Thursday, July 17, 2008

[EQ] Selected Comparisons of Measures of Health Disparities

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

McGill University, Montreal, Quebec

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. Bethesda, MD: National Cancer Institute, 2005. NIH Publication No. 05-5777.

 

 

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

University of Michigan, 2006

 

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 United States

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 Independence

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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