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National Healthcare Disparities Report, 2004

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Quality of Health Care

Cancer. An estimated 670,000 women in the United States will be diagnosed with cancer in 2004. Cancer incidence has been stable among men since 1995 but continues to rise among women. An estimated 270,000 women in the United States will die from cancer in 2004, making it the second leading cause of death after heart disease. Breast cancer is the most common cancer affecting women, accounting for a third of new cancers among women each year30.

Access to appropriate cancer screening services for all populations is a core element of efforts to reduce cancer health disparities31. Mammography is an effective means of reducing the incidence of late stage breast cancer and mortality caused by this cancer. In the 2003 NHDR, mammography was received less often by black, Asian, and AI/AN women compared with white women, by Hispanic women compared with non-Hispanic white women, and by low income and less educated women compared with more affluent women. In the 2004 NHDR, findings related to late stage breast cancer are highlighted.

Figure 4.11. Age-adjusted rate of late stage (stage II or higher) breast cancer per 100,000 women age 40 and older by race (top) and ethnicity (bottom), 1992-2001

Figure 4.11. Age-adjusted rate of late stage (stage II or higher) breast cancer per 100,000 women age 40 and older by race, 1992-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 4.11. Age-adjusted rate of late stage (stage II or higher) breast cancer per 100,000 women age 40 and older by ethnicity, 1992-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: SEER, 1992-2001.

Reference population: Women age 40 and older.

  • In all years, rates of late stage breast cancer were lower among API and AI/AN women compared with white women and among Hispanic women compared with non-Hispanic white women (Figure 4.11). Black-white differences were not significant.
  • Between 1992 and 2001, rates of late stage breast cancer decreased among black and AI/AN women.

Diabetes. In 2002, over 9.3 million women in the United States had diabetes32. Women are at greater risk than men for some complications related to diabetes, including diabetic ketoacidosis and cardiovascular disease due to diabetes33. In addition, poorly controlled diabetes during early pregnancy increases the risk for spontaneous abortion and major birth defects32. High quality management of diabetes includes hemoglobin A1c determination, lipid management, eye examination, foot examination, and influenza immunization34,35. Findings related to receipt of retinal eye examination by diabetic women are presented here. In 2001, diabetic men and women were equally likely to have a retinal eye examination in the past year (MEPS, 2001).

Figure 4.12. Women with diabetes who had a retinal eye exam in the past year by race, ethnicity, and income, 2000-2001

Figure 4.12. Women with diabetes who had a retinal eye exam in the past year by race, ethnicity, and income, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 2000-2001.

Reference population: Civilian noninstitutionalized women with diabetes age 18 and older.

  • In 2001, the proportion of adults with diabetes who had a retinal eye examination in the past year was lower among Hispanic compared with non-Hispanic white women and among poor and near poor compared with high income women (Figure 4.12). Black-white differences were not significant.
  • Between 2000 and 2001, rates of retinal eye examination improved among middle income diabetic women but did not change significantly among any racial or ethnic group.

Heart disease. Each year, about half a million women die of cardiovascular disease including 250,000 who die of heart attacks and 90,000 who die of stroke36. Although heart disease is the leading cause of death among both women and men, gender differences in cardiovascular care have been demonstrated and may relate to gender differences in disease presentation. Moreover, although major risk factors for cardiovascular disease can often be prevented or controlled through lifestyle changes, physicians are less likely to counsel women than men about diet, exercise, and weight reduction37. After a first heart attack, women are less likely than men to receive diagnostic and therapeutic procedures38 and cardiac rehabilitation39 and more likely to die or have a second heart attack40. Measures of quality of care for heart disease tracked in the NHDR include screening and counseling for cardiovascular risk factors, acute treatment of myocardial infarction and heart failure, and chronic management of hypertension and congestive heart failure. Findings related to receipt of aspirin and beta-blockers when hospitalized for acute myocardial infarction are highlighted here.

Figure 4.13. Elderly Medicare beneficiaries hospitalized for acute myocardial infarction who received aspirin (top) and beta-blockers (bottom) within 24 hours of admission by gender and race/ethnicity, 2000-2001

Receipt of aspirin

Figure 4.13. Elderly Medicare beneficiaries hospitalized for acute myocardial infarction who received aspirin, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Receipt of beta-blockers

Figure 4.13. Elderly Medicare beneficiaries hospitalized for acute myocardial infarction who received beta-blockers within 24 hours of admission by gender and race/ethnicity, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: CMS Quality Improvement Organization Program, 2000-2001.

Reference population: Medicare beneficiaries age 65 and older hospitalized for acute myocardial infarction.

Note: White and Black are non-Hispanic groups.

  • In 2001, elderly female Medicare beneficiaries hospitalized for acute myocardial infarction were less likely than male beneficiaries to receive aspirin within 24 hours of admission. Among elderly female Medicare beneficiaries, the proportion who received aspirin within 24 hours of admission was similar among non-Hispanic white, black, and Hispanic women (Figure 4.13, top).
  • In 2001, elderly female Medicare beneficiaries hospitalized for acute myocardial infarction were also less likely than male beneficiaries to receive beta-blockers within 24 hours of admission. Among both elderly female and male Medicare beneficiaries, the proportions who received beta-blockers within 24 hours of admission were lower among Hispanics compared with non-Hispanic whites (Figure 4.13, bottom). Black-white differences were not significant.

Osteoporosis. Osteoporosis is a disease characterized by loss of bone tissue that increases the risk of fractures of the hip, spine, and wrist. About 10 million people in the United States have osteoporosis and another 34 million with low bone mass are at risk for developing this disease. Because older women are at highest risk for osteoporosis, the U.S. Preventive Services Task Force recommends routine screening of women 65 and older for osteoporosis. White and Asian women are at greater risk for osteoporosis than black and Hispanic women41.

Figure 4.14. Elderly female Medicare beneficiaries who reported ever being screened for osteoporosis with a bone mass or bone density measurement by race, ethnicity, and income, 2000

Figure 4.14. Elderly female Medicare beneficiaries who reported ever being screened for osteoporosis with a bone mass or bone density measurement by race, ethnicity, and income, 2000. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medicare Current Beneficiary Survey, 2000.

Reference population: Female Medicare beneficiaries age 65 and older living in the community.

  • In 2000, the proportion of elderly female Medicare beneficiaries who were ever screened for osteoporosis with a bone mass or bone density measurement was lower among black compared with white women; among Hispanic compared with non-Hispanic white women; and among poor, near poor, and middle income compared with high income women (Figure 4.14).

Maternity care. Childbirth and reproductive care are the most common reasons for women of childbearing age to use health care. With more than 11,000 births each day in the United States, childbirth is the most common reason for hospital admission42. Comprehensive prenatal care may prevent complications of pregnancy and reduce preterm labor and neonatal mortality43. Given that birth outcomes may have lifetime effects, prenatal care is highly cost effective44. Findings related to initiation of prenatal care in the first trimester by pregnant women are presented here.

Figure 4.15. Mothers with prenatal care in the first trimester by race, ethnicity, and education, 2000-2001

Figure 4.15. Mothers with prenatal care in the first trimester by race, ethnicity, and education, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: National Vital Statistics System - Natality, 2000-2001.

Reference population: Women with live births.

  • In both 2000 and 2001, the proportion of mothers who initiated prenatal care in the first trimester was lower among black, NHOPI, and AI/AN women compared with white women; lower among Hispanic compared with non-Hispanic white women; and lower among women with less than a high school education or high school graduates compared with women with any college education (Figure 4.15).
  • Between 2000 and 2001, rates of prenatal care in the first trimester did not change significantly among any racial, ethnic, or education group.

Information about income is not typically collected on birth certificates, so education is commonly used as a proxy for SES. Racial and ethnic minorities have disproportionately less education than whites. To distinguish the effects of race, ethnicity, and education on quality of health care, measures are presented by level of education.

Figure 4.16. Mothers with prenatal care in the first trimester by race (top) and ethnicity (bottom) stratified by education, 2001

Figure 4.16. Mothers with prenatal care in the first trimester by race stratified by education, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 4.16. Mothers with prenatal care in the first trimester by ethnicity stratified by education, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: National Vital Statistics System - Natality, 2001.

Reference population: Women with live births.

  • Education explains some but not all of the differences in health care among women by race and ethnicity.
  • Racial and ethnic differences in mothers who initiate prenatal care in the first trimester tend to persist among women with similar education (Figure 4.16).
  • Only college educated whites and non-Hispanic whites achieved the Healthy People 2010 (HP2010) goal of 90% of mothers receiving prenatal care in the first trimester.

 

 

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