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.

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.

For example, Table 31 ranks the states based on adequacy of prenatal care for 2004.  While this measure is not available by race, a very similar and highly-correlated measure, prenatal care in the first trimester, is available by state and by race for the years 2001 to 2003.   In the United States overall, 83.7 percent of pregnant women received care within the first trimester.  Table 5 shows how this varied by race in the United States, and Table 16 shows prenatal care by race for each state.

Table 5

 Prenatal Care 2001 - 2003

Source: 2001-2003 data, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Birth File.
*Hispanic can be any race

The table shows the difference in prenatal care for individual races and ethnic groups compared to the overall rate. Native Americans have considerably lower (83 percent) prenatal care than average whereas non-Hispanic whites have more care (106%).  These disparities are directly addressable with focused efforts to reach out to pregnant women of all races.

Table 16  shows the prenatal care for each state by race or ethnicity.  It shows the percentage of pregnant women receiving care within the first trimester.  Areas of low care can be used to identify areas where increased efforts are justified. Some example areas are low care less than 60 percent for Hispanics in Alabama and Native Americans in New Mexico, South Dakota and Utah and less than 65 percent for non-Hispanic blacks in New Jersey, South Dakota and Utah, Hispanics in Indiana, Nevada, Oklahoma, South Carolina, South Dakota, Tennessee and Utah.

Disparities are also present in health outcomes.  Table 19 shows the age-adjusted rate for all invasive cancers.  For all races, the rate is 482.9 cases per 100,000 population.  However, it varies from less than 300 cases per 100,000 population for Hispanics in Alaska, Delaware, Iowa and North Carolina to more than 550 cases per 100,000 for blacks in Michigan. 

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.