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National Healthcare Disparities Report, 2003

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Chapter 3. Quality of Health Care (continued)

Tables 12-22

Table 12. Racial and Ethnic Differences in Effectiveness of Care: Mental Health

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Treatment of Depression
Suicide deaths per 100,000 populationiii 3  

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: NVSS-M, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian or Pacific Islander. This source did not collect information for >1 race. This source did not collect information on income or insurance.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

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Table 13. Socioeconomic Differences in Effectiveness of Care: Mental Health

Measure Income Differencei Educational Differenceii Insurance Differenceiii
<100% 100-199% 200-399% <HS HS Grad Uninsured
Treatment of Depression
Suicide deaths per 100,000 populationiii        

i Compared with persons with family incomes 400% of Federal poverty threshold or above.
ii Compared with persons with any college education.
iii Compared with persons under 65 with any private health insurance.

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Table 14. Racial and ethnic disparities in effectiveness of care: Respiratory diseases

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Influenza Immunization
% of high risk persons 18-64 who received influenza vaccine in past yeariii
% of persons 65 and over who received influenza vaccine in the past yeariii
% of adult nursing home residents who received influenza vaccine in past yeariv      
Hospital admissions for influenza per 100,000 population 65 and overv *v v    
Pneumococcal Immunization
% of high risk persons 18-64 who ever received pneumococcal vaccinationiii
% of persons 65 and over who ever received pneumococcal vaccinationiii
% of adult nursing home residents who ever received pneumococcal vaccinationiv      
Treatment of Pneumoniavi
% of pneumonia patients who have blood cultures taken before antibiotics *iv vi  
% of pneumonia patients who receive initial antibiotic dose within 8 hours of arrival *iv vi  
% of pneumonia patients who receive initial antibiotic consistent with current recommendations *iv vi  
% of pneumonia patients who receive influenza screening or vaccination *iv vi  
% of pneumonia patients who receive pneumococcal screening or vaccination *iv vi  
Treatment of Upper Respiratory Infection
Courses of antibiotics prescribed for sole diagnosis of common cold per populationvii      
Management of Asthma
Hospital admissions for asthma per 100,000 population under 18viii      
Hospital admissions for asthma per 100,000 population 18 and over8      
Treatment of Tuberculosis
Completion of TB Therapyix ix    

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: NHIS, 2000.
iv Source: NNHS, 1999. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
v Source: HCUP SID 16-State database, 2000. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.
vi Source: Medicare Quality Improvement Organization program. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asians or Pacific Islanders. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.
vii Source: NAMCS/NHAMCS, 1999-2000. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
viii Source: NHDS, 2000. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
ix Source: CDC's National TB Surveillance System, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 15. Socioeconomic Differences in Effectiveness of Care: Respiratory Diseases

Measure Income Differencei Educational Differenceii Insurance Differenceiii
<100% 100-199% 200-399% <HS HS Grad Uninsured
Influenza Immunization
% of high risk persons 18-64 who received influenza vaccination in the past yeariv
% of persons 65 and over who received influenza vaccination in the past year  
Pneumococcal Immunization
% of high risk persons 18-64 who ever received pneumococcal vaccination
% of persons 65 and over who ever received pneumococcal vaccination  

i Compared with persons with family incomes 400% of Federal poverty threshold or above.
ii Compared with mothers with any college education.
iii Compared with person under 65 with any private health insurance.
iv Source: NHIS, 2000.
HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 16. Racial and Ethnic Differences in Effectiveness of Care: Long term care

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Nursing Facility Careiii
% of nursing home residents with pain *iii 3  
% of nursing home residents with pressure sores *iii 3  
% of nursing home residents in physical restraints *iii 3  

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: CMS Resident Profile Table. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 17. Racial and Ethnic Differences in Patient Safety

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Nosocomial Infectionsiii
Infection due to intravenous lines or catheters per 1000 selected discharges *3\iii iii    
Postoperative septicemia per 1000 elective surgical discharges of 4+ days *iii iii    
Complications of Care3
Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1000 surgical discharges *iii iii    
Postoperative pulmonary embolus or deep vein thrombosis per 1000 surgical discharges *iii iii    
Postoperative respiratory failure per 1000 elective surgical discharges *iii iii    
Postoperative physiologic/metabolic derangements per 1000 elective surgeries *iii iii    
Complications of anesthesia per 1000 surgical discharges *iii iii    
Decubitus ulcers per 1000 selected stays of 4 or more days *iii iii    
Postoperative hip fractures per 1000 surgical discharges age 18+ years *iii iii    
Injuries or Adverse Events Due to Technical Errorsiii
Accidental laceration or puncture during procedure per 1000 discharges *iii iii    
Iatrogenic pneumothorax per 1000 relevant discharges *iii iii    
Postoperative abdominal wound dehiscence per 1000 relevant discharges *iii iii    
Foreign body left in during procedure per 1000 discharges *iii iii    
Transfusion reactions per 1000 selected discharges *iii iii    
Birth Related Traumaiii
Birth trauma injury per 1000 selected live births *iii iii    
Obstetric trauma per 1000 instrument-assisted deliveries *iii iii    
Obstetric trauma per 1000 vaginal deliveries without instrument assistance *iii iii    
Obstetric trauma per 1000 Cesarean deliveries *iii iii    
Potentially Avoidable Deathiv
Deaths per 1000 admissions in low-mortality DRGs *iii iii    
Medication Safety
Elderly prescribed inappropriate medicationsv iv      
Persons with provider who does not usually ask about medications and treatments other doctors may givevi v  

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: HCUP SID 16-State database, 2000. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asians or Pacific Islanders. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.
iv Source: HCUP SID 16-State database, 2000. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asians or Pacific Islanders. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.
v Source: MEPS, 1998. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
vi Source: MEPS, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 18. Socioeconomic Differences in Patient Safety

Measure Income Differencei Educational Differenceii Insurance Differenceiii
<100% 100-199% 200-399% <HS HS Grad Uninsured
Medication Safety
Elderly prescribed inappropriate medications4      
Persons with provider who does not usually ask about medications and treatments other doctors may give5

i Compared with persons with family incomes 400% of Federal poverty threshold or above.
ii Compared with mothers with any college education.
iii Compared with persons under 65 with any private health insurance.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 19. Racial and Ethnic Differences in Timeliness

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Usual Source of Careiii
% of persons who have a specific source of ongoing care
% of persons in fair or poor health who have a specific source of ongoing care
% of persons with a hospital, emergency room, or clinic as source of ongoing care
Unmet Need
% of families that experience difficulties or delays in obtaining health care or do not receive needed careiv iv  
% of families that experience difficulties or delays in obtaining health care due to financial or insurance reasonsiv iv  
% of persons always can get appointment for routine care as soon as wantedv v  
% of persons always can get care for illness or injury as soon as wantedv v  
Waiting Times
% of persons who usually wait >30 minutes before seeing provideriv iv  
% of emergent/urgent emergency department visits with wait >=1 hourvi vi      
% of semi-urgent/non-urgent emergency department visits with wait >=1 hourvi vi      
% of emergency department visits in which the patient left without being seenvi vi      

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: NHIS, 2000.
iv Source: MEPS, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian or Pacific Islander. This source did not collect information for >1 race.
v Source: MEPS, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian or Pacific Islander. This source did not collect information for >1 race.
vi Source: NHAMCS-ED, 1999-2000. This source did not collect information on Asians and NHOPIs separately. This source did not collect information for >1 race or about income or education. Missing rates preclude analysis by ethnicity.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 20. Socioeconomic Differences in Timeliness

Measure Income Differencei Educational Differenceii Insurance Differenceiii
<100% 100-199% 200-399% <HS HS Grad Uninsured
Usual Source of Careiv
% of persons who have a specific source of ongoing care
% of persons in fair or poor health who have a specific source of ongoing care
% of persons with a hospital, emergency room, or clinic as source of ongoing care
Unmet Need
% of families that experience difficulties or delays in obtaining health care or do not receive needed carev
% of families that experience difficulties or delays due to financial or insurance reasonsv
% of persons always can get appointment for routine care as soon as wantedvi
% of persons always can get care for illness or injury as soon as wantedvi
Waiting Times
% of persons who usually wait >30 minutes before seeing providerv
% of emergent/urgent emergency department visits with wait >=1 hourvii          
% of semi-urgent/non-urgent emergency department visits with wait >=1 hourvii          
% of emergency department visits in which the patient left without being seenvii          

i Compared with persons with family incomes 400% of Federal poverty thresholds or above.
ii Compared with persons with any college education.
iii Compared with person under 65 with any private health insurance.
iv Source: NHIS, 2000.
v Source: MEPS, 1999.
vi Source: MEPS, 2000.
vii Source: NHAMCS-ED, 1999-2000. This source did not collect information about income or education. Insurance contrast compares uninsured with persons with any private insurance including all ages.
HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 21. Racial and Ethnic Differences in Patient Centeredness

Measure Racial Differencei Ethnic Differenceii
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Patient-Provider Communicationiii
% of adults whose providers always listened carefully to them iii  
% of adults whose providers always explained things in a way they could understand iii  
% of adults whose providers always showed respect for what they had to say iii  
Patient-Provider Relationship
% of adults whose providers always spent enough time with themiii iii  

i Compared with whites.
ii Compared with non-Hispanic whites.
iii Source: MEPS, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islander. This source did not collect information for >1 race.
NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian/Alaska Native; HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

Table 22. Socioeconomic Differences in Patient Centeredness

Measure Income Differencei Educational Differenceii Insurance Differenceiii
<100% 100-199% Uninsured <HS HS Grad Uninsured
Patient-Provider Communicationiii
% of adults whose providers always listened carefully
% of adults whose providers always explained things in a way they could understand
% of adults whose providers always showed respect for what they had to say
Patient-Provider Relationship
% of adults whose providers always spent enough timeiii

i Compared with persons with family incomes 400% of Federal poverty threshold or above.
ii Compared with persons with any college education.
iii Compared with persons under 65 with any private health insurance.
HS=high school

Key to Quality of Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

Return to Contents

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