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Vital Signs

Good News and Bad News: Some Health Disparities Shrinking, Others Growing

In the 20 years since the Office of Minority Health was created, how much progress has really been made in narrowing the gap of unequal health outcomes between minority and majority Americans? While improvements--or lack thereof--in areas like health care access and quality are not always easy to quantify, in recent years studies such as the National Healthcare Disparities Report (NHDR), published annually for the past three years by the federal Agency for Healthcare Research and Quality (AHRQ), have helped shed some much-needed light on areas where disparities are beginning to shrink and those where improvement is still needed.

The new 2005 National Healthcare Disparities Report, released in January 2006, contains the usual mix of good and bad news. The NHDR tracks racial, ethnic and socioeconomic disparities in both quality of health care and access to care, based on four core quality measures--effectiveness, patient safety, timeliness and patient centeredness--and two access measures: facilitators/barriers to care and health care utilization. Some of the 2005 report’s key conclusions are:

• Disparities still exist. No surprises here. Disparities related to race, ethnicity and socioeconomic status still pervade the U.S. health care system. The report found evidence of disparities across all quality and access measures and in almost all aspects of care. Disparities exist across many types of care (preventive, acute, chronic), clinical conditions (e.g., cancer, diabetes, HIV, mental health), care settings (primary, dental, hospital, ER, home health, nursing homes) and subpopulations (women, children, the elderly, rural residents).

• Some disparities are diminishing. In the good news department, the NHDR finds that overall, more disparities in health care quality and access are narrowing than are widening for African Americans, Native Americans and Asians. To cite just two examples, rates of late-stage breast cancer decreased more rapidly from 1992 to 2002 among black women than white women. And treatment of heart failure improved more rapidly from 2002 to 2003 among American Indian Medicare beneficiaries than their white counterparts.

• Opportunities for improvement remain. The 2005 report’s most disturbing finding is that Hispanics are the only major ethnic minority group for whom most health care disparities are growing rather than shrinking, both in terms of quality and access. E.g., Hispanics had worse access to care than non-Hispanic whites for 88% of core report measures, compared to 50% for blacks and American Indians and 43% for Asians. Some other high-priority areas where improvement is urgently needed include: lack of health insurance among minority Americans, lack of a primary care provider among Asians, and worsening health disparities for poor people (regardless of race or ethnicity).

The complete 2005 National Healthcare Disparities Report can be obtained online at www.qualitytools.ahrq.gov or by contacting AHRQ at (800) 358-9295, email ahrqpubs@ahrq.gov.