Slide 1:

Health Disparities in Massachusetts: Data and Trends
Disparities Council
June 16, 2008

Source of information for entire presentation: Massachusetts Department of Public Health, Bureau of Health Statistics, Information, Research and Evaluation

Slide 2:

Racial Disparities in Health Indicators

Slide 3

Heading: Fair or Poor Self-Perceived Health Status, MA 1993-2007

This slide has a line chart showing trend over time by race of the percentage of residents who report their health is “fair” or “poor.” The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. The data depicted in the line graph is:

	1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	8.9	10.2	11.4	10.3	10.6	11.1	10.9	10.3	
Black non-Hispanic	18.5	17.4	16.8	13.2	16.9	15.4	15.6	20.3	
Hispanic	24.3	37.7	26.3	20.6	35	34	33.3	34	
	
There is another chart titled “Average (median) prevalence by race/ethnicity over time.”   For 1993 to 2007, the average percentage of white residents who reported fair or poor health was 10.5%, of black residents 16.8% and of Hispanics 33.7%.

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 4

Heading: Poor Self-Perceived Mental Health, Massachusetts 1993-2007

This slide has a line chart showing trend over time by race of residents who report their mental health is “poor.” The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic.  The data depicted in the line graph is:

	1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	8.3	9.6	9	7.6	9.3	9.3	8.9	8.7	
Black non-Hispanic	11.1	11.1	11.2	8	9.9	11.6	10.3	11.5	
Hispanic	15.6	13.3	11.5	14.3	13.4	12.6	12.1	11.3	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.”   From 1993 to 2007, the average percentage of white residents who reported fair or poor mental health was 8.9%, of Hispanics 12.9% and black residents 11.1%.

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 5

Heading: Overweight or Obese, MA 1990-2007

This slide has a line chart showing trend over time by race of percentage of residents who are overweight or obese The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. In general, each race has seen a steady increase for overweight and obesity since 1990. The data depicted in the line graph is:

	1990 and 1991	1992 and 1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	42.4	45.4	47.1	48.1	49.5	52.7	52.9	54.3	55.6	
Black non-Hispanic	59.7	61.6	57.2	62	66.1	66	64.4	68.9	70.3	
Hispanic	39.8	59.6	59.3	53.8	63.1	65.3	63.2	67.2	66.5	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.” For 1990 to 2007, the average percentage of white residents who were overweight or obese was 49.5%, of Hispanics 63.1% and black residents 64.4%.

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 6

Heading: Diabetes, MA 1990-2007

This slide has a line chart showing trend over time the percentage of residents by race who report having diabetes. The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. In general, each race has seen a steady increase in reported diabetes since 1990. The data depicted in the line graph is:

	1990 and 1991	1992 and 1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	4.3	4.5	3.6	4.5	4.4	5.1	5.3	5.2	5.8	
Black non-Hispanic	7.5	8.1	10.4	9.1	7.1	9.7	11.8	11.6	13	
Hispanic	3.8	6.7	11.9	5.6	6.3	10.6	11.5	12.1	14.1	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.” For 1990 to 2007, the average percentage of white residents who report having diabetes was 4.5%, of black residents 9.7% and Hispanic residents 10.6%

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 7

Heading: Current Smokers, MA 1990-2007

This slide has a line chart showing trend over time the percentage of residents by race who report smoking. The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. In general, each race has seen a steady decline in reported smoking since 1990. The data depicted in the line graph is:

	1990 and 1991	1992 and 1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	23.8	22.3	22.5	22.4	20.9	20.8	19.8	18.9	18	
Black non-Hispanic	21.5	23.6	25.7	14.5	23.1	21.1	16.8	17.6	17.7	
Hispanic	17.9	17.8	16.4	19.4	21.9	16	18.5	16.7	16.9	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.” For 1990 to 2007, the average percentage of white residents who report smoking was 20.9%, of black residents 21.1% and Hispanic residents 17.8%

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 8

Heading: Binge Drinkers, MA 1990-2007

This slide has a line chart showing trend over time the percentage of residents by race who report binge drinking. The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. The data depicted in the line graph is:

	1990 and 1991	1992 and 1993	1994 and 1995	1996 and 1997	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
White non-Hispanic	19.1	19.2	18.2	19.5	18.4	20.2	20.5	18.3	20.8	
Black non-Hispanic	15.4	14.8	13	5.2	16.5	12.7	9.7	15.2	11.3	
Hispanic	11.9	11.9	12.7	14.5	10.5	10.3	14.6	12.6	12.8	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.” For 1990 to 2007, the average percentage of white residents who report smoking was 19.2%, of black residents 13.0% and Hispanic residents 12.6%

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 9

Heading: Had mammography in the past two years, MA 1992-2007

This slide has a line chart showing trend over time the percentage of female residents by race who report having had a mammography in the past two years. This data looks at females who are recommended to get mammography. The races shown are White non-Hispanic, Black, non-Hispanic and Hispanic. The data depicted in the line graph is:

	1992 and 1993	1994 and 1995	1006 and 1007	1998 and 1999	2000 and 2001	2002 and 2003	2004 and 2005	2006 and 2007	
white NH	72.1	75.6	79.2	81.2	83.6	83.7	82.9	84.9	
black NH	71.4	81.7	84.5	87.6	87.3	86	84.9	82	
Hispanic	71	73	88.2	81.5	87.9	84.4	87.6	86	

There is another chart titled “Average (median) prevalence by race/ethnicity over time.” For 1990 to 2007, the average percentage of whites who report having a mammography in the past two years was 82.1%, of blacks 84.7% and Hispanics 85.2%.

Notes at bottom of page:
Percentages are age adjusted to 2000 US population.
Time trend in prevalence is shown when it is significant (p less than or equal to 0.05)

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation, BRFSS

Slide 10

Racial Disparities in Birth Outcome Indicators

Slide 11

Ratio of Rates Used to Compare Outcomes of Blacks, Hispanics, and Asians to that of Whites

Interpretation of ratio of rates and of its trend over time
1. Values of ratio of rates
•	<1 	rates are lower than that of whites 
•	=1	rates are equal to that of whites
•	>1	rates are higher than that of whites

2. When the observed ratio trend line crosses the Y=1 line, this indicates a change in the direction (better/worse) of the ratio, for a given outcome.

3. When the Annual Percent Change (APC) is statistically different from 0 (p<0.05) and: 
•	APC<0, this indicates that the gap (or ratio) is decreasing
•	APC=0, this indicates that the gap (or ratio) is stable
•	APC>0, this indicates that the gap (or ratio) is increasing

Slide 12

Interpretation of ratio of rates and APC for Adverse Outcomes

Values of ratio of rates
<1, 	better off than whites (B)
=1,	rates are equal to that of whites (E)
>1,	worse off than whites (W)

Values of the Annual Percent Change (APC)
If statistically different from 0 (p<0.05) and: 
APC<0, indicates that the racial disparity/gap is improving 
APC=0, indicates that the racial disparity/gap remains stable
APC>0, indicates that the racial disparity/gap is worsening

Slide 13
Heading: Ratio of Teen Birth Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of teen birth compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. All ratios for all years show that Hispanics, Blacks and Asians are worse off than Whites.  

The Black to White ratio for teen birth rates has been decreasing at 4.7% per year since 1996 to 2006. The Asian to White ratio for teen birth rates has been decreasing at 2.5% per year since 1996 to 2006.The Hispanic to White ratio for teen birth rates has been decreasing at 2.4% per year since 1996 to 2006.  Each of these APCs is marked with an * to show statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	6.83	4.16	1.20	
1997	7.29	4.28	1.59	
1998	6.97	3.93	1.47	
1999	6.21	3.61	1.47	
2000	5.61	2.92	1.23	
2001	5.74	2.86	1.41	
2002	5.87	3.06	1.43	
2003	5.72	2.56	1.23	
2004	5.59	2.82	1.08	
2005	5.68	2.82	1.19	
2006	5.70	2.76	1.08	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 14
Heading: Ratio of Infant Mortality Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of infant mortality rates compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Hispanics and Blacks are worse off than Whites.  For all years, Asians are better off than whites.

The Hispanic to White ratio for infant mortality rates has been increasing at 3.5% per year since 1996 to 2006. Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	1.10	2.45	0.50	
1997	1.40	2.43	0.56	
1998	1.44	2.29	0.57	
1999	1.18	2.61	0.41	
2000	1.34	3.33	1.05	
2001	1.77	2.93	0.76	
2002	1.71	2.82	0.73	
2003	1.38	3.12	0.66	
2004	2.01	3.04	0.72	
2005	1.80	2.18	0.80	
2006	1.39	2.68	0.44	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 15

Heading: Ratio of Cesarean Rates by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of cesarean rates compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks are worse off than Whites.  For all years, Asians and Hispanics are better off than whites.

The Asian to White ratio for cesarean rates has been increasing at 1.4% per year since 1996 to 2006. The Hispanic to White ratio for cesarean rates has been decreasing at 0.7% per year since 1996 to 2006.  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	0.86	1.01	0.78	
1997	0.88	1.03	0.76	
1998	0.84	1.05	0.77	
1999	0.89	1.06	0.83	
2000	0.83	1.00	0.79	
2001	0.84	1.05	0.84	
2002	0.85	1.03	0.83	
2003	0.86	1.02	0.89	
2004	0.84	1.03	0.86	
2005	0.81	1.01	0.86	
2006	0.80	0.96	0.86	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 16

Heading: Ratio of Gestational Diabetes Mellitus by Race Compared to White non-Hispanics Massachusetts Births 2000-2006

This slide has a line chart showing trend over time of the ratio of Gestational Diabetes Mellitus compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks, Hispanics and Asians are worse off than Whites.  

The annual percentage change for the Hispanic to White ratio was -1.0%. The annual percentage change for the Black to White ratio was -3.2%.  The annual percentage change for the Asian to White ratio was -0.3%.  None of the APCs show statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
2000	1.18	1.45	2.05	
2001	1.18	1.65	2.18	
2002	1.13	1.10	1.95	
2003	1.15	1.29	1.91	
2004	1.25	1.35	1.98	
2005	1.19	1.19	2.23	
2006	1.03	1.24	1.95	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 17

Heading: Ratio of Singleton Low Birth Weight Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of singleton low birth weight compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks, Asians and Hispanics are worse off than Whites.

The Black to White ratio for low birthweight has been decreasing at 1.4% per year since 1996 to 2006.  The Hispanic to White ratio for low birthweight has been decreasing at 1.0% per year since 1996 to 2006.   Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	1.67	2.51	1.36	
1997	1.60	2.16	1.35	
1998	1.53	2.39	1.48	
1999	1.56	2.38	1.29	
2000	1.64	2.36	1.47	
2001	1.60	2.00	1.44	
2002	1.61	2.44	1.53	
2003	1.56	2.27	1.44	
2004	1.55	2.08	1.14	
2005	1.42	2.03	1.36	
2006	1.47	2.15	1.30	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 18
Heading: Ratio of Smoking During Pregnancy Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of Smoking During Pregnancy compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks, Asians and Hispanics are better off than whites.

The Hispanic to White ratio for smoking during pregnancy has been decreasing at 3.5% per year since 1996 to 2006.  The Black to White ratio for smoking during pregnancy has been decreasing at 1.1% per year since 1996 to 2006. The Asian to White ratio for smoking during pregnancy has been decreasing at 4.8% per year since 1996 to 2006.  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	0.64	0.87	0.10	
1997	0.69	0.84	0.14	
1998	0.67	0.77	0.11	
1999	0.70	0.82	0.14	
2000	0.77	0.83	0.15	
2001	0.73	0.82	0.15	
2002	0.71	0.81	0.14	
2003	0.68	0.75	0.16	
2004	0.68	0.81	0.18	
2005	0.62	0.72	0.17	
2006	0.60	0.78	0.17	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 19
Heading: Ratio of Adequate Prenatal Care (APNC) by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of Adequate Prenatal Care compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks Asians and Hispanics are worse off than whites.

The Hispanic to White ratio for Adequate Prenatal Care has been increasing at 0.6% per year since 1996 to 2006.  The Asian to White ratio for Adequate Prenatal Care has been increasing at 0.3% per year since 1996 to 2006.  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	0.84	0.86	0.92	
1997	0.85	0.85	0.92	
1998	0.85	0.86	0.92	
1999	0.85	0.89	0.94	
2000	0.85	0.86	0.93	
2001	0.87	0.84	0.92	
2002	0.91	0.86	0.94	
2003	0.90	0.88	0.94	
2004	0.89	0.88	0.96	
2005	0.87	0.88	0.94	
2006	0.88	0.88	0.95	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 20
Heading: Ratio of Breastfeeding Rate by Race Compared to White non-Hispanics Massachusetts Births 1996-2006

This slide has a line chart showing trend over time of the ratio of Breastfeeding Rate compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for show that Blacks, Hispanics and Asians used to be worse off than Whites, but are now all better off than whites.

The Black to White ratio for breastfeeding has been increasing at 1.1% per year since 1996 to 2006The Hispanic to White ratio for breastfeeding has been increasing at 0.5% per year since 1996 to 2006. The Asian to White ratio for breastfeeding has been increasing at 0.5% per year since 1996 to 2006.  .  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	1.00	0.97	0.93	
1997	1.00	0.90	1.01	
1998	1.02	0.97	1.06	
1999	1.04	0.99	1.06	
2000	1.03	1.00	1.04	
2001	1.05	1.02	1.07	
2002	1.08	1.03	1.08	
2003	1.05	1.03	1.07	
2004	1.04	1.03	1.07	
2005	1.03	1.03	1.09	
2006	1.06	1.03	1.11	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 21

Summary of Racial Disparities in Selected Birth Outcomes

This table describes eight different birth outcomes, how the different races compare to whites and whether those ratios are improving, are stable or are getting worse.

Notes at bottom of page:
W means the racial group is worse off than Whites 
E  means the racial group has an equal rate than Whites   
B means the racial group is better than Whites  

Outcome	BLACK TO WHITES	HISPANICS TO WHITES	ASIAN TO 
WHITES	WHITES	
	2006 Ratio  
Status	2006 Ratio  	 Trend of Ratio	2006 Ratio  Status	2006 Ratio  (2006)	Trend of Ratio	2006 Ratio  Status	2006 Ratio 	 Trend of Ratio	 Trend of Rate	
Teen Birth	W	>1	Improving	W	>1	Improving	E	1	Stable	 	
Infant Death	W	>1	Stable	W	>1	Worsening	B	<1	Stable	 	
Cesareans	B	<1	Stable	B	<1	Improving	B	<1	Worsening	Worsening	
GDM	W	>1	Stable	E	1	Stable	W	>1	Stable	 	
LBW among singletons	W	>1	Improving	W	>1	Improving	W	>1	Stable	 	
Smoke	B	<1	Improving	B	<1	Improving	B	<1	Improving	Worsening	
APNC (Kotelchuck)	W	<1	Improving	W	<1	Improving	W	<1	Improving	 	
Breastfeed	B	>1	Improving	B	1	Improving	B	1	Improving	Worsening	

Slide 22

Racial Disparities in Incidence of Selected Cancers

Slide 23

Heading: Ratio of Colorectal Cancer Incidence by Race Compared to White non-Hispanics, Massachusetts Cancer Registry: 1996-2005

This slide has a line chart showing trend over time of the ratio of Colorectal Cancer Incidence compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks, Asians and Hispanics are better off than whites.

The Hispanic to White ratio for colorectal cancer incidence has been increasing at 4% per year since 1996 to 2005.  Since the trend analysis did not show significance for Blacks or Asians, the ratio has remained stable..  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	0.54	0.79	0.78	
1997	0.51	0.99	0.77	
1998	0.60	1.09	0.76	
1999	0.69	0.97	0.56	
2000	0.75	0.93	0.71	
2001	0.75	0.74	0.74	
2002	0.59	0.94	0.71	
2003	0.62	0.97	0.58	
2004	0.72	0.77	0.68	
2005	0.87	0.87	0.78	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 24

Heading: Ratio of Prostate Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Cancer Registry: 1996-2005

This slide has a line chart showing trend over time of the ratio of Prostate Cancer Incidence compared to White, non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Asians are better off than whites. For all years, Blacks are worse off than Whites. Hispanics used to be better off than whites, but beginning in 2002 began faring worse than whites.

The Hispanic to White ratio for prostate cancer incidence has been increasing at 3.4% per year since 1996 to 2005.. Each of the APCs marked with an * shows statistical significance. 

The ratios depicted in the line graph are:

Year	Hispanic to Whites	Black to Whites	Asian to Whites	
1996	0.88	1.46	0.47	
1997	0.82	1.73	0.58	
1998	0.79	1.90	0.37	
1999	0.91	1.67	0.44	
2000	1.07	1.57	0.33	
2001	0.93	1.82	0.56	
2002	1.04	1.42	0.43	
2003	0.99	1.50	0.52	
2004	1.18	1.72	0.47	
2005	1.04	1.46	0.35	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 25

Heading: Ratio of Female Breast Cancer Mortality Rates Compared to White non-Hispanics Massachusetts Deaths:1996-2006

This slide has a line chart showing trend over time of the ratio of Female Breast Cancer Mortality compared to White non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. 

Ratios for all years show that Asians and Hispanics are better off than whites (Note for 2003 Asian rates were not calculated because of small numbers). Black to white ratios have fluctuated over the years, usually as worse off than Whites but in 1999 and 2004 they were better. 

The Hispanic to White ratio for female breast cancer mortality has been increasing at 5.0% per year since 1996 to 2005.  Each of the APCs marked with an * shows statistical significance. 

The ratios depicted in the line graph are:

Year	Black to White	Hispanics to Whites	Asian to White	
1996	1.09	0.34	0.62	
1997	1.14	0.38	0.32	
1998	1.30	0.34	0.98	
1999	0.76	0.61	0.48	
2000	1.09	0.48	0.42	
2001	1.12	0.36	0.29	
2002	1.00	0.61	0.56	
2003	1.48	0.50	not calculated	
2004	0.76	0.44	0.23	
2005	1.33	0.67	0.24	
2006	1.52	0.55	0.50	

Notes at bottom of page:
* Statistically significant (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 26

Heading: Ratio of Lung Cancer Mortality Rates Compared to White non-Hispanics Massachusetts Deaths: 1996-2006

This slide has a line chart showing trend over time of the ratio of Lung Cancer Mortality compared to White non-Hispanics. The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Asians and Hispanics are better off than whites. Blacks are about the same as whites, sometimes slightly better and sometimes slightly worse.

There were no statistical changes in the trend of any of the ratios.  The annual percentage change for the Hispanic to White ratio was -1.4%. The annual percentage change for the Black to White ratio was -0.5%.  The annual percentage change for the Asian to White ratio was 1.5%.  None of the APCs showed statistical significance. 

The data depicted in the line graph is:

Year	Black to White	Hispanics to Whites	Asians to Whites	
1996	0.94	0.29	0.75	
1997	1.06	0.24	0.55	
1998	1.00	0.42	0.47	
1999	1.20	0.31	0.57	
2000	1.03	0.35	0.36	
2001	0.89	0.44	0.56	
2002	0.91	0.53	0.55	
2003	1.04	0.22	0.65	
2004	0.96	0.32	0.40	
2005	1.08	0.34	0.46	
2006	0.94	0.20	0.59	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 27

Heading: Ratio of Liver Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Cancer Registry: 1996-2005

This slide has a line chart showing trend over time of the ratio of Liver Cancer Incidence compared to White, non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios for all years show that Blacks, Asians and Hispanics are worse off than whites. 

The Asian to White ratio for liver cancer incidence has been decreasing at 5.0% per year since 1996 to 2005.  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanics to Whites	Black to Whites	Asian to Whites	
1996	1.26	1.48	5.01	
1997	0.95	1.10	6.13	
1998	2.57	1.51	4.74	
1999	2.72	1.82	4.06	
2000	2.68	1.49	3.59	
2001	2.49	2.38	3.90	
2002	2.51	1.59	3.59	
2003	2.49	2.18	4.28	
2004	1.87	1.74	3.09	
2005	1.83	1.27	3.62	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 28

Heading: Ratio of Stomach Cancer Incidence by Race Compared to White non-Hispanics Massachusetts Cancer Registry 1996-2005

This slide has a line chart showing trend over time of the ratio of Stomach Cancer Incidence compared to White non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios show that Blacks, Asians and Hispanics are worse off than whites. 

There were no statistical changes in the trend of any of the ratios.  The annual percentage change for the Hispanic to White ratio was 0.4%. The annual percentage change for the Black to White ratio was 0.1%.  The annual percentage change for the Asian to White ratio was -2.9%*.  Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Hispanics to Whites	Black to Whites	Asian to Whites	
1996	0.91	1.85	2.39	
1997	0.77	1.56	2.47	
1998	1.27	2.09	1.45	
1999	1.65	2.12	1.87	
2000	2.03	1.45	2.06	
2001	2.19	1.49	1.91	
2002	1.86	1.88	1.25	
2003	2.01	2.07	1.83	
2004	1.99	1.68	1.90	
2005	2.12	1.86	1.73	

Notes at bottom of page:
* Statistically significantly different from 0 (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 29

Summary of Racial Disparities in Incidence of Selected Cancers

 	BLACK TO WHITES	HISPANICS TO WHITES	ASIAN TO WHITES	WHITES	
 	Current Ratio  (2006)	Trend of Ratio	Current Ratio  (2006)	Trend of Ratio	Current Ratio (2006)	Trend of Ratio	Trend of Rate	
 	Status	Ratio	 	Status	Ratio	 	Status	Ratio	 	 	
Colorectal	E	1	STABLE	None	1	WORSENING	B	<1	STABLE	 	
Prostate	W	>1	STABLE	None	1	WORSENING	B	<1	STABLE	 	
Liver	E 	1	STABLE	W	>1	STABLE	W	>1	IMPROVING	 	
Stomach	W	>1	STABLE	W	>1	STABLE	W	>1	STABLE		

Notes at bottom of page:
W racial group is worse off than Whites 
E  racial group has an equal rate than Whites   
B racial group is better of than Whites  

Slide 30

Disparities in Mortality in Massachusetts

Slide 31

Heading: Note Regarding Mortality Rates for Hispanics, Asians and Native Americans

There are limitations to data from death certificates: there is an undercount of Hispanics, Asians, and Native Americans which may result in artificially low mortality rates

Slide 32

Heading: All Cause Mortality Age-Adjusted Death Rates: 1994-2004

This slide shows a column chart comparing death rates across five sub-populations. The data show that the age adjusted death rates for the years 1994 through 2004 are:

White non-Hispanic:  	810.3
Black non-Hispanic:  987
Hispanic:  498.2
American Indian non-Hispanic:  392.8 (marked as an underestimate)
American Indian (Alternative Estimate):  956.7 (marked as an adjusted estimate)

Notes at bottom of page:
Rates are per 100,000 population.  Age-adjusted to the 2000 US standard population

Source:
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 33

Heading: Ratio of All Cause Mortality Rates Compared to White non-Hispanics  Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of All Cause Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios show that for all years shown Blacks are worse off than whites and that Asians and Hispanics are better off than whites.

The Black to White ratio for all cause mortality has been decreasing at 1.5% per year since 1996 to 2006.  The Hispanic to White ratio for all cause mortality increased by 10.9% between 1996 and 2000 and has been decreasing at 1.0% per year since 2000.  The annual percentage change for the Asian to White ratio was not calculated. Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Blacks to Whites	Hispanics to Whites	Asians to Whites	
1996	1.34	0.46	0.58	
1997	1.37	0.52	0.58	
1998	1.33	0.59	0.58	
1999	1.23	0.65	0.56	
2000	1.15	0.71	0.54	
2001	1.18	0.69	0.53	
2002	1.18	0.68	0.52	
2003	1.22	0.68	0.52	
2004	1.16	0.68	0.53	
2005	1.19	0.68	0.53	
2006	1.16	0.66	0.51	

Notes at bottom of page:
* Statistically significant (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 34

Heading: Ratio of Heart Disease Mortality Rates Compared to White non-Hispanics  Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of Heart Disease Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios show that Blacks are usually slightly worse off than whites and that Asians and Hispanics are better off than whites.

There were no statistical changes in the trend of any of the ratios.  The annual percentage change for the Hispanic to White ratio was +1.7% from 1996 to 1998, +15.0% from 1998 to 2001 and -1.9% from 2001 to 2006. The annual percentage change for the Black to White ratio was +0.3%.  The annual percentage change for the Asian to White ratio was -1.5%.  None of the APCs show statistical significance. 

The data depicted in the line graph is:

Year	Black to White	Hispanic to White	Asian to White	
1996	0.97	0.39	0.44	
1997	1.06	0.41	0.41	
1998	1.12	0.40	0.37	
1999	1.12	0.49	0.51	
2000	1.02	0.55	0.39	
2001	1.09	0.61	0.40	
2002	1.03	0.66	0.40	
2003	1.15	0.56	0.44	
2004	1.10	0.55	0.31	
2005	1.16	0.58	0.35	
2006	0.96	0.59	0.42	

Notes at bottom of page:
* Statistically significant (p less than or equal to 0.05)
APC - annual percentage change

Source: 
Massachusetts Department of Public Health, Bureau of Health Information Statistics, Research and Evaluation

Slide 35

Heading: Ratio of Diabetes Mortality Rates Compared to White non-Hispanics  Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of Diabetes Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White and Black to White. Asian to White ratios are not shown. Ratios show that Blacks and Hispanics are worse off than Whites.

There were no statistical changes in the trend of any of the ratios.  The annual percentage change for the Hispanic to White ratio was +3.8%. The annual percentage change for the Black to White ratio was +0.4%.  Neither of the APCs show statistical significance. 

The data depicted in the line graph is:

Year	Blacks to Whites	Hispanics to Whites	
1996	2.06	0.98	
1997	2.69	1.32	
1998	2.28	1.28	
1999	2.32	1.95	
2000	1.83	2.26	
2001	2.33	1.34	
2002	2.26	2.17	
2003	2.45	1.64	
2004	1.99	1.54	
2005	2.18	1.81	
2006	2.51	1.67	

Slide 36

Heading: Ratio of Asthma Mortality Rates Compared to White non-Hispanics  Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of Asthma Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White and Black to White.  Asian to White ratios are not shown. Ratios show that for all years shown Blacks and Hispanics are worse off than Whites. (Note that for 1997 and 2003, the Hispanic to White ratio is not shown.)

The annual percentage change for the Hispanic to White ratio was not shown because of small numbers. The Black to White ratio for asthma mortality has been increasing at 3.0% per year since 1996 to 2006, this was not statistically significant. 

The data depicted in the line graph is:

Year	Black to White	Hispanics to Whites	
1996	2.17	2.23	
1997	4.03	Not calculated	
1998	2.76	1.68	
1999	2.27	3.21	
2000	2.48	5.67	
2001	3.21	4.33	
2002	4.05	2.51	
2003	3.78	Not calculated	
2004	2.19	4.77	
2005	2.76	2.36	
2006	4.75	3.54	

Slide 37

Heading: Ratio of Suicides Rates Compared to White non-Hispanics, Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of Suicide rates compared to White, non-Hispanics. 

The ratios shown are Hispanic to White and Black to White.  Asian to White ratios are not shown. Ratios show that for all years shown Blacks and Hispanics are better off than Whites.

The annual percentage change for the Hispanic to White ratio was -3.6%. The annual percentage change for the Black to White ratio was -0.3%.  Neither APC is statistically significant. 

The data depicted in the line graph is:

Year	Blacks to Whites	Hispanics to Whites	
1996	0.39	0.60	
1997	0.78	0.51	
1998	0.67	0.51	
1999	0.51	0.77	
2000	0.71	0.68	
2001	0.61	0.50	
2002	0.59	0.53	
2003	0.76	0.50	
2004	0.40	0.32	
2005	0.58	0.74	
2006	0.56	0.32	

Slide 38

Heading: Ratio of Homicide Rates Compared to White non-Hispanics, Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of Homicide rates compared to White, non-Hispanics. 

The ratios shown are Hispanic to White and Black to White.  Asian to White ratios are not shown. Ratios show that for all years shown Blacks and Hispanics are worse off than Whites.

The annual percentage change for the Hispanic to White ratio was -0.3%. The Black to White ratio for all homicides has been increasing at 2.3% per year since 1996 to 2006.    Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Blacks to Whites	Hispanics to Whites	
1996	11.78	3.33	
1997	11.33	5.08	
1998	11.80	7.00	
1999	11.50	6.40	
2000	9.40	5.20	
2001	13.90	6.20	
2002	12.92	5.77	
2003	12.00	8.33	
2004	14.27	6.18	
2005	13.46	3.85	
2006	14.00	4.23	

Slide 39

Heading: Ratio of HIV/AIDS Mortality Rates Compared to White non-Hispanics   Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of HIV / AIDS Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White and Black to White.  Asian to White ratios are not shown. Ratios show that for all years shown Blacks and Hispanics are worse off than Whites.

The annual percentage change for the Hispanic to White ratio was -0.7%. The annual percentage change for the Black to White ratio was -0.8%.  Neither of the APCs shows statistical significance. 

The data depicted in the line graph is:

Year	Blacks to Whites	Hispanics to Whites	
1996	10.28	5.59	
1997	13.45	7.38	
1998	9.45	9.81	
1999	7.65	8.87	
2000	9.98	9.56	
2001	9.62	6.19	
2002	10.93	7.15	
2003	8.63	7.28	
2004	9.44	8.18	
2005	12.37	8.82	
2006	8.56	5.25	

Slide 40

Heading: Ratio of Premature Mortality Rates Compared to White non-Hispanics  Massachusetts: 1996-2006

This slide has a line chart showing trend over time of the ratio of All Cause Mortality compared to White, non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios show that for all years shown Blacks are worse off than whites and that Asians are better off than whites. Hispanics have been about the same as Whites, hovering above or below 1.0.

The Black to White ratio for premature mortality has been increasing at 2.2% per year since 1996 to 2006.  The Hispanic to White ratio for all cause mortality increased at 4.8% between 1996 and 2002 and it has remained stable since 2002 (change in trend was not statistical significant).  The Asian to White ratio for premature mortality has been decreasing at 2.7% per year since 1996 to 2006.   Each of the APCs marked with an * shows statistical significance. 

The data depicted in the line graph is:

Year	Black to White	Hispanic to White	Asian to White	
1996	1.78	0.83	0.67	
1997	1.85	0.79	0.63	
1998	1.82	0.95	0.56	
1999	1.61	0.88	0.46	
2000	1.57	0.98	0.51	
2001	1.63	1.03	0.55	
2002	1.70	1.07	0.57	
2003	1.79	1.07	0.61	
2004	1.46	0.91	0.42	
2005	1.46	0.95	0.49	
2006	1.43	0.94	0.47	

Slide 41

Heading: Ratio of Mortality Rates for Causes Amenable to Health Care Compared to White non-Hispanics Massachusetts: 2000 and 2006

This slide has a column chart comparing 2000 to 2006 in terms of the ratio of Mortality Rates for Causes Amenable to Health Care compared to White, non-Hispanics. 

The ratios shown are Hispanic to White, Black to White and Asian to White. Ratios show that for 2000 and 2006, Blacks are worse off than Whites and that Asians are better off than Whites. Hispanics were better off than Whites in 2000 but were the same in 2006.

The data depicted in the column chart is:

Year	Blacks to Whites	Hispanics to Whites	Asians to Whites	
2000	1.36	0.61	0.39	
2006	1.56	0.99	0.58	

End