Epidemiologic Profiles of Racial and Ethnic Disparities in Health and Health Care

Disparities in health status and healthcare delivery have been ­documented in the USA throughout most of the last two centuries (Ewbank, Milbank Q 65 (Suppl 1):100–128, 1987; Krieger, Int J Health Serv 17(2):259–278, 1987; Kochanek et al., Am J Public Health 84(6):938–944, 1994). More recently, the Institute of Medicine (Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press, 2003) and the Agency for Healthcare Research and Quality (AHRQ) (U.S. Department of Health and Human Services, National Healthcare Disparities Report. http://www.ahrq.gov/qual/nhdr05/nhdr05.pdf, Accessed on 1 July 2006) have confirmed that disparities are pervasive and that improvements are possible. Eliminating these disparities is one of the two overarching goals of the Healthy People 2010 national public health agenda. In this endeavor, the availability of reliable, population-based indicators of disparities can be crucial for assessing the magnitude, trends, and impact of interventions designed to reduce and eventually eliminate disparities. These indicators can also serve to inform policy and program development, help set priorities, and assist in identifying areas where additional research is needed. In this chapter, we use published data from national health statistics and ­surveillance reports to present epidemiologic profiles of established disparities in health status and health care for population subgroups defined by race and ethnicity. We first introduce the categories of race and ethnicity and define the concept of disparities in health care. The distribution and demographic changes in the racial and ethnic categories are presented along with current projections to the year 2050. Selected examples of the Healthy People 2010 objectives and targets for ­elimination of disparities are discussed. Current data and trends on life ­expectancy, risk factor and chronic disease prevalence, other morbidity, mortality, access to care, and quality of care are then presented. The need for continued refinement of conceptual and methodological issues in the collection of ­healthcare data by race and ethnicity is also emphasized. The chapter concludes with caveats on the challenges and limitations in the interpretation of racial and ethnic ­comparisons in the healthcare setting and future opportunities for the ­development and implementation of programs and strategies to eliminate these disparities in health and health care.