%
28.2%
Virginia
25.2%
37.2%
25.1%
6.9%
NA
25.2%
28.6%
Washington
26.2%
33.8%
30.4%
7.4%
29.6%
40.7%
32.2%
West Virginia
32.1%
39.5%
29.7%
NA
NA
NA
41.8%
Wisconsin
26.5%
45.8%
21.1%
NA
NA
44.2%
39.1%
Wyoming
24.6%
NA
32.0%
NA
NA
42.4%
32.6%
United States
25.8%
38.2%
30.4%
9.0%
24.5%
35.1%
30.5%
District of Columbia
9.3%
34.4%
18.1%
8.2%
NA
NA
27.9%
 
 
Table 3: Prevalence of Diabetes by Race/Ethnicity and State (percent of adult population)
 
Non-Hispanic White
Non-Hispanic Black
Hispanic
Non-Hispanic Asian
Non-Hispanic Hawaiian / Pacific Islander
Non-Hispanic American Indian or Alaskan Native
 Non-Hispanic Multiracial
Alabama
10.9%
15.3%
16.0%
NA
NA
18.0%
 15.0%
Alaska
5.7%
NA
8.2%
5.0%
NA
5.7%
 4.9%
Arizona
8.6%
12.4%
10.7%
8.4%
NA
15.4%
 9.8%
Arkansas
9.3%
12.3%
8.8%
NA
NA
13.9%
 14.8%
California
7.0%
14.1%
10.1%
7.9%
10.0%
14.3%
 8.0%
Colorado
5.0%
10.3%
8.4%
5.4%
NA
9.6%
 5.7%
Connecticut
6.7%
11.5%
6.2%
6.7%
NA
NA
 5.4%
Delaware
7.9%
11.0%
7.1%
6.5%
NA
NA
 8.8%
District of Columbia
2.8%
15.4%
4.5%
4.8%
NA
NA
 8.5%
Florida
9.5%
13.4%
9.3%
8.1%
NA
15.3%
 11.7%
Georgia
8.4%
12.8%
9.0%
12.7%
NA
10.7%
 7.5%
Hawaii
4.7%
8.7%
9.4%
9.6%
10.1%
NA
 9.1%
Idaho
7.5%
NA
7.7%
NA
NA
12.0%
 9.0%
Illinois
7.4%
13.4%
8.2%
7.6%
NA
NA
 10.4%
Indiana
9.1%
14.8%
9.4%
5.1%
NA
11.8%
 13.7%
Iowa
7.4%
12.6%
4.6%
NA
NA
NA
 NA
Kansas
8.1%
12.2%
9.0%
2.5%
NA
20.2%
 9.8%
Kentucky
10.1%
14.9%
6.3%
NA
NA
20.3%
 13.4%
Louisiana
9.4%
13.4%
9.5%
NA
NA
11.7%
 13.4%
Maine
8.3%
NA
7.0%
NA
NA
18.1%
 13.1%
Maryland
8.0%
12.8%
5.5%
7.3%
NA
11.2%
 9.2%
Massachusetts
7.1%
11.1%
9.3%
6.4%
NA
11.7%
 6.7%
Michigan
8.6%
13.8%
10.7%
7.7%
NA
13.4%
 13.4%
Minnesota
6.3%
3.4%
7.4%
3.6%
NA
10.2%
 NA
Mississippi
10.4%
14.5%
8.7%
NA
NA
11.5%
 10.7%
Missouri
8.3%
13.2%
7.0%
NA
NA
10.0%
 14.5%
Montana
6.4%
NA
4.3%
NA
NA
14.4%
 10.0%
Nebraska
7.5%
11.7%
8.5%
4.7%
NA
9.8%
 6.1%
Nevada
8.2%
11.7%
6.6%
10.8%
NA
7.4%
 9.6%
New Hampshire
7.3%
NA
7.2%
6.7%
NA
7.8%
 8.9%
New Jersey
7.8%
13.7%
8.5%
7.6%
NA
18.8%
 7.4%
New Mexico
6.6%
12.9%
10.2%
2.9%
NA
9.7%
 10.1%
New York
7.9%
12.8%
8.2%
7.4%
NA
16.4%
 11.4%
North Carolina
8.7%
15.3%
4.9%
2.5%
NA
12.1%
 9.5%
North Dakota
7.1%
NA
6.5%
NA
NA
14.7%
 NA
Ohio
9.4%
15.3%
12.6%
6.7%
NA
14.4%
 9.3%
Oklahoma
9.4%
14.7%
9.7%
8.1%
NA
15.1%
 13.6%
Oregon
7.3%
NA
6.6%
3.9%
NA
10.3%
 10.5%
Pennsylvania
8.9%
15.7%
6.6%
5.8%
NA
12.4%
 10.1%
Rhode Island
7.3%
10.9%
7.6%
3.4%
NA
13.9%
 7.4%
South Carolina
8.9%
13.4%
10.0%
5.3%
NA
14.9%
 9.1%
South Dakota
6.6%
NA
6.4%
NA
NA
12.4%
 9.9%
Tennessee
10.5%
12.2%
6.3%
NA
NA
NA
 13.4%
Texas
8.1%
14.8%
10.6%
5.2%
NA
17.6%
 8.3%
Utah
6.2%
NA
5.8%
4.1%
NA
9.8%
 7.2%
Vermont
6.3%
NA
7.0%
NA
NA
11.4%
 12.4%
Virginia
8.0%
13.0%
3.7%
4.9%
NA
9.2%
 5.5%
Washington
7.4%
12.8%
6.8%
5.7%
7.0%
10.3%
 8.9%
West Virginia
11.8%
15.2%
11.7%
NA
NA
NA
 18.5%
Wisconsin
7.4%
12.4%
NA
NA
NA
15.8%
 NA
Wyoming
NA
NA
NA
NA
NA
NA
 NA
United States
8.2%
13.6%
9.7%
7.2%
8.3%
13.3%
 10.0%

Tables Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008-2010. NA indicates data is not available for this subgroup.

Tables Note: Differences between groups may be more or less than shown because the reliability of self-report data varies by ethnic and racial groups.