Health Disparity Within States

Many of the statewide measures reflect the condition of the "average" resident. However, when those measures are examined more closely, startling differences based upon race, sex and/or economic status may exist.

For example, Table 35 ranks the states based on premature death, an age-adjusted measure of the years of potential life lost (YPLL) before age 75 per 100,000 population for the year 2001. In the United States overall, 7,521 years of potential life before age 75 were lost per 100,000 population in 2001 when all races were included. However, startling differences emerge when you look at national information about premature death by race. To make accurate comparisons, the annual average over the period 1999 to 2001 must be considered. See Table 5 below.

Table 5

The table shows the difference in YPLL before age 75 when individual races and ethnic groups are compared to the overall rate. Asians and Pacific Islanders experience considerably less premature death than the average number (50.2 percent) whereas the black, non-Hispanic group experiences almost 75 percent more loss. The maximum variation between races occurs between two minority races -- black, non-Hispanic individuals experience 3.5 times as much loss as Asians and Pacific Islanders. Thus, many more black Americans are less able to lead full, productive lives than their Asian and Pacific Islander counterparts. These disparities have not changed significantly since first reported in the 2001 Edition.

Disparities in health outcomes are not only a national issue but also an issue for each state. While each state has unique issues that contribute to disparities, states that have been successful in reducing disparities in health indicators while retaining high overall health can serve as models for other states.

Table 13 shows YPLL before age 75 per 100,000 population for each state by race and ethnicity. It shows the maximum disparity between any two races within a state and the rank of each state based upon the ratio of the maximum loss to the minimum loss. A low rank means less disparity within the state.

The wide range in indicators by race and ethnicity is apparent, ranging from under 2.0 times in Vermont, Hawaii and Utah to more than 6.0 times in West Virginia, Texas, New Jersey and Indiana.

A uniformly healthy state would rank among the top states in both the overall YPLL (Premature Death Table 35) and in the intrastate disparities shown in Table 13. Minnesota is first in YPLL before age 75 for all races and is 16th in the disparity among races. This result shows that even though Minnesota leads the country in overall YPLL before age 75, not all population groups within the state participate equally in this benefit. Thus, in Minnesota, many more white, non-Hispanic individuals enjoy a longer, productive life than their American Indian or black, non-Hispanic counterparts. The differences in race are significant and can be used to identify and benchmark areas where increased efforts are justified.

Disparities are also present in other measures; access to adequate prenatal care is one example (Table 14). In the United States, 76.2 percent of pregnant women receive adequate prenatal care. By race, it varies from a low of 58.3 percent for pregnant American Indian women to a high of 78.3 percent for pregnant white women, a ratio of 1.34 (78.3/58.3). Individual states, however, have different degrees of variation among races, ranging from a low ratio in Connecticut of 1.12 to a high ratio in South Dakota of 1.78. This means that in South Dakota, a pregnant white woman is almost twice as likely as a pregnant American Indian woman to receive adequate prenatal care. In Connecticut, a pregnant white woman is only 12 percent more likely to receive adequate prenatal care as compared to a pregnant American Indian woman.

Disparities may be based on issues other than race. For example, it has been shown that mortality is strongly related to economic status. However, this type of data is not as readily available at a state-by-state level.