Chapter 4. Priority Populations (continued, 2)

National Healthcare Disparities Report, 2009


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

Stacked columns chart. percentages. Quality (22 C R M), Worse, 9 (41%), Same, 8 (36%), Better, 5 (23%), Access (5 C R M), Worse, 1 (20%), Same, 4 (80%), 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 for most current data year: 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 testWomen age 40 and over who reported they had a mammogram within the past 2 years
Breast cancer diagnosed at advanced stage  
Colorectal cancer deaths per 100,000 population per year  
Breast cancer deaths per 100,000 female population per year  
End stage renal diseaseHemodialysis patients with urea reduction ratio 65% or higher Dialysis patients registered on a waiting list for transplantation
Heart disease Hospital patients who received recommended care for heart failureHospital patients who received recommended care for heart attack
HIV and AIDS  New AIDS cases per 100,000 population age 13 and over
Maternal and child health  Children ages 19-35 months who received all recommended vaccines
Mental health and substance abuse  Suicide deaths per 100,000 population
Respiratory diseases Hospital patients with pneumonia who received recommended care 
 Tuberculosis patients who completed a curative course of treatment within 1 year of initiation of treatment 
Functional status preservation and rehabilitation Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosisHome health care patients whose ability to walk or move around improved
Supportive and palliative care Long-stay nursing home residents who were physically restrainedShort-stay nursing home residents with pressure sores
 High-risk long-stay nursing home residents with pressure sores 
 Home health care patients who were admitted to the hospital 
Patient safety Appropriate timing of antibiotics received by adult Medicare patients having surgery 
Access to care People under age 65 with health insurancePeople who have a usual primary care provider
  People who have a specific source of ongoing care
  People who were unable to get or delayed in getting needed medical care, dental care, or prescription medications
  People under age 65 uninsured all year

Figure 4.15. Change in AI/AN-White disparities over time

Stacked columns chart. percent. Quality (21 C R M), Worsening greater than 5%; 4 (19%), Worsening 1-5%; 4 (19%), Same, 3 (14%), Improving 1-5%; 9 (43%), Improving greater than 5%; 1 (5%), Access (5 C R M), Worsening >5%; 2 (40%), Worsening 1-5%; 1 (20%), Same, 0, Improving 1-5%; 2 (40%), Improving greater than 5%; 0.

Improving >5% = AI/AN-White difference becoming smaller at an average annual rate greater than 5%.

Improving 1-5% = AI/AN-White difference becoming smaller at an average annual rate between 1% and 5%.

Same = AI/AN-White difference not changing.

Worsening 1-5% = AI/AN-White difference becoming larger at an average annual rate between 1% and 5%.

Worsening >5% = AI/AN-White difference becoming larger at an average annual rate greater than 5%.

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 26 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
CancerWomen age 40 and over who reported they had a mammogram within the past 2 yearsAdults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood testColorectal cancer deaths per 100,000 population per year
Breast cancer diagnosed at advanced stage Breast cancer deaths per 100,000 female population per year
Colorectal cancer diagnosed at advanced stage  
End stage renal disease Hemodialysis patients with urea reduction ratio 65% or higherDialysis patients registered on a waiting list for transplantation
Heart disease Hospital patients who received recommended care for heart attack 
 Hospital patients who received recommended care for heart failure 
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  
Children ages 2-17 who had a dental visit  
Mental health and substance abuseSuicide deaths per 100,000 population  
Respiratory diseases Hospital patients with pneumonia who received recommended care 
 Tuberculosis patients who completed a curative course of treatment within 1 year of initiation of treatment 
Functional status preservation and rehabilitation  Home health care patients whose ability to walk or move around improved
Supportive and palliative careShort-stay nursing home residents with pressure soresLong-stay nursing home residents who were physically restrained 
High-risk long-stay nursing home residents with pressure soresHome health care patients who were admitted to the hospital 
Patient safetyAppropriate timing of antibiotics received by adult Medicare patients having surgery  
AccessPeople under age 65 uninsured all yearPeople under age 65 with health insurance 
People who have a usual primary care providerPeople who have a specific source of ongoing care 
 People who were unable to get or delayed in getting needed medical care, dental care, or prescription medications 

Note: Measures in bold indicate improvement or worsening at a rate of greater than 5% per year.

Focus on Indian Health Service Facilities

Nationwide, many AI/ANs who are members of a federally recognized Tribe rely on the IHS to provide access to health care in the counties on or near reservations.17,18,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 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 4.16. Hospital admissions for uncontrolled diabetes per 100,000 population age 18 and over in IHS, Tribal, and contract hospitals , 2003-2006 (left), and community hospitals (right), by race and ethnicity, 2003-2006

two trend line charts. rates. IHS hospitals (N P I R S), AI/AN, 2003, 37.8; 2004, 31.4; 2005, 29.3; 2006, 26.3

Community hospitals (H C U P S I D). Total, 2003, 22.0; 2004, 22.1; 2005, 21.0; 2006, 20.3; White, 2003, 13.5; 2004, 12.9; 2005, 13.1; 2006, 12.2; Black, 2003, 67.5; 2004, 70.7; 2005, 63.2; 2006, 65.7; API, 2003, 9.4; 2004, 10.8; 2005, 8.0; 2006, 7.2; Hispanic, 2003, 48.2; 2004, 51.0; 2005, 40.7; 2006, 37.8.

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, Office of Information Technology/NPIRS, National Data Warehouse, Workload and Population Data Mart; community hospitals: Agency for Healthcare Research and Quality, HCUP SID disparities analysis file, 2003-2006.

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 25 States that have 66% 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, 2004, 2005, and 2006 data from both data sources are presented.

  • From 2003 to 2006, 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 26.3 per 100,000; Figure 4.16).
  • There were no statistically significant changes for other racial and ethnic groups in community hospitals during this period.

For the nearly 2 million AI/ANs estimated to be living on reservations or other trust lands in 2009 where the climate is inhospitable, roads are often impassable, and transportation is scarce, health care facilities are far from accessible.19 These conditions contribute to high rates of perforated appendix, a problem that is receiving particular attention by IHS. Perforated appendix hospitalization rates, which decreased from 2003 to 2006, 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.20

Figure 4.17. Perforated appendixes per 1,000 admissions with appendicitis, age 18 years and over in IHS, Tribal, and contract hospitals (left), and community hospitals (right), by race and ethnicity, 2003-2006

Trend line chart. percentage. I H S hospitals (N P I R S), AI/AN, 2003, 384.4; 2004, 363.3; 2005, 355.8; 2006, 332.6

Community hospitals (H C U P S I D). Total; 2003, 299.7; 2004, 291.5; 2005, 287.2; 2006, 285.5; White; 2003, 294.6; 2004, 287.8; 2005, 282.7; 2006, 278.7; Black; 2003, 334.3; 2004, 308.7; 2005, 317.3; 2006, 323.4; API; 2003, 270.1; 2004, 266.8; 2005, 270.1; 2006, 271.4; Hispanic; 2003, 293.7; 2004, 291.8; 2005, 283.2; 2006, 283.7.

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, Office of Information Technology/NPIRS, National Data Warehouse, Workload and Population Data Mart, 2003-2006; community hospitals: Agency for Healthcare Research and Quality, HCUP SID disparities analysis file, 2003-2006.

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 25 States that have 66% 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, 2004, 2005, and 2006 data from both data sources are presented.

  • From 2003 to 2006, 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 332.6 per 1,000; Figure 4.17).
  • The rate in community hospitals during this period remained the same overall as well as for Whites and Blacks.

Hispanics or Latinos

Previous NHDRs showed that Hispanics had poorer quality of care and worse access to care than non-Hispanic Whites for many measures the reports track. Findings based on core report measures of quality and access to health care that support estimates for Hispanics are shown below.

Figure 4.18. Hispanics compared with non-Hispanic Whites on measures of quality and access

Stacked bar chart. percentage. Quality (38 C R M); worse, 25 (66%); same, 8 (21%); better, 5 (13%); Access (6 C R M), worse, 5 (83%); same, 0; better, 1 (17%).

Better = Hispanics receive better quality of care or have better access to care than non-Hispanic Whites.

Same = Hispanics and non-Hispanic Whites receive about the same quality of care or access to care.

Worse = Hispanics receive poorer quality of care or have worse access to care than non-Hispanic Whites.

Key: CRM = core report measures (Table 1.2).

Note: Data presented are the most recent available.

Table 4.9. Hispanics compared with non-Hispanic Whites on measures of quality and access for most current data year: Specific measures

TopicBetter than WhitesWorse than WhitesSame as Whites
CancerBreast cancer diagnosed at advanced stageWomen age 40 and over who reported they had a mammogram within the past 2 years 
Colorectal cancer diagnosed at advanced stageAdults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test 
Breast cancer deaths per 100,000 female population per yearColorectal cancer deaths per 100,000 population per year 
Diabetes Adults with diabetes who had three major exams in the past year 
End stage renal diseaseHemodialysis patients with urea reduction ratio 65% or higherDialysis patients registered on the waiting list for transplantation 
Heart disease Hospital patients who received recommended care for heart attackDeaths per 1,000 admissions with acute myocardial infarction as principal diagnosis, age 18 and over
 Hospital patients who received recommended care for heart failure
HIV and AIDS New AIDS cases per 100,000 population age 13 and over 
Maternal and child health Children ages 3-6 with a vision checkChildren ages 2-17 given advice about physical activity
 Children ages 2-17 who had a dental visitChildren ages 2-17 given advice about healthy eating
  Children ages 19-35 months who received all recommended vaccines
Mental health and substance abuseSuicide deaths per 100,000 populationAdults age 18 and over with past year major depressive episode who received treatment for the depression in the past yearPeople age 12 and over who completed substance abuse treatment in the past year
Respiratory diseases Adults age 65 and over who ever received pneumococcal vaccination 
 Hospital patients with pneumonia who received recommended care 
 Tuberculosis patients who completed a curative course of treatment within 1 year of initiation of treatment 
Lifestyle modification Adults with obesity given advice about exercise 
 Current smokers age 18 and over given advice to quit smoking 
Functional status preservation and rehabilitation Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosisHome health care patients whose ability to walk or move around improved
Supportive and palliative care Long-stay nursing home residents who were physically restrained 
 High-risk long-stay nursing home residents with pressure sores 
 Short-stay nursing home residents with pressure sores 
 Home health care patients who were admitted to the hospital 
Patient safety Appropriate timing of antibiotics received by adult Medicare patients having surgeryAdults age 65 and over who received potentially inappropriate prescription medications
Timeliness Adults who can sometimes or never get care for illness or injury as soon as wantedFailure to rescue
Patient centeredness Poor provider-patient communication—adults 
 Poor provider-patient communication—children 
AccessPeople who were unable to get or delayed in getting needed medical care, dental care, or prescription medicationsPeople under age 65 with health insurance 
 People under age 65 uninsured all year 
 People who have a specific source of ongoing care 
 People who have a usual primary care provider 
 People without a usual source of care due to a financial or insurance reason 

Figure 4.19. Change in Hispanic-non-Hispanic White disparities over time

Stacked columns chart. Percentage (rounded): Worsening >5 percent; Quality (37 C R M), 4 (11%); Access (6 C R M), 0; Worsening 1 - 5 percent; Quality (37 C R M), 6 (16%); Access (6 C R M), 1 (17%); Same; Quality (37 C R M), 15 (41%); Access (6 C R M), 1 (17%); Improving, 1.5 percent; Quality (37 C R M), 7 (19%); Access (6 C R M), 1 (17%); Improving, >5 percent; Quality (37 C R M), 5 (14%); Access (6 C R M), 3 (50%).

Improving >5% = Hispanic-non-Hispanic White difference becoming smaller at an average annual rate greater than 5%.

Improving 1-5% = Hispanic-non-Hispanic White difference becoming smaller at an average annual rate between 1% and 5%.

Same = Hispanic-non-Hispanic White difference not changing.

Worsening 1-5% = Hispanic-non-Hispanic White difference becoming larger at an average annual rate between 1% and 5%.

Worsening >5% = Hispanic-non-Hispanic White difference becoming larger at an average annual rate greater than 5%.

Key: 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 43 core report measures could be tracked over time for Hispanics and non-Hispanic Whites.

Table 4.10. Change in Hispanic-non-Hispanic White disparities over time: Specific measures

TopicImprovingWorseningSame
CancerWomen age 40 and over who reported they had a mammogram within the past 2 yearsAdults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood testBreast cancer diagnosed at advanced stage
Colorectal cancer diagnosed at advanced stageColorectal cancer deaths per 100,000 population per yearCancer deaths per 100,000 female population per year for breast cancer
Diabetes  Adults with diabetes who had three major exams in the past year
End stage renal disease Hemodialysis patients with urea reduction ratio 65% or higherDialysis patients registered on a waiting list for transplantation
Heart diseaseHospital patients with heart attack who received recommended hospital careHospital patients with heart failure who received recommended hospital careHeart attack mortality
HIV and AIDSNew AIDS cases per 100,000 population age 13 and over  
Maternal and child healthChildren ages 2-17 given advice about healthy eatingChildren ages 2-17 given advice about exerciseChildren ages 3-6 with a vision check
Children ages 2-17 who had a dental visit in the past year Children ages 19-35 months who received all recommended vaccines
Mental health and substance abuse Suicide deaths per 100,000 populationPeople age 12 and over who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year
  Adults age 18 and over with past year major depressive episode who completed treatment for the depression in the past year
Respiratory diseases Adults age 65 and over who ever received pneumococcal vaccinationTuberculosis patients who completed a curative course of treatment within 1 year of initiation of treatment
 Hospital patients with pneumonia who received recommended hospital care 
Lifestyle modificationCurrent smokers age 18 and over given advice to quit smokingAdults with obesity given advice about exercise 
Functional status preservation and rehabilitation  Home health care patients whose ability to walk or move around improved
Supportive and palliative care  Long-stay nursing home residents who were physically restrained
  High-risk long-stay nursing home residents who have pressure sores
  Short-stay nursing home residents who have pressure sores
  Home health care patients who were admitted to the hospital
Patient safetyAppropriate timing of antibiotics received by adult Medicare patients having surgeryAdults age 65 and over who received potentially inappropriate prescription medicationsFailure to rescue
TimelinessAdults who can sometimes or never get care for illness or injury as soon as wanted  
Patient centerednessPoor provider-patient communication—adults  
Poor provider-patient communication—children  
AccessPeople under age 65 with health insurancePeople who were unable to get or delayed in getting needed medical care, dental care, or prescription medicationsPeople who have a usual primary care provider
People under age 65 uninsured all year  
People who have a specific source of ongoing care  
People without a usual source of care due to a financial or insurance reason  

Note: Measures in bold indicate improvement or worsening at a rate of greater than 5% per year.

Focus on Hispanic Subpopulations

The Hispanic population in the United States is highly heterogeneous. Almost 60% of all Hispanics in the country are those of Mexican extraction, making this group the largest subpopulation. People originating from Puerto Rico, Central America, and South America are the next largest subgroups. Variation is seen in access to and quality of health care among Hispanics related to country of origin. Findings are presented below on differences among different Hispanic subpopulations on four quality measures focusing on prevention, chronic care management, and patient centeredness: colorectal cancer screening, diabetes management, and provider-patient communication. In addition, this section reports findings on one access measure, uninsurance.

This section also features selected measures from the CHIS. CHIS is an example of a data source that can provide data for Hispanic subgroups. In 2008, California's Hispanic population was nearly twice the percentage in the United States overall (36.6% in California compared with 15.4% of the 2008 U.S. population).9 Almost 30% of the Hispanic population in the United States lives in California.21

CHIS data show disparities among Hispanics in California, not only compared with non-Hispanic Whites but also within Hispanic subgroups (Mexican, Puerto Rican, Central American, and South American). The data also show disparities across Hispanic subgroups by income and insurance status. This section shows only some of the significant disparities for these groups in California from CHIS data. The selected measures in this section are limited to a subset of measures available to supplement the existing national measures used in the report.

Figure 4.20. Adults age 50 and over who received a sigmoidoscopy, colonoscopy, or fecal occult blood test in the past 5 years, California only, by race, Hispanic subgroup, income, and insurance status, 2007

Stacked column chart. percentage. California, Total, 66.1; non-Hispanic white, 69.2; Hispanic, 59.2; Mexican, 57.2; Puerto Rican, 72.5;  Central American, 60.1; South American, 58.1; Poor, 46.8; Low income, 57.5; Middle Income, 64.4; High Income, 67.9; Hispanic with private insurance, 62.2; Hispanic with Public Insurance, 52.6; Hispanic without Insurance, 32.4.

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2007.

Denominator: Civilian noninstitutionalized adults age 50 and over in California.

Note: Income groups are all Hispanic. For this measure, public insurance includes people with Medicare and/or Medicaid coverage.

  • Overall, Hispanics had a lower percentage than Whites of adults age 50 and over who had colorectal cancer screening (59.2% compared with 69.2%; Figure 4.20). Mexicans also had a lower percentage than Whites (57.2% compared with 69.2%). There were no statistically significant differences among Hispanic subgroups.
  • Among Hispanics, poor people and low-income people had a lower percentage than high-income people of adults age 50 and over who had colorectal cancer screening (46.8% and 57.5%, respectively, compared with 67.9%).
  • Among Hispanics, adults age 50 and over with public insurance were less likely to have colorectal cancer screening than people with private insurance (52.6% compared with 62.2%). Adults age 50 and over who were uninsured were almost half as likely as people with private insurance to have colorectal cancer screening (32.4% compared with 62.2%).

Figure 4.21. People age 40 and over with diabetes who had hemoglobin A1c testing, eye examination, and foot examination within the past year, California only, by ethnicity, income, and insurance status, 2007

California, Total, 45.1; non-Hispanic white, 51.4; Hispanic, 36.0; Mexican, 34.1; Central American, 48.9; Poor, 28.0; Low income, 30.8; Middle Income, 42.5; High Income, 51.3; Hispanic with private insurance, 41.1; Hispanic with Public Insurance Only, 38.7.

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2007.

Denominator: Civilian noninstitutionalized adults age 40 and over in California with diabetes.

Note: Income groups are all Hispanic. Data did not meet criteria for statistical reliability for Puerto Ricans, South Americans, and uninsured Hispanics.

  • Overall, Hispanics in California age 40 and over with diabetes were less likely than non-Hispanic Whites to have had all three recommended services for diabetes (36.0% compared with 51.4%; Figure 4.21).
  • There were no statistically significant differences among Hispanic subgroups in recommended care for diabetes.
  • Among Hispanics, the percentage of adults in California with diabetes who received all three recommended diabetes-related exams was lower for poor people (28.0%) and for low-income people (30.8%) than for high-income people (51.3%).
  • The percentage of Hispanic adults age 40 and over with diabetes who received all three recommended services for diabetes was not significantly different between people with any private insurance and people with public insurance.

Figure 4.22. People under age 65 uninsured all year, California only, by ethnicity and Hispanic subgroup, 2001, 2003, 2005, and 2007; by Hispanic subgroup, stratified by income; by education; by English proficiency; and by place of birth, 2007

Trend line chart. Percentages. By ethnicity and Hispanic subgroup. California, Total, 2001, 12.4; 2003, 11.9; 2005, 11.1; 2007, 11.2; non-Hispanic white, 2001, 6.1; 2003, 5.9; 2005, 5.8; 2007, 5.8; Hispanic, 2001, 22.0; 2003, 20.1; 2005, 17.8; 2007, 18.0; Mexican, 2001, 23.9; 2003, 21.8; 2005, 18.4; 2007, 18.9; Puerto Rican, 2001, no data; 2003, 13.5; 2005, no data; 2007, no data; Central American, 2001, 29.9; 2003, 25.1; 2005, 25.2; 2007, 26.4; South American, 2001, 11.9; 2003, 15.9; 2005, 13.9; 2007, 9.7.

By Hispanic subgroup, stratified by income; bar chart; percentages. Non-Hispanic white, Poor, 18.4; Low income, 15.8; Middle income, 9.6; High income, 3.1; Hispanic, Poor, 23.0; Low income, 21.1; Middle income, 12.5; High income, 4.1; Mexican, Poor, 26.4; Low income, 24.3; Middle income, 14.1; High income, 7; Central American, Poor, 31.8; Low income, 36.6; Middle income, 22.2; High income, no data; South American, Poor, no data; Low income, 25.9; Middle income, no data; High income, no data.

By Hispanic subgroup, stratified by education; bar chart; percentages; Non-Hispanic white, less than High School, 15.0; High School, 9.7; At Least Some College, 4.2; Hispanic, less than High School, 24.7; High School, 14.2; At Least Some College, 6.1; Mexican, less than High School, 27.0; High School, 17.8; At Least Some College, 9.8; Central American, less than High School, 36.3; High School, 23.5; At Least Some College, 15.3; South American, less than High School, no data; High School, no data; At Least S

By English proficiency; bar chart; percentages; 2007, English only, 7.8; Well/Very Well, 14.6; Not Well/Not at All; 41.5.

By place of birth; bar chart; percentages; 2007, Born in U.S., 6.6; Not Born in U.S., 24.6.

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2001, 2003, 2005, and 2007.

Denominator: Civilian noninstitutionalized population under age 65 in California.

Note: Data did not meet criteria for statistical reliability for Puerto Ricans for data years 2001, 2005, and 2007, for Puerto Rican income and education groups, and for South American income and education groups except low income and some college.

  • Overall, the percentage of Californians under age 65 who were uninsured all year decreased from 12.4% in 2001 to 11.2% in 2007 (Figure 4.22). For Hispanics, the percentage who were uninsured also decreased from 22.0% in 2001 to 18.0% in 2007.
  • In 2007, the percentage of Californians under age 65 who were uninsured all year was about three times as high for Hispanics as for non-Hispanic Whites (18.0% compared with 5.8%) overall. Among Hispanic subgroups, the percentage was about three times as high for Mexicans (18.9%) and about four times as high for Central Americans (26.4%) compared with non-Hispanic Whites (5.8%).
  • Among Hispanics, the percentage of people uninsured all year was more than five times as high for poor people (23.0%) as for high-income people (4.1%). For low-income people, the percentage was also more than five times as high (21.1%). The percentage was about three times as high for middle-income people (12.5%).
  • Across all income groups, Mexicans were more likely to be uninsured all year than non-Hispanic Whites. However, Central Americans had the highest rate of being uninsured all year among poor people and low-income people.
  • Among Hispanics, the percentage of people uninsured all year was more than four times as high for people with less than a high school education (24.7%) and more than twice as high for high school graduates (14.2%) compared with people with at least some college education (6.1%).
  • Across all education groups, Central Americans had the highest rate of being uninsured all year. Mexicans also had higher rates than non-Hispanic Whites across all education groups.
  • Among Hispanics, the percentage of people who were uninsured all year was five times as high for people who did not speak English well or at all as for people who were native English speakers (41.5% compared with 7.8%). The percentage of people who were uninsured all year was almost twice as high for people who speak English well or very well as for native English speakers (14.6% compared with 7.8%).
  • Among Hispanics, the percentage of people who were uninsured all year was almost four times as high for people who were not born in the United States as for people who were born in the United States.

Figure 4.23. Adults age 18 and over who reported difficulty understanding their doctor during their last visit within the past 2 years, California only, by ethnicity, Hispanic subgroup, income, and insurance status, 2007

Bar chart, percentages. California, Total, 3.9; non-Hispanic white, 2.6; Hispanic, 3.7; Mexican, 5.7;  Central American, 5.7; Poor Hispanic, 8.5; Low income Hispanic, 6.0; Middle Income Hispanic, 3.8; High Income Hispanic, 2.2; Hispanic with private insurance, 2.9; Hispanic with Public Insurance, 6.9; Hispanic without Insurance, 6.1.

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2007.

Denominator: Civilian noninstitutionalized adults in California age 18 and over.

Note: Income groups are all Hispanic. Data did not meet criteria for statistical reliability for Puerto Rican and South American subgroups.

  • Overall, Hispanics age 18 and over were more likely than non-Hispanic Whites to have difficulty understanding their doctor (5.5% compared with 2.6%; Figure 4.23). Mexicans and Central Americans were also more likely than non-Hispanic Whites to have difficulty understanding their doctor (5.7% and 5.7%, respectively, compared with 2.6%).
  • Among Hispanics, poor adults (8.5%), low-income adults (6.0%), and middle-income adults (3.8%) were more likely than high-income adults (2.2%) to have difficulty understanding their doctor.
  • Among Hispanics, adults with public insurance and adults without insurance were more likely to have difficulty understanding their doctor than those with private insurance (6.9% and 6.1%, respectively, compared with 2.9%).

Figure 4.24. Adults age 18 and over who reported language as the reason they had difficulty understanding their doctor during their last visit within the past 2 years, California only, by ethnicity, Hispanic subgroup, income, and insurance status, 2007

Bar chart. percentage. California, Total, 2.3; non-Hispanic white, 1.5; Hispanic, 3.7; Mexican, 4.0; Central American, 4.1; Poor Hispanic, 5.3; Low income Hispanic, 5.7; Middle Income Hispanic, 2.4; High Income Hispanic, 1.4; Hispanic with private insurance, 2.9; Hispanic with Public Insurance, 3.9; Hispanic without Insurance, 5.0.

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2007.

Denominator: Civilian noninstitutionalized adults in California age 18 and over.

Note: Income groups are all Hispanic. Data did not meet criteria for statistical reliability for Puerto Rican and South American subgroups.

  • Hispanics had a higher percentage than non-Hispanic Whites who reported language as the reason they had difficulty understanding their doctor during their last visit (3.7% compared with 1.5%; Figure 4.24). Among Hispanics, Mexicans (4.0%) and Central Americans (4.1%) had a higher percentage than non-Hispanic Whites (1.5%).
  • Among Hispanics, poor and low-income adults had a higher percentage than high-income adults who reported language as the reason they had difficulty understanding their doctor during their last visit (5.3% and 5.7%, respectively, compared with 1.4%).
  • Among Hispanics, people without insurance had a higher percentage than people with private insurance who reported language as the reason they had difficulty understanding their doctor during their last visit (5.0% compared with 2.9%).

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.



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Current as of March 2010
Internet Citation: Chapter 4. Priority Populations (continued, 2): National Healthcare Disparities Report, 2009. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhdr09/Chap4b.html