Selected Comparisons of Measures of Health Disparities
A Review Using Databases Relevant to Healthy People 2010 Cancer-Related Objectives
Sam Harper John Lynch
Department of Epidemiology, Biostatistics, and Occupational Health
US National Cancer Institute, 2008
Available online PDF [102p.] at: http://webpages.mcgill.ca/staff/Group1/sharpe2/web/2008ncimonograph2.pdf
“…The purpose of this report is to empirically evaluate the performance and suitability of various measures of health disparity for the purpose of monitoring disparities in cancer-related health outcomes.
The goal of these analyses was to examine the consistency of different measures of health disparity across a range of cancer-related outcomes.
First, we concluded that all measures of health disparity implicitly or explicitly contain value judgments concerning the relative importance of capturing different aspects of health disparity. Two of the most important considerations concern:
1) How much weight to give to individuals?
2) How much to weight the health of individuals of different social groups? Should our measures of health disparity be more sensitive to health improvement among the socially disadvantaged than the advantaged?
Summary of results of these analyses:
1. Does the choice of a measure of disparity matter for assessing cancer-related disparity trends?
2. How often does the choice of disparity measure matter?
3. Why does the choice of disparity measure matter?
4. What are the implications for monitoring health disparities?
Content:
Executive Summary
Introduction
Methods
Measures of Absolute Disparity
Measures of Relative Disparity 1
Presentation of Results
Results
Case Study 1: Racial Disparities In Lung Cancer Incidence, 1990-2001
Case Study 2: Area Socioeconomic Disparities in Lung Cancer Incidence, 1988-1999
Case Study 3: Area Socioeconomic Disparities In Colorectal Cancer Mortality, 1950-2000
Case Study 4: Area Socioeconomic Disparities in Prostate Cancer Mortality, 1950-2000
Case Study 5: Socioeconomic Disparities in Smoking, 1965-2003
Case Study 6: Race and Ethnic Disparities in Breast Cancer Incidence, 1990-2001
Case Study 7: Socioeconomic Disparities in Obesity, 1960-2000
Case Study 8: Race and Ethnic Disparities in Cervical Cancer Incidence, 1990-2001
Case Study 9: Social Disparities in Mammography Screening, 1987-2003
Case Study 10: Geographic Disparities in Stomach Cancer Mortality, 1950-2001
Socioeconomic Disparity Trends
Race and Ethnic Disparity Trends
Geographic Disparity Trends
Comparing Socioeconomic and Race and Ethnic Disparity Trends
Conclusions
Appendix: Random Variation
References
This report was written under contract from the Surveillance Research Program (SRP) and the Applied Research Program (ARP) of the Division of Cancer Control and Population Sciences of the National Cancer Institute, NIH.
This monograph was written as a follow-up to:
Harper S, Lynch J. Methods for Measuring Cancer Disparities: Using Data Relevant to Healthy People 2010 Cancer-Related Objectives.
NCI Cancer Surveillance Monograph Series, Number 6.
Methods for Measuring Cancer Disparities:
Using Data Relevant to Healthy People 2010 Cancer-Related Objectives
Sam Harper, John Lynch, Center for Social Epidemiology and Population Health
This report was written under contract from the Surveillance Research Program (SRP) and the Applied Research Program (ARP) of the Division of Cancer Control and Population Sciences of the National Cancer Institute, NIH. Additional support was provided by the Office of Disease Prevention in the Office of the Director at the National Institutes of Health
Available online as PDF file [80p.] at: http://seer.cancer.gov/publications/disparities/measuring_disparities.pdf
“……This report raises some conceptual issues and reviews different methodological approaches germane to measuring progress toward the goal of eliminating cancer-related health disparities. Despite the increased attention to social disparities in health, no clear framework exists to define and measure health disparities. This may create confusion in communicating the extent of cancer-related health disparities and hinder the ability of public health organizations to monitor progress toward the Healthy People 2010 cancer objectives. ….”
Table of Contents
Summary .
Introduction .
Initiatives to Eliminate Health Disparities
Brief History of Measuring Disparities in the
Health Inequality and Health Inequity
Defining Health Disparities
Issues in Evaluating Measures off Health Disparity
Total Disparity vs. Social-Group Disparity
Relative and Absolute Disparities .
Reference Groups
Social Groups and “Natural” Ordering
The Number of Social Groups
Population Size
Socioeconomic Dimension
Monitoring Over Time
Subgroup Consistency .
Decomposability
Scale
Transparency/Interpretability for Policy Makers
Measures of Health Disparity
Measures of Total Disparity .
Measures of Social-Group Disparity
Measures of Average Disproportionality
Choosing a Suite of Health Disparity Indicators
Summary Indicators .
References
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