Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner
National Healthcare Disparities Report, 2004

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Disparities Are Pervasive

Consistent with extensive research and findings in the 2003 report, the 2004 report finds that disparities related to race, ethnicity, and socioeconomic statusi pervade the American health care system. While varying in magnitude by condition and population, disparities are observed in almost all aspects of health care, including:

  • Across all dimensions of quality of health care including effectiveness, patient safety, timeliness, and patient centeredness.
  • Across all dimensions of access to care including getting into the health care system, getting care within the health care system, patient perceptions of care, and health care utilization.
  • Across many levels and types of care including preventive care, acute care, and chronic care.
  • Across many clinical conditions including cancer, diabetes, end stage renal disease, heart disease, and respiratory diseases.
  • Across many care settings including primary care, dental care, mental health care, substance abuse treatment, emergency rooms, hospitals, and nursing homes.
  • Within many subpopulations including women, children, elderly, persons with disabilities, residents of rural areas, and individuals with special health care needs.

To begin to quantify disparities systematically, a subset of measures for which comparable data are available for 2000 and 2001 are highlighted in the 2004 report. This subset consists of 38 measures of effectiveness of health care and 31 measures of access to health care. Data sources are the Surveillance, Epidemiology, and End Results (SEER) program, U.S. Renal Data System (USRDS), Medical Expenditure Panel Survey (MEPS), the Centers for Disease Control and Prevention (CDC) AIDS Surveillance System, National Vital Statistics System-Natality (NVSS-N), National Immunization Survey (NIS), National Health Interview Survey (NHIS), and National Hospital Discharge Survey (NHDS). For each measure, racial, ethnic, and socioeconomic groups are compared with an appropriate comparison group; each group could receive care that is poorer than, about the same as, or better than the comparison groupii. For each group, the percentage of measures for which the group received poorer care was then calculated.

Figure H.1. Percent of measures for which members of selected racial groups experience poorer quality of care (top) or have worse access to care (bottom) compared with whites in 2000 and 2001

Quality

Figure H.1. Percent of measures for which members of selected racial group experience poorer quality of care compared with whites in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Access

Figure H.1. Percent of measures for which members of selected racial group have worse access to care compared with whites in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: SEER, USRDS, MEPS, CDC AIDS Surveillance System, NVSS-N, NIS, NHIS, NHDS, 2000-2001.

Note: Poorer quality of care and worse access to care indicate that for a particular measure, the group does not receive as high quality care or have as much access to care as whites and that the relative difference is at least 10% and statistically significant with p < 0.05. Number of measures available for each group is indicated in parentheses.

Key: AI/AN = American Indian and Alaska Native

Of measures tracked in 2000 and 2001, in both years:

  • Blacks received poorer quality of care than whites for about two-thirds of quality measures and had worse access to care than whites for about 40% of access measures (Figure H.1).
  • Asiansiii received poorer quality of care than whites for about 10% of quality measures and had worse access to care than whites for about a third of access measures.
  • American Indians and Alaska Natives (AI/ANs) received poorer quality of care than whites for about a third of quality measures and had worse access to care than whites for about half of access measures.

Figure H.2. Percent of measures for which Hispanics experience poorer quality of care (top) or have worse access to care (bottom) compared with non-Hispanic whites in 2000 and 2001

Quality

Figure H.2. Percent of measures for which Hispanics experience poorer quality of care compared with non-Hispanic whites in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Access

Figure H.2. Percent of measures for which Hispanics have worse access to care compared with non-Hispanic whites in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: SEER, USRDS, MEPS, CDC AIDS Surveillance System, NVSS-N, NIS, NHIS, NHDS, 2000-2001.

Note: Poorer quality of care and worse access to care indicate that for a particular measure, the group does not receive as high quality care or have as much access to care as non-Hispanic whites and that the relative difference is at least 10% and statistically significant with p < 0.05. Number of measures available for each group is indicated in parentheses.

Figure H.3. Percent of measures for which the poor experience poorer quality of care (top) or have worse access to care (bottom) compared with high income individuals in 2000 and 2001

Quality

Figure H.3. Percent of measures for which the poor experience poorer quality of care compared with high income individuals in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Access

Figure H.3. Percent of measures for which the poor have worse access to care compared with high income individuals in 2000 and 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: SEER, USRDS, MEPS, CDC AIDS Surveillance System, NVSS-N, NIS, NHIS, NHDS, 2000-2001.

Note: Poorer quality of care and worse access to care indicate that for a particular measure, the group does not receive as high quality care or have as much access to care as high income individuals and that the relative difference is at least 10% and statistically significant with p < 0.05. Number of measures available for each group is indicated in parentheses.

Of measures tracked in 2000 and 2001, in both years:

  • Hispanics received lower quality of care than non-Hispanic whites for half of quality measures and had worse access to care than non-Hispanic whites for about 90% of access measures (Figure H.2).
  • Poor peopleiv received lower quality of care for about 60% of quality measures and had worse access to care for about 80% of access measures than those with high income (Figure H.3).

i Consistent with Healthy People 2010, the NHDR defines disparities as any differences among populations. In addition, all disparities discussed in the NHDR meet criteria based on statistical significance and size of difference described in Chapter 1. Income and education are the primary measures of socioeconomic status used in the report.
ii Data on all measures were not available for all groups; see Tables 1.2 and 1.3 for lists of measures available for each group. Only relative differences of at least 10% and statistically significant with p < 0.05 are discussed in this report.
iii Including "Asians or Pacific Islanders (APIs)" when information is not collected separately for each group.
iv "Poor" is defined as having family incomes less than 100% of the Federal poverty level and "high income" is defined as having family incomes 400% or more of the Federal poverty level.


 

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care