Bijou R. Hunt

Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States

INTRODUCTION This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 1990 and 2009. METHODS The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-9=174 and ICD-10=C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. RESULTS At the final time point (2005-2009), two RRs were less than 1, but neither significantly so, while 39 RRs were >1, 23 of them significantly so. Of the 41 cities included in the analysis, 35 saw an increase in the Black:White RR between 1990-1994 and 2005-2009. In many of the cities, the increase in the disparity occurred because White rates improved substantially over the 20-year study period, while Black rates did not. There were 1710 excess Black deaths annually due to this disparity in breast cancer mortality, for an average of about 5 each day. CONCLUSION This analysis revealed large and growing disparities in Black:White breast cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. Much work remains to achieve equality in breast cancer mortality outcomes.

Age-Adjusted Diabetes Mortality Rates Vary in Local Communities in a Metropolitan Area: Racial and Spatial Disparities and Correlates

OBJECTIVE Diabetes has held steady as the seventh leading cause of death in the U.S. since 2006. While aggregated data provide insights into how the country as a whole, or even as states, is faring with respect to diabetes mortality, disaggregation provides data that may facilitate targeted interventions and community engagement. RESEARCH DESIGN AND METHODS We analyzed deaths from diabetes for residents of Chicago to calculate age-adjusted diabetes mortality rates (AADMRs). We calculated AADMRs for Chicago by race/ethnicity and community area. We also examined the correlation between AADMR and 1) racial/ethnic composition of a community area and 2) median household income. RESULTS The AADMR for Chicago (27.5 per 100,000 population) was significantly higher than the national rate (22.5). Within both the U.S. and Chicago, the highest AADMRs were found among non-Hispanic blacks, followed by Hispanics, and then non-Hispanic whites. Within Chicago, Puerto Ricans displayed the highest AADMR at 45.7, compared with 35.0 at the national level. There was a strong positive correlation between the proportion of black residents in a community area and the AADMR (0.64). There was a strong negative relationship between household income and the AADMR for the entire city (−0.63) and for the predominantly black community areas (−0.52). CONCLUSIONS These data provide insight into where the worst diabetes mortality problems reside in Chicago. Our hope is that these data can be used to work toward the development of solutions to the very high diabetes mortality rates observed in several communities in Chicago and in similar communities throughout the U.S.

Black:White disparities in lung cancer mortality in the 50 largest cities in the United States

INTRODUCTION This paper presents race-specific lung cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for the 5-year intervals 1990-1994 and 2005-2009. METHODS The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasms of trachea, bronchus, and lung (lung cancer) (ICD-9=162 and ICD-10=C33-C34). Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. We calculated correlation coefficients for 12 ecological variables and the RRs. RESULTS At the final time point (2005-2009), 15RRs were less than 1, but only 8 significantly so while 29RRs were greater than 1, 16 of them significantly so. Of the 45 cities included in the analysis, 21 saw an increase in the Black:White RR between the first and second time points. Measures of socioeconomic status (SES) and inequalities therein were found to be associated with the RRs. CONCLUSION This analysis revealed large disparities in Black:White lung cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. The data demonstrate considerable variation in the degree of disparity across cities, even among cities within the same state. These data can inform and motivate local health officials to implement targeted prevention and treatment strategies where they are needed most, ultimately contributing to a reduction in the disparity in lung cancer mortality rates.

Black:white disparities in breast cancer mortality in the 50 largest cities in the United States, 2005–2014

INTRODUCTION This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 2005 and 2014. METHODS The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-10=C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 2010-2014. To measure the racial disparity, we calculated Black:White rate ratios (RRs) and confidence intervals for each 5-year period. To determine whether changes over time in the disparity were statistically significant, we calculated a 2-sided z score for the change in the relative percent difference between the Black and White rates for 2005-2009 and 2010-2014. RESULTS At the most recent time point (2010-2014), the RR was significantly greater than 1.00 in the US and 24 cities. The change in the Black:White disparity was statistically significant in five cities and the US. The percent difference increased significantly in Atlanta, GA (from 4.1 to 117.4, p<0.001); San Antonio, TX (from 24.4 to 79.3, p=0.034); and the US (from 39.7 to 43.1, p=0.007). The percent difference decreased significantly in Memphis, TN (from 111.0 to 68.9, p=0.043); Philadelphia, PA (from 43.1 to 23.5, p=0.049); and Boston, MA (from 48.9 to 0.7, p=0.022). CONCLUSION This analysis provides updated city-level breast cancer mortality data for Black and White women through 2014, and reveals that in the US and 24 of the 43 largest US cities, Black women continue to die from breast cancer at a higher rate than their White counterparts. Importantly, however, a few cities, Memphis, Boston and Philadelphia, showed a decrease in the Black:White breast cancer mortality disparity between 2005-2009 and 2010-2014.

Metrics for the Systematic Evaluation of Community-Based Outreach

There is an extensive literature on the use of community-based outreach for breast health programs. While authors often report that outreach was conducted, there is rarely information provided on the effort required for outreach. This paper seeks to establish a template for the systematic evaluation of community-based outreach. We describe three types of outreach used by our project, explain our evaluation measures, present data on our outreach efforts, and demonstrate how these metrics can be used to inform a project’s decisions about which types of outreach are most effective.

Maternal Smoking in Chicago: A Community-Level Analysis

Birth certificate data were employed to determine the prevalence of maternal smoking in Chicago communities by race and ethnicity. For purposes of comparison, we present data for the U.S. and the city of Chicago as a whole. Across the city of Chicago, 5.6% of women smoked during pregnancy, a rate much lower than the national average of 13.9%. The maternal smoking rate among non-Hispanic (NH) Black women (11.8%) was more than twice that of NH White women (4.5%) and almost 10 times that of Hispanic women (1.2%). For predominantly NH White and NH Black communities, we observed a significant, negative relationship between household income and the percentage of women who smoke during pregnancy. The prevalence of smoking among NH Black women in Chicago was particularly high, demonstrating an unmet need for appropriate interventions.

Black:White Health Disparities in the United States and Chicago: 1990–2010

ObjectivesIn order to assess progress in eliminating health disparities, a Healthy People 2010 goal, both at the national level and in Chicago, Illinois, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2010.MethodsWe examined 17 health status indicators. In order to determine whether a disparity widened, narrowed, or remained unchanged between 1990 and 2010, we examined the relative percentage difference in rates at both time points and at each location. We calculated P values to determine whether changes in relative percentage difference over time were statistically significant.ResultsDisparities between non-Hispanic Black and non-Hispanic White populations widened for 8 of the 17 health status indicators examined for the USA (6 significantly), whereas in Chicago the majority of disparities widened (9 of 17, 4 significantly). The mortality gap is responsible for more than 60,000 excess Black deaths per year in the USA.ConclusionsDespite substantial effort and funds aimed at meeting the Healthy People 2010 goal of eliminating health disparities, minimal progress has been made.

Stroke Mortality Rates Vary in Local Communities in a Metropolitan Area Racial and Spatial Disparities and Correlates

Background and Purpose— For the past decade, stroke has held steady as one of the top 4 leading causes of death in the United States. Aggregated data provide information about how the country or individual states are faring with respect to stroke mortality, but disaggregation provides data that may facilitate targeted interventions and community engagement. Methods— We analyzed deaths from stroke to residents of Chicago to calculate age-adjusted stroke mortality rates (AASMRs). We calculated AASMRs for Chicago by race/ethnicity, sex, and community area. We also examined the correlation between AASMR and (1) racial/ethnic composition of a community area and (2) median household income. Results— The AASMR for Chicago (44.9 per 100 000 population) was significantly higher than the national rate (42.2). Within both the United States and Chicago, the highest AASMRs were found among non-Hispanic blacks, followed by non-Hispanic whites, and then Hispanics. There was a strong, positive correlation between the proportion of black residents in a community area and the AASMR (0.58). There was a strong, negative relationship between household income and the AASMR for the entire city (−0.56) and for the predominantly black community areas (−0.47). Conclusions— These data provide insight into where the worst stroke mortality problems reside in Chicago. We anticipate that the data can be used to work toward the development of solutions to the high stroke mortality rates observed in several of Chicago’s community areas and in similar communities throughout the United States.

Keys to the Successful Implementation of Community-Based Outreach and Navigation: Lessons from a Breast Health Navigation Program.

The well-documented racial disparities in breast cancer mortality have prompted an aggressive response from the public health community, including the development and implementation of breast health education and breast cancer navigation programs. Many programs are successfully reaching women and providing education and motivation to get screened, and separately, many programs are successfully navigating women who have received abnormal results from a screening mammogram and need follow-up. However, a crucial gap in services remains, where women in the community are not receiving systematic navigation to their initial screening mammogram. This paper describes a community-based, community health worker-led breast health education and screening navigation program, details the metrics used to measure navigation outcomes, and discusses unique features of this project which could be adapted within other settings to initiate similar programming.

Racial Disparities in Prostate Cancer Mortality in the 50 Largest US Cities

INTRODUCTION This paper presents race-specific prostate cancer mortality rates and the corresponding disparities for the largest cities in the US over two decades. METHODS The 50 largest cities in the US were the units of analysis. Data from two 5-year periods were analyzed: 1990-1994 and 2005-2009. Numerator data were abstracted from national death files where the cause was malignant neoplasm of prostate (prostate cancer) (ICD9=185 and ICD10=C61). Population-based denominators were obtained from US Census data. To measure the racial disparity, we calculated non-Hispanic Black: non-Hispanic White rate ratios (RRs), rate differences (RDs), and corresponding confidence intervals for each 5-year period. We also calculated correlation and unadjusted regression coefficients for 11 city-level variables, such as segregation and median income, and the RDs. RESULTS At the final time point (2005-2009), the US and all 41 cities included in the analyses had a RR greater than 1 (indicating that the Black rate was higher than the White rate) (range=1.13 in Minneapolis to 3.24 in Los Angeles), 37 of them statistically significantly so. The US and 26 of the 41 cities saw an increase in the Black:White RR between the time points. The level of disparity within a city was associated with the degree of Black segregation. CONCLUSION This analysis revealed large disparities in Black:White prostate cancer mortality in the US and many of its largest cities over the past two decades. The data show considerable variation in the degree of disparity across cities, even among cities within the same state. This type of specific city-level data can be used to motivate public health professionals, government officials, cancer control agencies, and community-based organizations in cities with large or increasing disparities to demand more resources, focus research efforts, and implement effective policy and programmatic changes in order to combat this highly prevalent condition.