Chapter 4. Priority Populations (continued)

National Healthcare Disparities Report, 2008


Asians

Previous NHDRs showed that Asians had similar or better quality of care than Whites but worse access to care than Whites for many measures the reports track. Findings based on core report measures of quality and access to health care that support estimates for either Asians or Asians and Pacific Islanders in aggregate are shown below.

Figure 4.3. Asians compared with Whites on measures of quality and access

Stacked columns chart shows Asians compared with Whites on measures of quality and access. Quality (27 CRM): Worse, 9; Same, 11; Better, 7. Access (5 CRM): Worse, 1; Same, 4; Better, 0.

Better = Asians receive better quality of care or have better access to care than Whites.
Same = Asians and Whites receive about the same quality of care or access to care.
Worse = Asians receive poorer quality of care or have worse access to care than Whites.
CRM = core report measures (Table 1.2)
Note: Data presented are the most recent available.

Table 4.5. Asians compared with Whites on measures of quality and access: Specific measures


TopicBetter than WhitesWorse than WhitesSame as Whites
CancerColorectal cancer diagnosed at advanced stageAdults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test 
Colorectal cancer deaths per 100,000 population per year  
End stage renal diseaseAdult hemodialysis patients with adequate dialysis (urea renal reduction ratio 65% or greater)  
Dialysis patients who were registered on a waiting list for transplantation  
Heart disease  Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI)
  Recommended hospital care for heart attack
  Recommended hospital care for heart failure
HIV and AIDSNew AIDS cases per 100,000 population age 13 and over  
Maternal and child health Children ages 2-17 for whom a health provider ever gave advice about physical activityPregnant women who first received prenatal care in the first trimester
  Children ages 19-35 months who received all recommended vaccines
Mental health and substance abuseSuicide deaths per 100,000 population  
Respiratory diseases Adults age 65 and over who ever received pneumococcal vaccination.Patients with tuberculosis who completed a curative course treatment within 12 months of initiation of treatment.
 Recommended hospital care for pneumonia 
Nursing home, home health, and hospice careAdult home health care patients who were admitted to the hospitalLong-stay nursing home residents with physical restraintsHigh-risk, long-stay nursing home residents with pressure sores
  Adult home health care patients whose ability to walk or move around improved
  Short-stay nursing home residents with pressure sores
Patient safety Adult surgery patients who received appropriate timing of antibioticsAdults age 65 and over who received potentially inappropriate prescription medicines
 Failure to rescue 
Timeliness Adults who can sometimes or never get care for illness or injury as soon as wantedEmergency department visits in which patients left without being seen
Patient centeredness Adults with poor provider-patient communication 
Access to care People with a usual primary care providerPeople under age 65 with health insurance
  People under age 65 who were uninsured all year
  People with a specific source of ongoing care
  People without a usual source of care who indicated a financial or insurance reason
  • For 9 of the 27 core report measures of quality, Asians had significantly poorer quality of care than Whites. For example, Asians were less likely than Whites to get recommended care for pneumonia and to ever receive a pneumococcal vaccine. For 7 measures, Asians had significantly better quality of care than Whites (Figure 4.3). For example, Asian dialysis patients were more likely than Whites to have adequate dialysis and to be on a waiting list for transplantation.
  • For 1 of the 5 core report measures of access, Asians had significantly worse access to care than Whites; Asians were less likely than Whites to have a usual primary care provider. Asians had the same access to care as Whites for 4 of the 5 measures. For example, there was no statistically significant difference between Asians and Whites in having a usual source of care..

Figure 4.4. Change in Asian-White disparities over time

Stacked columns chart shows change in Asian-White disparities over time. Quality (22 CRM): Worsening greater than 5%, 2; Worsening 1-5%, 7; Same, 9; Improving 1-5%, 4; Improving greater than 5%, 0. Access (5 CRM): Worsening greater than 5%, 0; Worsening 1-5%, 1; Same, 2; Improving 1-5%, 2; Improving greater than 5%, 0.

Improving > 5% = Asian-White difference becoming smaller at an average annual rate greater than 5%.
Improving 1-5% = Asian-White difference becoming smaller at an average annual rate between 1% and 5%.
Same = Asian-White difference not changing.
Worsening 1-5% = Asian-White difference becoming larger at an average annual ate between 1% and 5% per year.
Worsening > 5% = Asian-White difference becoming larger at an average annual rate greater than 5%.
CRM = core report measures (Table 1.2)
Note: The time period for this figure is the most recent and oldest years of data used in the NHDR. Only 27 core report measures could be tracked over time for Asians and Whites.

Table 4.6. Change in Asian-White disparities over time: Specific measures


TopicImprovingWorseningSame
CancerColorectal cancer deaths per 100,000 population per yearColorectal cancer diagnosed at advanced stage 
 Adults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test 
End stage renal disease Adult hemodialysis patients with adequate dialysis (urea renal reduction ratio 65% or greater) 
 Dialysis patients who were registered on a waiting list for transplantation 
Heart diseaseDeaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI)  
HIV and AIDSNew AIDS cases per 100,000 population age 13 and over  
Maternal and child healthChildren ages 19-35 months who received all recommended vaccines Pregnant women who first received prenatal care in the first trimester
  Children ages 2-17 for whom a health provider ever gave advice about physical activity
Mental health and substance abuse  Suicide deaths per 100,000 population
Respiratory diseases Adults age 65 and over who ever received pneumococcal vaccination.Patients with tuberculosis who completed a curative course treatment within 12 months of initiation of treatment.
Nursing home, home health, and hospice care Short-stay nursing home residents with pressure soresLong-stay nursing home residents with physical restraints
  High-risk, long-stay nursing home residents with pressure sores
  Adult home health care patients whose ability to walk or move around improved
  Adult home health care patients who were admitted to the hospital
Patient safety Adult surgery patients who received appropriate timing of antibioticsFailure to rescue
Timeliness Adults who can sometimes or never get care for illness or injury as soon as wanted 
Patient centeredness Adults with poor provider-patient communication 
Access to carePeople under age 65 who were uninsured all yearPeople with a specific source of ongoing carePeople under age 65 with health insurance
People with a usual primary care provider People without a usual source of care who indicated a financial or insurance reason
  • Of core report measures of quality that could be tracked over time for Asians and Whites, Asian-White differences became smaller for 4 measures but larger for 9 measures (Figure 4.4). For 9 measures, Asian-White differences did not change over time.
  • Of core report measures of access that could be tracked over time for Asians and Whites, Asian-White differences became smaller for 2 measures but larger for 1 measure. For 2 measures, the Asian-White differences did not change over time.

Native Hawaiians and Other Pacific Islanders

The ability to assess disparities among NHOPIs for the NHDR has been hampered for two main reasons. First, the NHOPI racial category is relatively new to Federal data collection. Before 1997, NHOPIs were classified as part of the Asian and Pacific Islander racial category and could not be identified separately in most Federal data. In 1997, the Office of Management and Budget promulgated new standards for Federal data on race and ethnicity and mandated that information about NHOPIs be collected separately from information about Asians.7 However, these standards have not yet been incorporated into all databases. Second, when information about this population was collected, databases often included insufficient numbers of NHOPIs to allow reliable estimates.

Consequently, in previous NHDRs, estimates for the NHOPI population could be generated for only a handful of NHDR measures. A lack of quality data on this population prevents the NHDR from detailing disparities for this group. This year, the NHDR features data from the Behavioral Risk Factor Surveillance System (BRFSS) to supplement the NHDR information for the NHOPI population. Preventive care and access to care measures were selected to highlight the quality of care for people who identified themselves as NHOPI (including people of mixed race who identified primarily as NHOPI). These measures include cholesterol screening, influenza and pneumococcal vaccinations, and health insurance.

Data from BRFSS does not replace the need for continued efforts to improve data collection and statistical methods to provide more information on health and health care of the NHOPI population. While BRFSS may have larger samples of NHOPIs due to State efforts to improve sample sizes, the survey is not necessarily a comprehensive survey of health and health care. Other surveys and data collection efforts, such as vital statistics and hospital administrative data, include more topics but do not identify NHOPIs or have large enough sample sizes to provide data for these populations. Also, for all national data sources, the relatively small population sizes of many Pacific Islander groups can cause these populations to be overlooked when categorized as NHOPIs. In addition, identifying individuals with chronic conditions or other health conditions within such small populations further reduces the sample sizes that exist. However, as data become available, this information will be included in future reports.

Preventive Care: Cholesterol Screening

In the State of Hawaii, where 54% of Native Hawaiians reside, cardiovascular disease is the leading cause of death.8 Screening for risk factors for cardiovascular disease such as high blood pressure and high cholesterol are important in preventing disease. Cholesterol screening is shown below to highlight one aspect of cardiovascular disease prevention for Native Hawaiians.

Figure 4.5. Adults who did NOT receive a cholesterol check in the last 5 years, 2005

Bar chart showing percent of adults who did not receive a cholesterol check in the last 5 years, 2005. Total: 26.6%; White: 24.6%; and NHOPIs: 34.8%.

Key: NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2005.
Note: These data are self-reported from a survey of adults in a household.

  • The percentage of adults who did not receive a cholesterol check in the last 5 years was significantly higher for NHOPIs than for Whites (34.8% compared with 24.6%; Figure 4.5).

Preventive Care: Influenza and Pneumococcal Vaccinations for Older Adults

Older adults are at increased risk for complications from influenza and pneumococcal infections, and vaccination is an effective strategy to reduce illness and deaths due to influenza and pneumonia. The U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention recommend annual influenza vaccinations and at least one pneumococcal vaccination for all older individuals.

Figure 4.6. Adults who did NOT receive an influenza vaccination in the last 12 months, 2006

Bar chart showing percent of adults age 65 and over who did not receive an influenza vaccination in the last 12 months, 2006. Total: 33%; White: 30.6%; and NHOPIs: 15.9%

Key: NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006.
Note: These data are self-reported from a survey of adults in a household.

  • The percentage of older adults who did not receive flu shots in the last 12 months was lower for NHOPIs than for Whites (15.9% compared with 30.6%; Figure 4.6).

Figure 4.7. Adults age 65 and over who have never received pneumococcal vaccination, 2006

Bar chart showing percent of adults age 65 and over who have never received pneumococcal vaccination, 2006. Total: 35%; White: 32.6%; and NHOPIs: 20.0%.

Key: NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006.
Note: These data are self-reported from a survey of adults in a household.

  • The percentage of older adults who have never received a pneumococcal vaccination was lower for NHOPIs than for Whites (20.0% compared with 32.6%; Figure 4.7).

Access to Care: Health Insurance

Having health insurance is an important facilitator to getting health care. Individuals without health care coverage are less likely to have a usual source of care and access to preventive care and are more likely to delay needed care.

Figure 4.8. Adults who were uninsured all year, 2006

Bar chart showing percent of adults who were uninsured all year, 2006. Total: 15.5%; White: 12.7%; and NHOPIs: 19.7%.

Key: NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006.
Note: These data are self-reported from a survey of adults in a household.

  • The percentage of adults who did not have any health insurance in the past year was higher for NHOPIs than for Whites (19.7% compared with 12.7%; Figure 4.8).
  • The percentage of adults ages 18-64 who did not have any health insurance was not significantly different between NHOPIs and Whites (15.3% for Whites, 20.9% for NHOPIs; data not shown).

American Indians and Alaska Natives

Previous NHDRs showed that AI/ANs had poorer quality of care and worse access to care than Whites for many measures tracked in the reports. Findings based on core report measures of quality and access that support estimates for AI/ANs are shown below.

Figure 4.9. AI/ANs compared with Whites on measures of quality and access

Stacked column chart shows AI/ANs compared with Whites on measures of quality and access. Quality (19 CRM): Worse, 8; Same, 9; Better, 2. Access (3 CRM): Worse, 2; Same, 1; Better, 0.

Better = AI/ANs receive better quality of care or have better access to care than Whites.
Same = AI/ANs and Whites receive about the same quality of care or access to care.
Worse = AI/ANs receive poorer quality of care or have worse access to care than Whites.
Key: AI/AN = American Indian or Alaska Native; CRM = core report measures (Table 1.2).
Note: Data presented are the most recent available.

Table 4.7. AI/ANs compared with Whites on measures of quality and access: Specific measures


TopicBetter than WhitesWorse than WhitesSame as Whites
CancerColorectal cancer diagnosed at advanced stageAdults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test 
Colorectal cancer deaths per 100,000 population per year  
End stage renal disease Dialysis patients who were registered on a waiting list for transplantationAdult hemodialysis patients with adequate dialysis (urea renal reduction ratio 65% or greater)
Heart disease  Recommended hospital care for heart attack
 Recommended hospital care for heart failure 
HIV and AIDS  New AIDS cases per 100,000 population age 13 and over
Maternal and child health Pregnant women who first received prenatal care in the first trimesterChildren ages 19-35 months who received all recommended vaccines
Mental health and substance abuse  Suicide deaths per 100,000 population
Respiratory diseases Recommended hospital care for pneumoniaPatients with tuberculosis who completed a curative course treatment within 12 months of initiation of treatment.
Nursing home, home health, and hospice care Long-stay nursing home residents with physical restraintsShort-stay nursing home residents with pressure sores
 High-risk, long-stay nursing home residents with pressure soresAdult home health care patients whose ability to walk or move around improved
 Adult home health care patients who were admitted to the hospital 
Patient safety  Adult surgery patients who received appropriate timing of antibiotics
Access to care People under age 65 with health insurancePeople with a usual primary care provider
 People under age 65 who were uninsured all year 
  • Only about half of the core report measures of quality supported estimates for AI/ANs.
  • For 8 of the 19 core report measures of quality, AI/ANs had significantly poorer quality of care than Whites (Figure 4.9). For example, AI/ANs were less likely than Whites to receive colorectal cancer screening and recommended care for heart failure. For 2 measures, AI/ANs had better outcomes than Whites (colorectal cancer diagnosed at advanced stage and colorectal cancer mortality).
  • For 2 of the 3 core report measures of access, AI/ANs had significantly worse access to care than Whites. AI/ANs had significantly worse access to care than Whites. AI/ANs under age 65 were less likely than Whites to have health insurance and were more likely to be uninsured all year.

Figure 4.10. Change in AI/AN-White disparities over time

Stacked column chart shows change in AI/AN-White disparities over time. Quality (15 CRM): Worsening greater than 5%, 1; Worsening 1-5%, 3; Same, 6; Improving 1-5%, 3; Improving greater than 5%, 2. Access (3 CRM): Worsening greater than 5%, 0; Worsening 1-5%, 1; Same, 0; Improving 1-5%, 2; Improving greater than 5%, 0.

Improving >5% = AI/AN-White difference becoming smaller at rate greater than 5% per year.
Improving 1-5% = AI/AN-White difference becoming smaller at rate between 1% and 5% per year.
Same = AI/AN-White difference not changing.
Worsening 1-5% = AI/AN-White difference becoming larger at rate between 1% and 5% per year.
Worsening >5% = AI/AN-White difference becoming larger at rate greater than 5% per year.
Key: AI/AN = American Indian or Alaska Native; CRM = core report measures (Table 1.2)
Note: The time period for this figure is the most recent and oldest years of data used in the NHDR. Only 18 core report measures could be tracked over time for AI/ANs and Whites.

Table 4.8. Change in AI/AN-White disparities over time: Specific measures


TopicImprovingWorseningSame
Cancer Adults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood testColorectal cancer diagnosed at advanced stage
  Colorectal cancer deaths per 100,000 population per year
End stage renal disease Adult hemodialysis patients with adequate dialysis (urea renal reduction ratio 65% or greater)Dialysis patients who were registered on a waiting list for transplantation
HIV and AIDSNew AIDS cases per 100,000 population age 13 and over  
Maternal and child healthChildren ages 19-35 months who received all recommended vaccines  
Mental health and substance abuseSuicide deaths per 100,000 population  
Respiratory diseases  Patients with tuberculosis who completed a curative course treatment within 12 months of initiation of treatment.
Nursing home, home health, and hospice careShort-stay nursing home residents with pressure soresLong-stay nursing home residents with physical restraintsHigh-risk, long-stay nursing home residents with pressure sores
 Adult home health care patients who were admitted to the hospitalAdult home health care patients whose ability to walk or move around improved
Patient safetyAdult surgery patients who received appropriate timing of antibiotics  
Access to carePeople under age 65 with health insurancePeople under age 65 who were uninsured all year 
People with a usual primary care provider  
  • Fewer than half of the core report measures could be tracked over time for AI/ANs.
  • Of core report measures of quality that could be tracked over time for AI/ANs and Whites, AI/AN-White differences became smaller for 5 measures. For example, AI/AN-White differences in recommended vaccinations for children and the rate of new AIDS cases have decreased over time.
  • AI/AN-White differences became larger for 4 measures (Figure 4.10). For example, the difference in colorectal cancer screening has worsened over time. For 6 measures, AI/AN-White differences did not change over time. These include nursing home residents with pressure sores and home health care patients with improved mobility.
  • Of core report measures of access that could be tracked over time for AI/ANs and Whites, AI/AN-White differences became smaller for 2 measures (people under age 65 with health insurance and people with a usual primary care provider) but larger for 1 measure (people under age 65 who were uninsured all year).

Focus on Indian Health Service Facilities

Nationwide, many AI/ANs who are members of a federally recognized tribe nationwide rely on the Indian Health Service (IHS) to provide access to health care in the counties on or near reservations where they may obtain services.9-10, ix Due to low numbers and lack of data, information about AI/AN hospitalizations is difficult to obtain in most Federal and State hospital utilization data sources. The NHDR addresses this gap by examining utilization data from IHS, Tribal, and contract hospitals.

Diabetes is one of the leading causes of morbidity and mortality among AI/AN populations. Its prevention and control are a major focus of the IHS Director's Chronic Disease Initiative and the IHS Health Promotion/Disease Prevention Initiative. Addressing barriers of access to health care is a large part of the overall IHS goal of ensuring that comprehensive, culturally acceptable personal and public health services are available and accessible to AI/ANs.

Figure 4.11. Hospitalizations for uncontrolled diabetes per 100,000 population 18 years and over in IHS, Tribal, and contract hospitals (top), and community hospitals (bottom) by race and ethnicity, 2003-2005

Line chart showing hospitalizations for uncontrolled diabetes per 100,000 population 18 years and over in IHS, Tribal, and contract hospitals, 2003-2005 by race. 2003, 37.8; 2004, 31.0; 2005, 29.3.

Line chart showing hospitalizations for uncontrolled diabetes per 100,000 population 18 years and over in community hospitals (HCUP SID), ethnicity, 2003-2005. 2003: Total, 22.1; White, 13.5; Black, 67.5; API, 9.4; Hispanic, 48.2; 2004: Total, 22.1; White, 12.9; Black, 70.7; API, 10.8; Hispanic, 51.0; 2005: Total, 22.0; White, 12.9; Black, 65.7; API, 9.2; Hispanic, 42.0.

Key: AI/AN = American Indian or Alaska Native, API = Asian or Pacific Islander; HCUP SID = Healthcare Cost and Utilization Project State Inpatient Databases; NPIRS = National Patient Information Reporting System.
Source: IHS, Tribal, and contract hospitals: IHS NPIRS; 2003-2005; community hospitals: Agency for Healthcare Research and Quality, HCUP SID disparities analysis file, 2003-2005.
Note: White, Black, and API are non-Hispanic populations. Data are adjusted for age and gender. The HCUP SID disparities analysis file is designed to provide national estimates using weighted records from a sample of hospitals from 23 States that have 63% of the U.S. resident population. Years of IHS data prior to 2003 use a denominator based on the 1990 Census. This source is not comparable with estimates following those years, which are based on 2000 Bridged Census Data. Therefore, for comparing IHS with national estimates, only 2003 and 2004 data from both data sources are presented.

  • From 2003 to 2005, the age-adjusted rate of hospitalizations for uncontrolled diabetes decreased for AI/ANs in IHS, Tribal, and contract hospitals (from 37.8 per 100,000 to 29.3 per 100,000; Figure 4.11).
  • There were no significant changes for other racial and ethnic groups in community hospitals during this period.

For the more than 538,000 AI/ANs living on reservations or other trust lands where the climate is inhospitable, roads are often impassable, and transportation is scarce, health care facilities are far from accessible.11 These conditions contribute to high rates of perforated appendix and hospitalizations for urinary tract infections, two problems that are receiving particular attention by IHS. Perforated appendix and urinary tract infection hospitalization rates, which decreased from 2003 to 2004, are illustrative of the efforts underway, as well as the work that needs to continue to achieve high quality, comprehensive care that is accessible to AI/ANs.12

Figure 4.12. Perforated appendixes per 1,000 admissions with appendicitis, age 18 years and over with appendicitis in IHS, Tribal and contract hospitals (top), and community hospitals (bottom) by race and ethnicity , 2003-2005

Line graph showing hospitalizations for perforated appendix per 1,000 population 18 years and over with appendicitis in IHS, Tribal and contract hospitals (NPIRS) by race, 2003-2005. 2003: 384.4; 2004, 363.3; 2005: 355.8.

Line graph showing hospitalizations for perforated appendix per 1,000 population 18 years and over with appendicitis in community hospitals (HCUP SID), by ethnicity, 2003-2005. Community hospitals (HCUP SID): Total: 2003, 299.7; 2004, 291.5, 2005: 270.1. White: 2003, 294.6; 2004, 287.8, 2005: 282.7. Black: 2003, 334.2; 2004, 308.7, 2005: 317.3. API: 2003, 269.8; 2004, 266.8, 2005: 270.1. Hispanic: 2003, 293.8; 2004, 291.8, 2005: 290.0.

Key: AI/AN = American Indian or Alaska Native, API = Asian or Pacific Islander; HCUP SID = Healthcare Cost and Utilization Project State Inpatient Databases; NPIRS = National Patient Information Reporting System.
Source: IHS, Tribal, and contract hospitals: IHS NPIRS; 2003-2005 community hospitals: Agency for Healthcare Research and Quality, HCUP SID disparities analysis file, 2003-2005.
Note: White, Black, and API are non-Hispanic populations. Data are adjusted for age and gender. The HCUP SID disparities analysis file is designed to provide national estimates using weighted records from a sample of hospitals from 23 States that have 63% of the U.S. resident population. Years of IHS data prior to 2003 use a denominator based on the 1990 Census. This source is not comparable with estimates following those years, which are based on 2000 Bridged Census Data. Therefore, for comparing IHS with national estimates, only 2003 and 2004 data from both data sources are presented.

  • From 2003 to 2005, the age-adjusted rate of appendicitis hospitalizations with perforated appendix decreased for AI/ANs in IHS, Tribal, and contract hospitals (from 384.4 per 1,000 to 355.8 per 1,000; Figure 4.12).
  • The rate in community hospitals during this period also decreased overall (from 299.7 per 1,000 to 287.2 per 1,000), for Whites (from 294.6 per 1,000 to 282.7 per 1,000), and for Blacks (from 334.3 per 1,000 to 317.3 per 1,000).

Figure 4.13. Hospitalizations for urinary tract infection per 100,000 population age 18 years and over in IHS, Tribal, and contract hospitals (top) and community hospitals (bottom), by race and ethnicity, 2003-2005

Line chart showing hospitalizations for urinary tract infection per 100,000 population 18 years and over in IHS, Tribal, and contract hospitals (NPIRS), 2003-2005: adults--2003, 212.1; 2004, 205.2; 2005: 186.3.

Line chart showing hospitalizations for urinary tract infection per 100,000 population 18 years and over in community hospitals (HCUP SID), 2003-2005. Total--2003, 164.6; 2004, 175.7; 2005: 178.5. White--2003, 149.8; 2004, 159.5; 2005: 165.3. Black--2003, 235.9; 2004, 255.6; 2005: 235.9. API--2003, 115.7; 2004, 127.3; 2005: 114.9. Hispanic--2003, 255.0; 2004, 262.6; 2005: 252.0.

Key: AI/AN = American Indian or Alaska Native, API = Asian or Pacific Islander; HCUP SID = Healthcare Cost and Utilization Project State Inpatient Databases; NPIRS = National Patient Information Reporting System.
Source: IHS, Tribal, and contract hospitals: IHS NPIRS; 2003-2005 community hospitals: Agency for Healthcare Research and Quality, HCUP SID disparities analysis file, 2003-2005.
Note: White, Black, and API are non-Hispanic populations. Data are adjusted for age and gender. The HCUP SID disparities analysis file is designed to provide national estimates using weighted records from a sample of hospitals from 23 States that have 63% of the U.S. resident population. Years of IHS data prior to 2003 use a denominator based on the 1990 Census. This source is not comparable with estimates following those years, which are based on 2000 Bridged Census Data. Therefore, for comparing IHS with national estimates, only 2003 and 2004 data from both data sources are presented.

  • From 2003 to 2005, the rate of hospitalizations for urinary tract infection for AI/AN adults in IHS, Tribal, and contract hospitals decreased from 212.1 per 100,000 to 186.3 per 100,000 (Figure 4.13).
  • In comparison, from 2003 to 2005, hospitalizations for urinary tract infection in community hospitals increased overall (from 164.6 per 100,000 to 178.5 per 100,000) and for Whites (from 149.8 per 100,000 to 165.3 per 100,000).

ix Of potentially eligible AI/ANs, 74% sought health care in 2004 at an IHS or tribally contracted facility, according to the most recent published IHS estimates developed by the Office of Public Health Support, Division of Program Statistics.


Current as of March 2009
Internet Citation: Chapter 4. Priority Populations (continued): National Healthcare Disparities Report, 2008. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhdr08/Chap4a.html