Examining Progress Toward Elimination of Racial and Ethnic Health Disparities for Healthy People 2020 Objectives Using Three Measures of Overall Disparity

Abstract

Background Healthy People provides science-based, 10-year targets for public health objectives for the U.S. population. As in the preceding two decades, Healthy People 2020 (HP2020) included an overarching goal related to health disparities. Objective This report examines changes in health disparities over time by race and ethnicity for HP2020 objectives using three measures of disparity. Methods Data were analyzed for 506 objectives from 68 data sources from 2001 to 2018. Analyses were restricted to HP2020 objectives with data by race and ethnicity at the baseline and final timepoints for a minimum set of population groups. Health disparities by race and ethnicity were evaluated using three measures that were used in HP2020: the maximal rate difference, maximal rate ratio, and summary rate ratio. Changes in disparities over time were evaluated by comparing the baseline and final timepoints for each of the respective measures. Based on the statistical significance of the change (n = 469) or, when statistical significance could not be assessed, the magnitude of the change (n = 37), each of the disparities measures was categorized as having narrowed, shown little or no detectable change, or widened. Analyses were conducted to compare findings and evaluate agreement in the change categories. Results Little or no change was detected in disparities for most of the objectives, regardless of the measure used (76.9% for the maximal rate difference, 83.3% for the maximal rate ratio, and 92.1% for the summary rate ratio). For each measure, a slightly higher percentage of objectives were categorized as having narrowed rather than widened in disparities. Agreement in the disparities change categories across objectives was 75.6% for the three measures. Conclusion These findings show that health disparities persist and that multiple measures provide different approaches for assessing progress toward their elimination.