The City of Houston Health Disparities Data Report
March 2008 The City of Houston Health Disparities Data Report
2008
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Distributed by the City of Houston Department of Health and Human Services Dear Fellow Houstonians:
The Houston Department of Health and Human Services (HDHHS) is committed towards eliminating health disparities for vulnerable populations as defined by race/ethnicity, socio- economic status, geography, gender, age, disability status, and risk status related to sex and gender. Health disparities are defined as differences in health conditions which exist between specific population groups, resulting in one group having a disproportionate burden of disease, disability, or premature death.
The purpose of the HDHHS is to protect and promote the health and well-being of all Houston residents through advocacy, education, and community-based health services. Houston is both the largest city in Texas and fourth largest city in the United States; a growing, diverse city with a vibrant economy in industries of energy, production, processing, science, medicine, and technology. The Texas Medical Center is one of the largest concentrations of hospitals and medical teaching facilities in the nation, and is renowned as a leader in research, education, and medical treatment. Despite the gains in overall health care and public health, not all Houstonians have seen the same benefits in improved health advances.
The HDHHS, in conjunction with local, statewide, and national efforts, is committed to eliminating health disparities among vulnerable populations. Mayor Bill White and other community and health care leaders are working to address this important social justice issue. Eliminating health disparities will require efforts to address the persistent racial, economic, and other social challenges that lead to inequitable health outcomes. Investing in the health of Houstonians must begin with improving access to quality preventive health services, creating conditions for socially and physically healthy communities, reducing poverty and other social inequities, and promoting healthy lifestyles. This requires an understanding of the vulnerable groups in Houston and the risk factors which affect each group.
This report is the first in a series designed to foster concrete and actionable change. We hope it will promote coordinated efforts amongst all our health and community partners to highlight and help address the glaring social health inequities uncovered in this report.
Respectfully,
Stephen L. Williams, M.Ed., M.P.A. Director Houston Department of Health and Human Services PAGE 2 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 1
Introduction and Highlights
“The future health Overview of the nation will be Health disparities are differences in health conditions that exist between determined to a specific population groups, resulting in one group having a disproportionate large extent by how burden of disease, disability, or premature death. These population groups effectively we work can be defined through different demographic measures, such as with communities geography, gender, age, sexual orientation, socio-economic status, or race/ ethnicity. Since evidence shows that health disparities among race/ethnic to reduce and groups correlate with differences in other socio-economic factors, in this eliminate health report, we will focus on health disparities based on race/ethnicity. disparities between non-minority and Since race is a social construct rather than a biological one, health disparities are not the result of differences in genetic factors either. Instead, minority racial disparities in health are the result of social factors that create populations inequalities among different racial/ethnic groups. These factors include experiencing poverty, unemployment, education, safe and affordable housing, health care disproportionate access, transportation, discrimination, and racism. burdens of disease, Health disparities affect everyone, not just populations which are disability, and economically and socially disadvantaged. Not only are health disparities premature death.” unjust, they affect economic productivity and drive up the cost of health care for everyone. Therefore, eliminating health disparities will help to create — Centers for healthy, productive, and economically viable communities. Moreover, demographic trends show that racial/ethnic groups which experience poorer Disease Control health will continue to grow and make up a larger proportion of the total and Prevention, Houston and U.S. population in the future. Thus, addressing health Office of Minority disparities has become both a local and national priority, as the inter- Health & Health connection affects us all. Disparities
Purpose of this Report
This health disparities data report is not intended to Addressing health disparities requires a shift in think- be a definitive explanation of how social inequities ing: rather than focusing on changing individual be- such as poverty or racism lead to differences in haviors, the focus will shift to altering conditions at health outcomes. However, it is meant to highlight the community level that influence health. The elimi- some factors related to the health of racial/ethnic nation of health disparities requires multidisciplinary groups and identify potential underlying causes. action and partnerships to address social and envi- ronmental factors in order to create safe and healthy To understand the health disparities which exist neighborhoods in Houston. among different racial/ethnic groups in Houston, this report begins with a look at Houston’s demo- The Houston Department of Health and Human Ser- graphic makeup. Next, it examines differences in vices (HDHHS) hopes this report can be used to some social factors that influence health outcomes, highlight and identify disparities which exist and also otherwise known as health determinants, among serve as a useful planning tool. The idea is to help different racial/ethnic groups in Houston. Finally, a guide the creation of public policies and efficient use “health profile” is given for each racial/ethnic group, of resources to transform living conditions in order to providing a closer look at some health burdens build healthier communities benefiting everyone. which disproportionately affect these populations. PAGE 2 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Other Efforts on Health Disparities
This report builds upon the work of many others, Recently, RAND Health1 created the Center for in both public and private sectors. The U.S. De- Population Health and Health Disparities to study partment of Health and Human Services (HHS) how neighborhood environments influence health. includes eliminating health disparities as one of its main goals, as featured in it’s Healthy People Other efforts toward reducing health disparities have 2010 program focused on disease prevention focused, in particular, on reducing gaps in health and health promotion. The Office of Minority care access and improving health care quality. The Health & Health Disparities (OMHD) of the Cen- federal Agency of Healthcare Research and Quality ters for Disease Control and Prevention (CDC) has released a series of reports on national health also targets eliminating health disparities for vul- care disparities. Major health insurers, including nerable populations. Many other state and local Aetna, CIGNA, Kaiser Permanente, and United- health departments, including Boston, New York Health Group, have also focused their attention on City, Alameda County, Indiana, and Minnesota decreasing health care disparities through various have produced reports documenting health dis- activities such as forming a collaboration to share parities which exist in their respective localities. new strategies, gathering and analyzing data, cul- Various strategies used by different states to ad- tural-competency trainings, and targeted education, dress disparities have included creating state- outreach, and interventions. A more detailed table wide task forces, holding community forums, and of areas in health disparities identified by various offering grants to fund new initiatives to reduce organizations can be found in Appendix A. More health disparities. Major research institutions information on health care disparities can be found have also prioritized health disparity reduction. in the section on health care access.
Highlights of this Report
Houston is a diverse city with a large, grow- The Hispanic or Latino population in Houston ing minority population. Over 60% of the experiences worse outcomes for some health population is made up of Hispanic or Latino, indicators than the White population (non- Black or African American, and Asian resi- Hispanic or Latino). These include higher mor- dents. tality rates from diabetes, obesity, tuberculosis, and kidney disease. They also have lower lev- Socio-economic status affects health; els of health care access for preventive ser- hence, minorities in Houston experience vices. greater disparities in socio-economic fac- tors. The Hispanic or Latino population in The White population (non-Hispanic or Latino) in Houston has lower levels of educational Houston has worse outcomes for some health attainment and experience greater poverty indicators than other racial/ethnic groups. than other racial/ethnic groups in Houston. These include higher rates of mortality from chronic lower respiratory disease, Alzheimer’s, Access to health care services affects and suicide, as well as higher rates of breast health outcomes. Hispanics or Latinos and cancer and heart disease. Asians in Houston experience the greatest obstacles to health care access. A larger There is a lack of information and data on the percentage of Hispanics or Latinos lack health status of the Asian population in Houston. health insurance or a regular source of care Although some efforts are being made to obtain and are unable to afford health services. data, more collaboration and resources are needed. The little information that is available The Black or African American population in indicates that Asians have less access to cancer Houston experiences worse health for a screening, experience higher rates of tuberculo- wide-range of health indicators than any sis and hepatitis B, and engage in lower rates of other racial/ethnic groups in Houston. These physical activity. include greater rates of overweight/obesity, infant mortality, diabetes, HIV/AIDS and Improved data collection and standardization other sexually transmitted diseases, and are needed to correctly identify all high-risk mortality for numerous conditions including populations and monitor the effectiveness of heart disease, cancer, stroke, and diabetes. interventions.
1 RAND Health is a research division within RAND Corporation (the name initially derived from a contraction of the term research and development), the first organization to be called a “think tank” and a leading nonprofit institution focused over 50 years on improving policy and decision-making through research and analysis. RAND Health continues that tradition, advancing understanding of health and health behaviors, and examining how the organization and financing of care affect costs, quality, and access. More information may be found at www.rand.org/health CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 3
Demographics The difference between Race and Ethnicity The standards of Race and Ethnicity are officially follow those used in the U.S. Census, which allows established by the Executive Office of the Presi- people to self-designate the racial/ethnicity categories dent, Office of Management and Budget (OMB), they identify most closely with. These groups include with five minimum categories for data on race: White (non-Hispanic or Latino), Black or African American Indian or Alaska Native, Asian, Black or American, Asian, and Hispanic or Latino. Other racial African American, Native Hawaiian or Other Pa- categories used in the Census, such as American In- cific Islander, and White; and, two categories on dian/Alaska Native and Native Hawaiian/Other Pacific ethnicity: “Hispanic or Latino” and “Not Hispanic or Islander do not appear in this report since there were Latino.”1 not enough Houston residents that self-identified in these categories. Race is a social construct and does not conform to any biological, anthropological, or genetic crite- Although racial/ethnicity categories have been clearly ria or similarities. Ethnicity is defined as the heri- defined per the official standards of the U.S. Census tage, nationality group, lineage, or country of birth Bureau, the HDHHS does not assume all data collec- of the person or the person’s parents or ancestors tors (used in this report) followed the same criteria. before their arrival to the United States.2 How Race and Ethnicity categories are The race and ethnicity categories set forth in the defined in this report. standards should not be interpreted as being pri- marily biological or genetic in reference. Race “White” refers to people having origins in any of and ethnicity may be thought of in terms of social the original peoples of Europe, the Middle East, or and cultural characteristics as well as ancestry.1 North Africa. It includes people who indicated The ethnic term “Hispanic” was officially adopted their race or races as “White” or wrote in entries by the U.S. Census Bureau in the 1970’s to cate- such as Irish, German, Italian, Lebanese, Near gorize people’s origin or descent from Mexico, Easterner, Arab, or Polish. Puerto Rico, Cuba, Central or South America, “Black or African American” refers to people Caribbean, and Spain who they deemed shared having origins in any of the Black racial groups of common cultural values. In 2000, the ethnic term Africa. It includes people who indicated their race “Latino” first appeared on the census form with or races as “Black, African American or Negro,” or additional space to write Hispanic origins, such as wrote in entries such as African American, Afro Salvadoran or Dominican, a practice started in the American, Nigerian, or Haitian. 1990 census.3 “Asian” refers to people having origins in any of The federal government considers Race and His- the original peoples of the Far East, Southeast panic or Latino origin to be two separate and dis- Asia, or the Indian subcontinent. It includes peo- tinct concepts. Hispanics or Latinos may be of ple who indicated their race or races as “Asian any race, including White, Black or African Ameri- Indian,” “Chinese,” “Filipino,” “Korean,” can, American Indian or Alaska Native, Asian, Na- “Japanese,” “Vietnamese,” or “Other Asian,” or tive Hawaiian or Other Pacific Islander, and Some 4 wrote in entries such as Burmese, Hmong, Paki- Other Race. stani, or Thai. For persons who consider themselves to be multi- “Other” refers to people having origins of Ameri- racial, biracial, or mixed race, Census 2000 first can Indian/Alaska Native, Native Hawaiian/Other allowed the opportunity for survey respondents to Pacific Islander, and individuals belong to two or self-identify more than one race to indicate their more racial groups. racial identity. “Hispanic or Latino” ethnicity refers to a person In public health, race categories can be used to of Mexican, Puerto Rican, Cuban, South or Cen- provide consistent data to measure the glaring tral American, or other Spanish culture or origin health disparities and risks of different popula- regardless of race. tions. Race and ethnicity categories in this report SOURCE: U.S. Census Bureau, Overview of Race and Hispanic Origin, 2001.
1 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Federal Register Notice, October 30, 1997, Office of Management and Budget (OMB). 2 Questions and Answers for Census 2000 Data on Race, U.S. Census Bureau, March 14, 2001. 3 The Hispanic Population, Census 2000 Brief, U.S. Census Bureau. 4 Racial and Ethnic Classifications Used in Census 2000 and Beyond, U.S. Census Bureau, April 12, 2000. PAGE 4 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Houston/Harris County’s Demographic Makeup
Like many other large cities in the United States, Harris County Population in 2005, by Houston is a diverse city with a large, growing Race/Ethnicity minority population. In 2005, Houston/Harris County’s total estimated population was about 3.6 million. Of these residents, 38% were White. The Other Hispanic or Latino population was the largest As ian 1% minority group at 38%, representing over one out 5% of every three Houston residents. The Black or Black White African American population was about half that 18% size at 18%, and Asians made up the smallest 38% minority group at 6%. Other racial groups included American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and individuals belonging to two or more racial groups. Hispanic or Latino 38%
SOURCE: U.S. Census Bureau, American Community Survey, 2005.
Immigration Fertility
In 2004, almost one in every four Houston resi- dents was born outside the U.S. These immi- Fertility Rates in Harris County, grants came largely from Latin America, with 4% by Race/Ethnicity from Asia, and 1% each from Europe and Africa. Of the minority groups, the Hispanic or Latino and Asian populations have the largest percentages of 120 100 foreign-born. The breakdown of these subgroups 100 can be seen on the following pages. 72 80 65 Place of Birth of Harris County 60 47 Residents, 2005 40
Latin Reproductive Age 20 America, 0 18% Births 1,000 per Women of
Africa, 1% Asian White
Asia, 4% African Hispanic or Latino Black or American Eur ope, 1%
SOURCE: U.S. Census Bureau, American Community Survey, 2005. U.S. & U.S. Territories, Another factor which influences demographics is the 75% number of births in a population. The Hispanic or Latino population in Houston has the highest general fertility rate.
SOURCE: U.S. Census Bureau, American Community Survey, 2005. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 5
Demographics of Houston’s Hispanic or Latino Population
The Hispanic or Latino population is the largest minority group in Hous- Countries of Origin for Harris County's ton/Harris County. Approximately Hispanic or Latino Population 42% of this population is foreign- born. Although Hispanic or Latino immigrants come from many different Other Central American Countries 0.9% countries, the largest percentage is from Mexico. The Hispanic or Latino Colombia 1.4% population is the youngest of all race/ ethnic groups in Houston: 83% of Other South American Countries 1.5% this group is under the age of 45. Guatemala 1.8% Within the Hispanic or Latino popula- tion group, there are differences de- El Salvador 5.2% pending on one’s country of origin. For example, immigrants from Cuba Mexico 31.6% and South America usually arrive in Houston with higher levels of educa- U.S. & U.S. Territories 57.7% tion and professional training than 1 U.S.-born Hispanics or Latinos. 0% 20% 40% 60% 80% Immigrants from Mexico and Central America usually come to the U.S. Percentage of Hispanic or Latino Population with less formal education and eco- nomic resources, and fill lower- SOURCE: U.S. Census Bureau, American Community Survey, 2004. skilled occupations. They are at higher risk of poverty.1
Demographics of Houston’s Black or African American Population
The Black or African American popu- lation is the second largest minority Countries of Origin for Harris County's group in Houston. Of all minorities, Black or African American Population they have the longest history in Houston. In fact, only 11% of the Black population is foreign-born. Trinidad & Tobago 0.4% The immigrants in this group come largely from Nigeria, Kenya, and Ja- Jamaica 0.4% maica, with a few from other African Other Caribbean Countries 0.6% and Central American/Caribbean countries. Kenya 0.7%
Nigeria 1.9% Distinctions exist among the Black or African American population group Other African Countries 1.9% depending, again, on the country of U.S. & U.S. Territories 96.0% origin. Immigrants from Africa, largely Nigeria, have higher levels of 0% 20% 40% 60% 80% 100% 120% education than any other immigrant group, whereas those from Latin Percentage of Black or African American Population America and the Caribbean, largely Jamaica, come with educational lev- SOURCE: U.S. Census Bureau, American Community Survey, 2004. els comparable to U.S.-born Blacks or African Americans.1
1Klineberg SL. The Houston Area Survey 1982-2005: Public Perceptions in Remarkable Times. 2Department of Labor, Occupational Safety and Health Administration (OSHA). PAGE 6 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Demographics of Houston’s Asian Population
The Asian population is the smallest minority group in Houston, yet the most diverse. It has Countries of Origin for Harris the largest proportion of immigrants with ap- County's Asian Population proximately 74% of the Asian population for- eign-born. The largest percentage of Asian im- migrants come from Vietnam, followed closely Other South Eastern Asia 3.0% by India, then China. Japan 3.3% The Asian population is not homogeneous and Korea 4.0% includes many groups who differ in language, Pakis tan 4.8% culture, and length of residence in the United States. Asian refers to people having origins in Philippines 7.7% any of the original peoples of the Far East, China 12.2% Southeast Asia, or the Indian subcontinent. Asian groups are not limited to nationalities but India 14.4% 1 include ethnic terms as well, such as Hmong. Vietnam 22.7% The Vietnamese face greater socio-economic U.S. & U.S. Territories 25.9% challenges than other Asians. A greater per- centage of Vietnamese do not have high school 0% 10% 20% 30% diplomas, compared with the other Asian Percentage of Asian Population groups.2 Most of the Vietnamese immigrants in Houston who arrived after the 1980s came to 2 escape political persecution or war. They gen- SOURCE: U.S. Census Bureau, American Community Survey, 2004. erally have lower formal education and speak little English.2
Demographics of Houston’s White Population
The White population (non-Hispanic or Latino) is currently the largest population group in Countries of Origin for Houston's Houston, but is experiencing little growth. This White Population population is older, on average, than the other race/ethnic groups. In Houston, like other cit- ies in the U.S., the White population is “aging” Southern Europe 0.2% more rapidly: 41% of the White population is 45 and older. Unlike the other racial/ethnic Northern Africa 0.3% groups in Houston, this group does not have a continuous influx of younger immigrants. Only Western Europe 0.8% 5% of this group is foreign-born. These immi- grants come largely from Iran, the U.K., Rus- Eastern Europe 0.9% sia, and other European countries. Northern Europe 0.9% The chart on the right shows Western Asia in- cluding Lebanon, Israel, Turkey, Iran, etc. Western Asia 1.0% Northern Europe includes the U.K., Ireland, etc. Eastern Europe includes Russia, Hungary, Ro- U.S. & U.S. Territories 95.0% mania, Ukraine, etc. Western Europe includes France, Germany, etc. Northern Africa in- 0% 20% 40% 60% 80% 100% cludes Egypt, and Southern Europe includes Greece, Italy, etc. Percentage of White Population
SOURCE: U.S. Census Bureau, American Community Survey, 2004.
1We the People: Asians in the United States, U.S. Census Bureau, December 2004. 1Klineberg SL. The Houston Area Survey 1982-2005: Public Perceptions in Remarkable Times. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 7
Socioeconomic Status and Health How does socio-economic status The Whitehall Study: affect health? Socio-economic Status Affects Health
Studies have shown that socio-economic status, The well-known Whitehall Study1 followed the same measured in terms of education and income, af- population of civil servants who worked white-collar fect health status in many ways. People with jobs in London over a period of time, and revealed lower socio-economic status have worse health disparities in health outcomes resulting from outcomes because of their limited ability to afford differences in socio-economic status. The subjects all basic necessities such as nutritious food, safe, had the same national health service and were from quality housing, medical care, and health insur- the educated middle-class, yet those in lower civil ance. Socio-economic status also determines service positions had higher mortality rates, and those educational and employment opportunities and in higher civil service positions had lower rates for affects the context in which people live, such as many different health conditions and diseases. Health the availability of resources within communities, status improved with increasing levels of socio- and exposure to various health risks. Disparities economic status. This study showed that there were in socio-economic status affect people’s health factors operating at a broader societal level that status across all racial groups. determined health, rather than merely individual factors that caused disease.
Self-reported Health Status
In 2005, the Texas Department of Self-Reported Health Status of Harris State Health Services asked adults County Adults in Houston to rate their health as “Excellent,” “Very Good,” “Good,” “Fair,” or “Poor.” Over a quarter of 100% Hispanics or Latinos in Houston rate 80% their health as “Fair” or “Poor,” nearly twice that of Whites. 71% 60% 74% 85% 40% Black or African American and Hispanic or Latino persons were 20% 29% more likely to report their health 26% 15% 0% as “Fair” or “Poor” than Whites. Hispanic or Black or White Percentage of respondents of Percentage Latino African American Fair or Poor Good, Very Good, Excellent
SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Harris County, 2005.
1 Marmot MG, Smith, GD, Stansfeld S, et al. Health Inequalities Among British Civil Servants: The Whitehall II Study. Lancet. 1991;337:1387-93. PAGE 8 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Education
Educational attainment is a socio-economic indicator U.S.-Born Harris County Residents because people with higher levels of education tend to Without High School Diplomas have greater income potential and better health out- comes, such as lower mortality and fewer illnesses and disabilities.1 25% 20% 20% Educational attainment is not equivalent across race/ 15% 12% ethnic groups in Houston. Whites and Asians have the largest levels of education. 10% 5% 5% 0% Hispanic or Black or White Percentage respondents of Latino African American U.S.-Born Harris County Residents
SOURCE: Rice University Houston Area Survey 2005, Data from 1994-2005. With College Degree or Higher *Data not available for Asians. 70% 61% A greater percentage of Blacks or African Ameri- 60% cans and Hispanics or Latinos do not have a high 46% school diploma. In fact, the percentage of U.S.- 50% born Hispanic or Latino adults who do not have a 40% high school diploma is more than three times 30% 25% greater than that of Whites. 20% 16% 10% The same pattern holds for adults who attain a respondents of Percentage college degree or higher. Again, a lower percent- 0% age of Blacks or African Americans and Hispan- Hispanic Black or Asian White ics or Latinos have a bachelor’s degree. The or Latino African disparity in educational attainment is greatest American for the Hispanic or Latino population in Hous- ton, followed by Blacks or African Americans. SOURCE: Rice University Houston Area Survey 2005, Data from 1994-2005.
Income
Racial disparities in income and wealth are sig- nificant factors which underlie racial disparities in Per Capita Income of Houston Residents health status. Minorities are significantly more likely to have lower incomes than their White $40,000 $35,496 counterparts. According to the U.S. Census $30,000 $23,271 Bureau, the average income for a White person $17,045 $12,978 in Houston in 2004 was $35,496. Hispanics or $20,000 Latinos and Blacks or African Americans had $10,000 average incomes of less than half this amount. $0 Hispanic Black or As ian White or Latino African American
SOURCE: U.S. Census Bureau, American Community Survey, 2004.
1 Lahelma E, Martikainen P, Laaksonen M, Aittomaki A. Pathways between socioeconomic determinants of health. J Epidemiol Community Health. 2004;58:327-32. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 9
Occupation and Employment The Working Poor National Unemployment Rates by Race/Ethnicity The U.S. Department of Labor released the report “A Profile of the Working Poor” in 2004.1 High- lights from this national report include Asian Female 3.1 Black or African American and Hispanic or Latino workers were more likely to be among Asian Male 3.0 the working poor than Whites, at all levels of Hispanic Female 5.9 educational attainment. Workers with lower educational attainment Hispanic Male 4.8 had a higher risk of being poor. For instance, in 2004, 15.2% of workers with less than a Black Female 8.4 high school diploma were among the working poor, compared to 1.7% of college graduates. Black Male 9.5 Those employed in management and profes- sional related occupations had the lowest White Female 4.0 probability of being among the working poor, whereas those in service occupations had the White Male 4.0 highest probability. Black or African American and Hispanic or 0.0 2.0 4.0 6.0 8.0 10.0 Latino teenage workers were more likely to be Rate per 100,000 persons in poverty. Among families, those with children under 18 years old were more likely to live in poverty or SOURCE: U.S. Department of Labor, Bureau of Labor Statistics, Current Population be among the working poor. Survey, 2006
Occupational Employment in U.S. by Race/Ethnicity The working poor are more likely to experience labor market problems such as unemployment, low earnings, 12% Production, transportation, & material 10% and involuntary part-time employ- 16% 1 mov ing 18% ment. National labor statistics show 12% that unemployment rates are higher Natural resources, construction, & 4% 7% among Blacks or African Americans maintenance 20% and Hispanics or Latinos. 25% 22% Sales & office 26% This chart shows the distribution of 21% workers in different occupational cate- 15% gories by race/ethnicity. Nationally, 16% Service 24% nearly a quarter of Hispanic or Latino 24% and Black or African American work- 36% ers are employed in service occupa- 47% Management, professional, & related 27% tions. Hispanics or Latinos are least 17% represented in management and pro- 0% 10% 20% 30% 40% 50% fessional related occupations.
Percentage of Employed Persons In Harris County, the lower educa- tional levels of Blacks or African Hispanic Black Asian White Americans and Hispanics or Latinos may preclude them from certain occu- SOURCE: U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, 2006 pational categories, increasing their risk of being poor, uninsured, and liv- ing in poverty.
1 An individual is classified as “working poor” if he/she was in the labor force for over half the year with an income below poverty level. U.S. Department of La- bor, U.S. Bureau of Labor Statistics. “A Profile of the Working Poor, 2004.” May 2006, Report 994. PAGE 10 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Poverty Threatens Poverty Houston’s Prosperity: The United States government determines the federal poverty level yearly. In 2004, the federal poverty level was $18,850 in yearly income for a family “Thus we find ourselves of four according to the U.S. Census Bureau Approximately 20% of at a remarkable hinge Hispanics or Latinos and 20% of Blacks or African Americans in Houston in history, a time when had incomes below the poverty level in 2004. Whites had the smallest percentage of persons with incomes below the poverty level (5.2%). 75% of everyone in the region is 60 years or older is Anglo, and Harris County Residents Living in close to 75% of Poverty everyone under the age More 25% 21% minorities, 19% of 30 is either Black or 20% both Hispanic. These are children and 15% the two populations 11% adults, live that are by far the most 10% 5% in poverty. likely to be living in 5% poverty and that have 0% been the least well Hispanic or Black or As ian White served historically by Latino African the region’s educational American and social service institutions. SOURCE: U.S. Census Bureau, American Community Survey, 2004. Poverty places children at risk for lower educational achievement, Clearly, if the socio- inadequate nutrition, and poor health outcomes in childhood and adulthood. economic disparities Hispanic or Latino and Black or African American children in Houston are are not substantially more likely to live at or below the poverty level than children of any other reduced, if too many of race/ethnic group. In 2004, 28.5% of Hispanic or Latino children and 25.5% of Black or African American children lived in households at or below the Houston’s “minority” poverty level, compared with 4.2% of White children. youth remain unprepared to succeed in the knowledge Harris County Children Living in Poverty economy of the twenty- 30% 29% first century, it is 26% difficult to envision a 25% More Black or prosperous future for African 20% American and the region.” Hispanic or 15% 11% Latino -Stephen Klineberg, 10% Houston 4% Ph.D., Rice University1 5% residents live in poverty 0% than Whites. Hispanic Black or Asian White or Latino African American
SOURCE: US Census Bureau, American Community Survey, 2004.
1 Klineberg SL. The Houston Area Survey 1982-2005: Public Perceptions in Remarkable Times, Rice University. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 11
Geographic Distribution of Poverty in Houston
In 2000, the neighborhoods in Houston with the Approximately 16% of Houston families were below highest concentrations of poverty were Greater the poverty level in 2000.1 The highest concentra- Third Ward, Greater Fifth Ward, Downtown, and tion of poverty among Houston families was also in Settegast. These areas had over 40% of their the eastern half of Houston. The greatest number of population below the federal poverty level.1 Un- families experiencing poverty were in the southwest fortunately, many Houston residents struggle with outside the 610 Loop and north of downtown.1 poverty; in 2000, in half of Houston’s Super Neighborhoods, 20-40% of the population fell below poverty level.1 These areas were mostly concentrated in the eastern half of the City, with a few areas in the northwest and southwest as well.
SOURCE: Houston Department of Health and Human Services, Community Health Statistics– GIS.
1 Houston Housing and Households 2000, City of Houston Planning and Development Department, Long Range Planning Division. PAGE 1 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Section PAGE 12 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Racism and Discrimination How does Race/Ethnicity affect health? Racism and discrimination can cause poor health For example, in Houston’s Third Ward (which had in minority groups, indirectly or directly. Institution- one of the highest poverty rates in 2000), property alized racism affects the educational, employment, values have increased and attracted developers.1 housing, and social opportunities of minorities. Higher tax rates and rent could lead to displace- These inequities in social structure and class can ment of the area’s poor residents. In health care cause minority groups to become marginalized and settings, racism leads to differences in health care have less access to quality education and higher- treatment for minorities, and can cause mistrust of paying jobs. They may be forced to live in commu- the health care system, delaying patients from nities and housing that pose greater environmental seeking timely medical attention. hazards, such as lead paint or hazardous waste sites, and fewer resources, such as political capital Racism also can have a direct impact on the men- or public transit. Living in higher crime areas and tal and physical health of individuals, causing in- unsafe neighborhoods also make it more difficult to creased stress, hypertension, heart disease, de- maintain a healthy lifestyle. Parks, or other areas pression, smoking, and alcohol use in minority for recreation/physical activity, may not be avail- populations. Researchers have observed that dis- able or safe and food options can become more crimination also has long-term consequences over limited with fewer grocery stores and a greater con- a person’s life, and can even contribute to low birth centration of fast food restaurants. Ultimately, in- weight in infants, particularly for the Black or Afri- equitable policies can result. can American population.2
Environmental and Neighborhood Segregation
In Houston, racial and ethnic groups are unevenly Segregation masks concentrated poverty levels, distributed throughout the city, as in most metropoli- exposure to environmental risks, and poor tan areas. Residents tend to live near others of the employment and educational opportunities. same racial or ethnic group. While there are some Residents of highly segregated cities have higher advantages to having similar racial and ethnic com- rates of illness and mortality than residents of more munities, the level of racial segregation can nega- integrated cities.3 tively affect health outcomes.
The Racial Dissimilarity Index is often used to Racial Dissimilarity Index for measure the level of segregation within communities, showing the percentage of residents Harris County in a census tract who are of a given racial/ethnic group who would theoretically have to move in 80% 71.8% order to have the same number of residents as a 70% 59.2% comparison racial/ethnic group within the same 60% 54.0% census tract (usually Whites). 50% 40% For Houston, the Racial Dissimilarity Index is 71.8 30% 20% for Blacks or African Americans and Whites. This 10% means that 71.8% of Blacks or African Americans 0% would have to move to another neighborhood for Hispanic or Black or Asian Blacks or African Americans and Whites to be evenly distributed across all neighborhoods in Latino African Houston. The highest level of segregation in American Houston exists between White and Black or
African American residents. SOURCE: U.S. Census Bureau, Census Scope 2000
1 Madere M., Third Ward property values are soaring, joint study says. Houston Chronicle. May 17, 2006. 2 Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal and Child Health Journal. 2003;7:13-30. 3 Berkman LF, Kawachi I. Social Epidemiology. 1st ed. New York, NY: Oxford University Press; 2000. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 13
Residences of the White Population in Houston
In 2000, more than 50% of Houston residents in Super Neighborhoods west of downtown were White.1 The largest concentration of Whites was in Kingwood, Clear Lake, Memorial, Greater Uptown, and Alief.1
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007
1 Houston Housing and Households 2000, City of Houston Planning and Development Department, Long Range Planning Division. PAGE 14 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT Residences of the Black or African American Population in Houston
In 2000, Black or African American residents made up the majority of residents in Super Neighbor- hoods to the south and northeast.1 The largest populations of Blacks or African Americans were in Alief, Greater Fondren Southwest, and Central Southwest, with large percentages in Alief, Brae- burn, Greater Inwood, and Greater Greenspoint as well.1
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007.
1 Houston Housing and Households 2000, City of Houston Planning and Development Department, Long Range Planning Division. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 15
Residences of the Hispanic or Latino Population in Houston
In 2000, Hispanic or Latino residents were the majority in Super Neighborhoods in the southeast and north, with large percentages in the northwest as well.1 The largest populations of Hispanics were located in Northside/Northline, East End, Sharpstown, Gulfton, and Alief.1
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007.
1 Houston Housing and Households 2000, City of Houston Planning and Development Department, Long Range Planning Division. PAGE 16 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Residences of the Asian Population in Houston
In 2000, the largest concentrations of Asians lived in the southwest and Northside/Northline areas. Ninety percent of the Asian population lived in the Medical Center, Westbranch, and Alief.1
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007.
1 Houston Housing and Households 2000, City of Houston Planning and Development Department, Long Range Planning Division. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 17 Lead Poisoning: A Case Study
Childhood lead poisoning is an environmental health problem which can be an indicator of Demographics of Houston poorer quality housing or lower socio-economic Residents at Higher Risk for status communities. The Childhood Lead Poi- soning Prevention Program at HDHHS identified Childhood Lead Poisoning risk factors for childhood lead poisoning. Some of these factors are socio-economic, such as families that live in older homes built before 20% 18.6% 1970 or families with children who receive pub- 14.5% licly funded medical or social services. Other 15% 11.1% risk factors are cultural practices, such as cook- ing/storing food in lead glazed pottery or using 10% home remedies which may contain lead. Target ZIP codes were identified in which children were 5% 2.7% at greater risk for lead poisoning. Demograph- ics for these ZIP codes show that over half of 0% the residents in those areas are Hispanic or La- population of Percentage Hispanic Black or Asian White tino, and almost 43% are White. However, look- or Latino African ing at Houston as a whole, we see that a greater percentage of Hispanics or Latinos and Blacks American or African Americans live in these high risk ar- eas, compared with Whites. SOURCE: U.S. Census Bureau, American Community Survey, 2000.
Houston Areas at High Risk for Childhood Lead Poisoning
SOURCE: HDHHS Childhood Lead Poisoning Prevention Program. “The ABC’s of Lead Screening for Children: A Quick Reference for Medical Providers.” PAGE 18 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Other Environmental Inequities: TRI Facilities
The U.S. Environmental Protection Agency’s (EPA) database Toxics Release Inventory (TRI) lists facilities that have reported toxic releases into the environment. TRI facilities are industry groups that use, manufacture, treat, transport, store, or release toxic chemicals.
Many of these facilities are concentrated in southeast and northwest Houston, along U.S. Highway 290.
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 19
Other Environmental Inequities: Superfund & Hazardous Waste Sites
Superfund is a program established by the fed- The greatest concentrations of Superfund and haz- eral government to clean up uncontrolled hazard- ardous waste sites are located in southeast Hous- ous waste sites. These sites involve abandoned, ton. accidentally spilled, or illegally dumped hazard- ous waste that threaten the environment or hu- man health.
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007. PAGE 20 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Other Environmental Inequities: Landfills
Landfills, both active and inactive, have a greater distribution throughout Houston than TRI facilities or hazardous waste sites. However, southeast and northwest Houston still contain many landfill sites.
SOURCE: HDHHS Office of Surveillance & Public Health Preparedness, Community Health Statistics, 2007. PAGE 1 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 21
Health Care Access
A growing body of research has shown that racial/ mined that health disparities existed in many dis- ethnic minorities are less likely than Whites to receive ease areas including cancer, cardiovascular dis- health care of comparable quality, irrespective of ease, and diabetes, and across many clinical pro- their income or health insurance coverage. At Con- cedures/treatments. The Healthcare Research and gress’ request, the Institute of Medicine assessed Quality Act of 1999 directed the federal Agency of racial/ethnic disparities in health care in 1999 and Healthcare Research and Quality to develop an- issued their findings in a report entitled “Unequal nual reports to track health care disparities in the Treatment: Confronting Racial and Ethnic Disparities U.S., including the National Healthcare Disparities in Healthcare.” They found that minorities were con- Report. Key findings from these reports are listed sistently less likely to receive necessary health ser- below. vices, including clinical procedures. They also deter-
Highlights: 2003 National Healthcare Disparities Report
Inequalities in health care quality exist. Examples include: = Minorities are more likely to be diagnosed with late-stage breast cancer and colorectal cancer. = Patients with lower socio-economic status are less likely to receive care for diabetes and are more likely to be hospitalized “The evidence of the for diabetes complications. damaging health Health care disparities exact a heavy personal and societal price. consequences of Differential health care access may lead to disparities in health care quality. Examples include: racial and ethnic = Minorities and people of lower socio-economic status are less disparities in health likely to receive recommended immunizations, have health care continues to insurance, or have a regular source of health care. be overwhelming.” = Asians, Hispanics or Latinos, and people of lower socio- economic status are more likely to have difficulties communicating with their physicians and accessing health care -John W. Rowe, information (including prescription information). M.D., Chairman, Often, opportunities to provide preventive care are missed. President & CEO of Examples include: Aetna.1 = Blacks or African Americans and poorer patients are more likely to be hospitalized for health conditions that usually do not require hospitalization if there are appropriate preventive services. = Minorities and patients with lower socio-economic status are less likely to receive recommended cancer screening and are more likely to have late-stage cancer when diagnosed. There is limited knowledge about why disparities exist and data limitations impede improvement, but progress is possible. Some of the factors that lead to disparities in health care include differential access, fragmentation and inequalities in the healthcare system, cultural or linguistic barriers to care, cost-containment incentives, and health care settings where minorities obtain care.
1 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Healthcare Disparities Report. July 2003. PAGE 22 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Highlights: 2005 National Healthcare Disparities Report
Minorities and the poor receive lower quality health care and “(Al)though myriad have worse access to care. sources contribute to For most minority groups, progress has been made so disparities in these disparities, some quality of care and health care access are diminishing. However, for Hispanics or Latinos, disparities in quality of care and health care evidence suggests that access are, instead, increasing. bias, prejudice, and stereotyping on the part of healthcare For more information, visit: providers may contribute to The Institute of Medicine differences in care.” http://www.iom.edu/
The Agency of Healthcare Research and Quality http://www.ahrq.gov/ -Institute of Medicine1 The National Healthcare Disparities Report 2005 http://www.ahrq.gov/qual/nhdr05/nhdr05.htm
The National Healthcare Disparities Report 2003 http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm
Access Risk Factor: Language
Linguistic barriers can have a harmful effect on health outcomes by creating obstacles to Linguistically Isolated health care access and utilization. Difficulties Houston Households with English can hamper a person’s ability to seek medical services or understand the health care they are given. Persons with 0% 10% 20% 30% 40% Limited English Proficiency (LEP) are also less likely to have a regular source of medical care or follow their doctor’s Spanish 36% instructions.
In 2004, 36% of Houston residents spoke a Asian 31% language other than English at home, compared to 19% of the total U.S. Indo- population. Over one out of every ten 13% European households in Houston are linguistically isolated, meaning no member of the household aged 14 or older spoke English Other 16% “very well.” First generation Hispanic or Latino and Asian households are most Home at Spoken Language Primary likely to experience language barriers. SOURCE: U.S. Census Bureau, 2004.
1 Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: The National Academies Press; 2003. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 23
Access Risk Factor: Lack of Health Insurance
People who are uninsured have little access to primary Percent Uninsured in Harris County, and preventive health services. Thus, necessary treat- 2005 ment for health conditions is delayed, leading to worse health outcomes and higher risks of mortality. Moreover, lack of preventive care forces many uninsured residents 35% 31.4% to seek costly care in already overburdened emergency 30% 25.1% rooms. Young adults and people with lower socio- 25% economic status are at greater risk of being uninsured.1 20% 15.9% Texas has the largest proportion of uninsured 15% residents in the U.S. Within Texas, Harris County has 10% the largest percentage of uninsured—approximately 31% of its population lacks health Percentage Uninsured 5% insurance. The percent of uninsured in Harris County is 0% nearly double that of the national average. Harris Texas U.S. County People with lower socio-economic status are more likely to lack health insurance, since those with higher educa- SOURCE: Code Red: The Critical Condition of Health in Texas. tional attainment are able to earn higher incomes and April 17, 2006. Task Force for Access to Health Care in Texas. receive health benefits through work or are able to afford health services. Access Risk Factor: Health Insurance Disparities There are racial/ethnic disparities among the unin- increase the risk of being uninsured for the His- sured in Harris County. The Hispanic or Latino panic or Latino population: the lower average population is more likely to be uninsured than age of the population, lower income levels, and any other racial/ethnic group. Nearly 56% of His- lower educational attainment. Also, a large panics or Latinos were uninsured in 2005, compared number of Hispanics or Latinos are immigrants to 9% of Whites (BRFSS). A 2004 study of selected and work in low-wage jobs that do not provide Asian groups in Harris, Fort Bend, Brazoria, and health benefits. Galveston County show that 21% of Chinese and 31% of Vietnamese residents lack health insur- ance.1 One of the Healthy People 2010 goals is for everyone to have health insurance. Several factors What is Healthy People 2010? Healthy People 2010 (HP2010) is a set of na- Harris County Residents Without tional health objectives which identify the most Health Insurance important preventable health risks for a wide- range of public health priorities. Designed by leading federal agencies with the most relevant 100% 90% scientific expertise to measure progress over 80% time, it established specific, measurable objec- 70% 55.7% tives in disease reduction and health promotion 60% 50% for the U.S. to achieve by the target year of 40% 2010. More information can be found at: 30% 17.6% www.healthypeople.gov 20% 9.0% 10% Wherever possible, the corresponding Healthy
Percentage of respondents 0% Hispanic or Black or White People 2010 goals have been included in this Latino African data report to show the progress of Harris American County in comparison to these national objec- tives.
*Data for Asians not available. SOURCE: Texas Department of State Health S ervices (TDSHS), Behavioral Health & Risk Factor Survey, Harris County, 2005.
1 Hoang TV, Gor BJ, Hernandez M, Liang J, Esparza A, Detry M, Yi JK, Jones LA. Asian American Health Needs Assessment, 2006 Community Report. Houston (TX): Center for Research on Minority Health, The University of Texas M.D. Anderson Cancer Center; 2006 Nov. PAGE 24 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Access Risk Factors: Lack of Regular Care Providers & Cultural Competency
Blacks or African Americans and Whites Harris County Residents with a Usual Primary are almost 40% more likely than Hispanics Care Provider* or Latinos to have at least one personal doctor, which indicates a usual primary 100% care provider. Hispanics or Latinos in 83% 83% 85% Houston are most likely to lack a regular 80% care provider, so opportunities to pro- 60% 51% vide preventive care are often missed.
40% According to a report issued by the Texas 20% Department of State Health Services,1 mi- norities are inequitably underrepresented 0% in the health care workforce and in schools Hispanic Black or White HP 2010** of higher education. For example, al- Percentage of Respondents of Percentage or Latino African though Hispanics or Latinos account for Am erican more than a third of the total population in Texas, only 15% of first-year medical stu- dents and 13.7% of active primary care *Data not available for Asians. “Usual Primary Care Provider” refers to at least one personal physicians are Hispanic or Latino.1 doctor. ** Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Health & Risk Factor Minority patients are more likely to seek Survey, Harris County, 2005. care from physicians of the same race/ ethnicity, so ensuring a diverse healthcare workforce would increase culturally compe- tent health services and patient compli- ance.2 Furthermore, minority physicians are more likely to work in medically under- served areas and serve lower socio- economic status patient populations.2
Access Risk Factors: Disparities in Ability to Pay
Hispanics or Latinos are more likely to Harris County Residents Who Could Not Afford forego medical care due to cost than to See Doctor When Needed other racial/ethnic groups. More than in Previous Year three times as many Hispanics or Latinos are unable to afford care as Whites. A 33% high percentage of Blacks or African 35% Americans (more than twice the 30% 24% percentage of Whites) also go without 25% medical care because they are unable to 20% pay. 15% 10% 10% Healthy People 2010 sets a target of 7% 5% for all people experiencing difficulties or 0% delays in obtaining needed health care, Hispanic or Black or White
Percentage of Resopndents of Percentage which includes the inability to afford Latino African necessary care. Am erican
*Data not available for Asians. SOURCE: Texas Department of State Health Services, Behavioral Health & Risk Factor Survey, Harris County, 2005.
1 Gunn BA. Texas Health Care Workforce Supply Trends. Texas Department of State Health Services. May 9, 2006. E Publication NO.E25-12401. Available from http://www.dshs.state.tx.us/chs/hprc/workbri.pdf 2 Forte GJ, McGinnis SL, Armstrong DP, Moore J. A Profile of New York’s Underrepresented Minority Physicians, 2006. The Center for Healthcare Workforce Studies. School of Public Health, University at Albany. Available from http://www.albany.edu/news/pdf_files/minority_physicians_report.pdf CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 25
Introduction to Health Profiles
In the previous section, examination was made Why are non-Hispanic Whites used as on how various social inequities could lead to a reference group? health disparities among the various racial/ethnic groups in Houston. The following sections will In identifying health disparities for each racial/ explore each of these groups separately and ethnic group in Houston, we’ve used the non- highlight some of the health burdens which Hispanic White population as a comparison disproportionately affect each racial/ethnic group. group, as is the usual practice for measuring In the process, health areas of high-risk have health disparities. (Note: the Hispanic or Latino been identified for each racial/ethnic group and ethnic group may self-identify as any race; the modeled after other health department reports, majority being categorized as White. This group given available data. To begin, health outcomes is not included with the overall White population; for the largest minority group in Houston thus, the term “non-Hispanic White.”) Although (Hispanics or Latinos) will be examined and non-Hispanic Whites, particularly those with continued to the other minority groups in lower socio-economic status, experience worse descending demographic order. Differences in outcomes in some health areas, overall, their socio-economic and health status do exist within health status is better than most other racial/ subgroups within each minority population, but ethnic groups. Ideally, to see the full extent of this level of detail is often unavailable. disparities which exist, we would compare outcomes from racial/ethnic minority groups to non-Hispanic Whites with higher socio-economic status. However, again, this level of detail is unavailable.
Effects of Racism/Discrimination The Hispanic Paradox
Literature shows that racism/discrimination has Although the Hispanic or Latino ethnic group played a large role in the disproportionate burden faces large disparities in health determinants, of mortality among Blacks or African Americans. they often appear to have better health outcomes Blacks or African Americans in the U.S. as a group. In public health circles, this is known consistently have the lowest life expectancy and as the “Hispanic Paradox.” Although there is greatest premature mortality. Furthermore, they debate surrounding this issue, researchers have have worse birth outcomes than any other group, observed that over time, as new Hispanic or La- even when comparing groups in the same socio- tino immigrants become acculturated to the diet economic level. Research shows that the and lifestyle in the U.S., their health outcomes experience of racism and discrimination has a become more similar to those of other ethnic cumulative long-term effect on the health of groups who have a longer history in the U.S. individuals over their entire life. These adverse However, some aspects of Hispanic or Latino health effects can impact the health of the next culture do protect the health of this subgroup generation as well, contributing to low birth 1 from certain health outcomes. For example, weight and infant mortality. family values are strong in this group, and often, extended family members live together in the same household. This social support has protec- tive effects on health outcomes for this group, resulting in higher life expectancy.
1 Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal and Child Health Journal. 2003;7:13-30. PAGE 1 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Section PAGE 26 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Summary Health Profile: Hispanics or Latinos
The Hispanic or Latino population is the largest and Disparities in Health Outcomes fastest growing minority group in Houston according to the U.S. Census Bureau. This group faces the National trends indicate that Hispanics or Latinos greatest social inequities, but against these odds, are disproportionately affected by health outcomes such as higher rates of asthma, diabetes, chronic appear to have better health outcomes in several areas. However, since Hispanics or Latinos are obstructive pulmonary disease, HIV/AIDS, obesity, younger on average than their White counterparts, suicide, teenage pregnancy, and tuberculosis (CDC Office of Minority Health). Local data supports health statistics for this group can be misleading if differences in health outcomes naturally arising from some of these findings. these age discrepancies are not taken into consid- Hispanic or Latino residents of Houston/Harris eration. Thus, health discrepancies for this group may be understated and could worsen as the popu- County face the following disparities in health out- lation ages and becomes more acculturated to the comes, compared with other racial/ethnic groups: U.S. Hispanics or Latinos are expected to make up a larger segment of the Houston population in the Higher mortality rates due to diabetes, homi- future, so health disparities for this group can be cide, and kidney disease. expected to have an even greater impact on the fu- Lowest levels of self-assessed health ture health of all Houstonians. status. Higher rates of births to adolescent mothers. Disparities from Health Determinants Lowest levels of access to preventive ser- vices such as cholesterol checks, diabetes National data indicate that as a group, Hispanics or care, and adequate and timely prenatal Latinos have lower incomes, lower educational lev- care. els, and less access to health care than other racial/ Higher prevalence of overweight among ethnic subgroups. Local data supports this finding. Hispanic or Latino adults and children. In fact, Hispanic or Latino residents in Houston/ Higher rates of gonorrhea. Harris County face the following disparities in health Highest rates of tuberculosis. determinants, compared with other racial/ethnic Higher rates of HIV/AIDS. groups: Lowest levels of recommended physical activity and nutrition. On average, Hispanics or Latinos have the lowest levels of educational attainment, Higher levels of alcohol consumption. even among those born in the U.S. Hispanics or Latinos have the lowest aver- Areas of Better Health age levels of income and highest poverty rates Hispanic or Latino residents in Houston/Harris County Hispanics or Latinos are most likely to face experience better health than other racial/ethnic language barriers while receiving medical groups for the following health conditions/behaviors: care because many are Limited English Pro- ficiency (LEP) households. Highest levels of life expectancy. Hispanic or Latino residents face the great- Best birth outcomes, such as low levels of low est obstacles to health care access. A large birth weight and infant mortality. majority of them lack health insurance and Best cardiovascular health outcomes; how- do not have a regular health care provider. ever, since the available data on this was not Also, more Hispanics or Latinos were un- age-adjusted, the advantages we see for this able to seek necessary medical treatment group may simply be due to the younger aver- due to cost than any other group. age age of the Hispanic or Latino population. Lowest rates of smoking. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 27
Hispanics: Mortality
Selected Leading Causes of Death Hispanic or Latino males and females, on average, have greater life expec- Selected Leading Causes of Death Among Hispanic tancy than Whites or Blacks or African & White Harris County Residents Americans. The leading causes of death among all Houston residents are Cause of Death Hispanic White HP 2010* Objective similar to those in the rest of the U.S.: or Latino Mortality Mortality heart disease, cancer, and stroke. Mortality These are also the leading causes of death for Hispanics or Latinos. How- Diabetes 35.1 18.6 45 or lower ever, Hispanics or Latinos have lower rates of mortality from these conditions, compared to other racial/ethnic groups, Kidney Disease 22.0 14.8 N/A so focus is on other conditions in which disparities in mortality do exist for this Chronic Liver 13.4 10.9 N/A group. Disease/ Cirrhosis The top ten leading causes of death for Hispanics or Latinos in Houston, in de- Homicide 10.8 6.1 3 or lower scending order, are: heart disease, can- cer, stroke, diabetes, accidents, kidney *Rates are age-adjusted deaths per 100,000 persons. ** Healthy People 2010, see page 23. diseases, septicemia, influenza/ SOURCE: Texas Department of State Health Services, Bureau of Vital Statistics, 2005. pneumonia, chronic lower respiratory disease (chronic bronchitis, asthma, emphysema, etc.), and chronic liver dis- ease/cirrhosis.
Diabetes Mortality Violence
Mortality Rate from Diabetes Death Rate from Homicides
50 45 12 10.8 40 35.1 10 30 8 6.1 18.6 6 20 4 3 10 2 0 0 Hispanic White HP 2010** Hispanic or White HP 2010** Deaths per 100,000 persons* 100,000 per Deaths Deaths per 100,000persons* or Latino Latino
*Rates are age-adjusted. *Rates are age-adjusted. ** Healthy People 2010, see page 23. ** Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Bureau of Vital SOURCE: Texas Department of State Health Services, Bureau of Vital Statis- Statistics, 2005. tics, Harris County, 2005. Diabetes is a major cause of death which dispro- Homicide is the 11th leading cause of death for portionately affects Blacks or African Americans Hispanics or Latinos. Hispanics or Latinos in and Hispanics or Latinos. Nearly 90% more His- Houston are 75% more likely to die from homicide panics or Latinos die from diabetes than Whites. than Whites. PAGE 28 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Hispanics or Latinos: Maternal/Child
Prenatal Care Access
Harris County Women Who Harris County Women Who Received Inadequate Prenatal Received Prenatal Care in First Care Trimester
90% 40% 32.5% 100% 89% 74% 30% 80% 60% 20% 16.5% 40% 10% 20%
Percentage ofbirths 0% 0% Hispanic or White Hispanic White HP2010
Latina Percentage of pregnant women or Latina
SOURCE: Texas Department of State Health Services, Harris County, 2003. SOURCE: Texas Department of State Health Services, Harris County, 2003.
Despite the high fertility rate of the Hispanic or Hispanic or Latina women also are less likely to Latino population, they receive lower rates of receive timely prenatal care. Only 74% of adequate prenatal care. The adequacy of Hispanic or Latina women receive recommended prenatal care is determined by whether it meets prenatal care in the first trimester of their the Kessner criteria of timeliness and frequency, pregnancies. adjusted for the duration of pregnancy. Hispanic or Latino mothers are nearly twice as likely to Hispanic or Latina women have less access to receive inadequate prenatal care, compared to adequate and timely prenatal services than Whites. Whites.
Adolescent Births Adolescent Births in Harris Adolescent births are more common among His- County panics in Houston. Nearly 6% of all births in the Hispanic population group are to adolescent moth- 7% 5.7% ers under 18 years of age. This is nearly three 6% times the percentage of births in the White popula- 5% tion to adolescent mothers. Furthermore, nearly 4% two out of every three adolescent births in Harris 3% 1.9% County are to Hispanic or Latina females, com- 2% pared with 1 out of every 10 adolescent births to 1% White females. racial/ethnic group 0% Hispanic or White Percentage of total births in Latino
SOURCE: Texas Department of State Health Services, Harris County, 2003. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 29
Hispanics or Latinos: Cancer Cervical Cancer
Harris County Cervical Cancer Harris County Cervical Cancer Incidence Mortality
18.3 20 5 4.2 15 4 2.7 8.3 3 2.0 10 2 5 1 0 0 Hispanic or White Hispanic White HP2010** Rates per 100,000 persons* Deaths per 100,000 persons* Latino or Latino
*Rates are average annual age-adjusted rates *Rates are average annual age-adjusted rates. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas ** Healthy People 2010, see page 23. Department of State Health Services, 2000-2004. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004.
Although most cancers are more prevalent among Access to cancer screening services is lower the Black or African American population, cervical among the Hispanic or Latino population in cancer is one area which disproportionately af- Houston. Hispanics or Latinos were less likely to fects Hispanics or Latinos. Hispanics or Latinos in receive a recommended mammogram and pap Houston are more than twice as likely to become smear in the past year than Whites. diagnosed with cervical cancer as Whites, and are 60% more likely to die from it. They are also less likely to be screened for cervical cancer through a pap smear.
Harris County Women Who Harris County Women Who Received a Mammogram in the Received a Pap Smear in the Past 2 Years Past 3 Years
71% 70% 95% 70% 69% 90% 69% 90% 68% 86% 67% 66% 85% 66% 80% 65% 80% 64% 63% 75%
Percentage of Respondents of Percentage Hispanic or White HP2010* Respondents of Percentage Hispanic White HP2010* Latino or Latino
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Texas Behavioral Risk SOURCE: Texas Department of State Health Services, Texas Behavioral Risk Factor Surveillance System, 2004. Factor Surveillance System, 2004. PAGE 30 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Hispanics or Latinos: Diabetes Diabetes Prevalence What is Public Health Service Region 6?
Adult Diabetes Prevalence in In this report, we have used data from Houston Harris County or Harris County wherever possible. However, some racial/ethnicity data, such as the hospital discharge rates for diabetes-related conditions is 10% 8.6% only available for larger geographical areas. 8% 6.9% Public Health Service Region 6 is one such area. 6% It encompasses a total of 13 counties, including 4% Harris, Brazoria, Fort Bend, Galveston, Chambers, Liberty, Walker, Montgomery, Waller, 2% Austin, Colorado, Wharton, and Matagorda. 0% Hispanic or White Percentage of respondents Although diabetes is more prevalent among the Latino White population group in Houston, it causes higher rates of death among the Hispanic or SOURCE: Texas Department of State Health Services, Behavioral Risk Factor Latino population, suggesting disparities among Surveillance System, Harris County, 2005. diabetes care.
Uncontrolled Diabetes Lower Extremity Amputations
Hospita l Discha rge Ra te for Hospital Discharge Rates for Uncontrolled Diabetes Lower Extremity Amputations
40 33.1 200 180 30 150 20 15.5 100 57.23 persons* 10 50 13.9 0 0 Discharges per 100,000 100,000 per Discharges Hispanic or White Hispanic White HP 2010** Discharges per 100,000 persons* Latino or Latino
*Rates are age-adjusted. *Rates are age-adjusted. SOURCE: Texas Department of State Health Services, Texas Diabetes Council, ** Healthy People 2010, see page 23. Public Health Region 6, 2000. SOURCE: Texas Department of State Health Services, Texas Diabetes Council, Public Health Region 6, 2000. Diabetes care and management is a critical concern for Hispanics or Latinos. Although Foot care is an important aspect of diabetes diabetes is a manageable disease, mortality from management. Diabetes reduces blood flow and 1 diabetes is higher among Hispanics or Latinos in sensation in the lower extremities. Amputations Houston. Furthermore, hospital discharge data for are preventable, given proper care and Public Health Service Region 6 show that Hispanics management. Hispanics or Latinos are more or Latinos are more than twice as likely to be than four times as likely to suffer amputations of hospitalized for uncontrolled diabetes as Whites. their lower extremities as Whites.
1Diabetes management tips: http://www.mayoclinic.com/health/diabetes-management/DA00008 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 31
Hispanics or Latinos: Diet, Weight, and Exercise
Overweight/Obese Adults
Overweight or Obese Adults in Overweight Adults in Harris Harris County County
80% 50% 44% 67.3% 58.2% 40% 60% 40% 33% 40.0% 30% 40% 20% 20% 10% 0% 0%
Hispanic or White HP 2010* respondents of Percentage Hispanic or White HP 2010* Percentage of respondents of Percentage Latino Latino
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk Factor SOURCE: Texas Department of State Health Services, Behavioral Health and Surveillance System, Harris County, 2005. Risk Factor Survey , Harris County, 2005.
Body mass index (BMI) is a measure of body fat, Almost 20% more Hispanic or Latino adults in based on one’s height and weight. A BMI greater Houston are overweight, compared to Whites. than 25 is considered overweight, while one greater than 30 is considered obese.
A greater proportion of Hispanics or Latinos in Houston are either overweight or obese, compared with Whites.
Overweight Youth Overweight Students in Houston
Hispanic or Latino youth are also more likely to 16% be overweight. More than twice as many 13.7% Hispanic or Latino high school students are 14% overweight, compared to White high school 12% students. 10% 8% 6.2% Hispanic or Latino adults and youth are 6% 5.0% more likely to be overweight than Whites. 4% 2% Percentage of respondents 0% Hispanic or White HP 2010* Latino
* Healthy People 2010, see page 23. SOURCE: Youth Risk Behavior Surveillance Survey, 2001. PAGE 32 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Physical Activity Houston Adults Without Sufficient The Center for Disease Control and Prevention’s Exercise (CDC) recommendation for physical activity for adults is moderate physical activity (at least 30 80% 68.3% minutes per day) for 5 days a week or vigorous 53.0% physical activity (at least 20 minutes per event) 60% for 3 days a week. 40% 30.0%
20% Hispanics or Latinos in Houston are 29% more likely not to have engaged in sufficient physical 0% Percentage of respondents activity, as recommended. Hispanic White HP 2010
SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Harris County, 2005.
Nutrition
Healthy People 2010 (HP 2010) recommends Houston Adults Without Sufficient that adults consume at least 3 servings of Intake of Fruits & Vegetables vegetables and 2 servings of fruit per day. The HP 2010 goal is for 50% of adults to consume 100% 79.7% the recommended amount of vegetables per day 80% 69.6% and 75% to consume the recommended amount of fruit per day. 60% 50.0% 40% Hispanics or Latinos are 15% more likely not to 20% have consumed the recommended amounts of 0% fruits and vegetables. Percentage of respondents Hispanic White HP 2010
SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Harris County, 2005.
Access: Cholesterol Checks Houston Adults Without a Cholesterol Check In Last Five Although Hispanics or Latinos are less likely to Years report being diagnosed with high blood cholesterol, hypertension, stroke, and heart disease, they also 54.7% are less likely to have had their cholesterol 60% checked recently. Hispanics or Latinos are two and a half times more likely than Whites to not 40% 17.9% 20.0% have had their cholesterol checked in the past five 20% years. Respondents Percentage of 0% Hispanic White HP 2010
SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey , Harris County, 2005. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 33
Hispanics or Latinos: Infectious Disease Gonorrhea HIV/AIDS
Gonorrhea Prevalence in Harris HIV/AIDS Incidence in Harris County County, 2005
70 60.6 6 5.2 60 5 50 4 40 27.7 3 2.5 30 19 2 20 1.0 10 1 0 0 Rate per 100,000 persons 100,000 per Rate Rate per 100,000 persons Hispanic or White HP 2010* Hispanic or White HP 2010* Latino Latino
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services & Houston Department of SOURCE: Houston HIV Prevention Community Planning Group 2007 Com- Health and Human Services case files, 2000-2004, Houston/Harris County. prehensive Plan Update, U.S. Census Bureau, American Community Survey 2005. The Houston Department of Health and Human Ser- vices and the Texas Department of State Health The Black or African American population has the Services monitor rates of sexually transmitted dis- highest rate of infection for HIV/AIDS in Harris eases. According to their files, gonorrhea and other County. However, Hispanics or Latinos also have sexually transmitted diseases are most prevalent a higher rate of infection than Whites. Hispanic or among the Black or African American population; Latino residents are twice as likely to become gonorrhea rates are high in the Hispanic or Latino infected with HIV/AIDS than White residents. population as well. Gonorrhea is twice as common among Hispanics or Latinos as Whites in Houston.
Tuberculosis
In 2005, Hispanic or Latino residents in Harris TB Incidence in Harris County, County were nearly four times more likely to 2005 become infected with tuberculosis as White
10 8.5 8 6
4 2.17 2 0
Rate 100,000 per persons Hispanic or Latino White
SOURCE: Big Cities Health Inventory, 2007, Houston Department of Health and Human Services, Bureau of TB Control, U.S. Census Bureau, American Community Survey, 2005 PAGE 34 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Hispanics or Latinos: Health Behaviors Smoking
Houston Adults Who Currently Houston High School Students Who Smoke Smoked in the Past Month
Hispanic 26.9% Hispanic 17.5%
Black 16.3% Black 11.9%
White 17.9% White 27.2%
HP 2010* 12.0% HP 2010* 21.0%
0% 5% 10% 15% 20% 0% 10% 20% 30% Percentage of respondents Percentage of respondents
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk Factor SOURCE: Texas Department of State Health Services, Youth Behavioral Surveillance System, 2005. Risk Factor Surveillance System, Houston, 2001. Smoking rates among the Hispanic or Latino and The smoking rates for Hispanic or Latino and White population in Houston are similar. However, White adolescents in Houston are similar, both both groups smoke more than the Black or African are substantially higher than that of Black or Afri- American population in Houston. Thus, the Black or can American adolescents, which is used for ref- African American group was used for reference. erence here. There are more Hispanics or Latinos who smoke than Blacks or African Americans.
Alcohol Binge Drinking Among Houston Binge drinking, or having five or more drinks in a Adults row, is more common among the Hispanic or Latino population in Houston than the White or Black or 20% African American populations. Hispanics or Latinos 15.9% are 62% more likely to binge drink than Whites, and 15% over twice as likely to binge drink than Blacks or 9.8% 10% African Americans. 5% 0%
Percentage of respondents of Percentage Hispanic or White Latino
SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Harris County, 2005. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 35
Hispanic or Latino and White adolescents Houston High School Students Who in Houston have similar binge drinking Binge Drink rates. Since Black or African American adolescents have the lowest rate, they are used as the reference group. Hispanic or Hispanic or Latino 32.4% Latino adolescents are over three times as likely to binge drink as Black or African Black or African American 9.9% American adolescents.
White 36.0%
HP 2010* 11.0%
0% 10% 20% 30% 40% Percentage of respondents
*Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Youth Behavioral Risk Factor Surveillance System, Houston, 2001.
Sexual Activity
Houston High School Students Condom Use Among Sexually Who Have Had Sexual Active High School Students Intercourse 100% 77.9% 60% 80% 49.7% 59.0% 50% 60% 40% 35.1% 40% 30% 20% 15.0% 20% 10% 0% 0% Percentage of respondents Hispanic or Black or
Percentage of respondents Hispanic White HP 2010* Latino African or Latino American
*Healthy People 2010, see page 23. *Data for Whites not available SOURCE: Texas Department of State Health Services, Youth Behavioral SOURCE: Texas Department of State Health Services, Youth Behavioral Risk Risk Factor Surveillance Survey, Houston, 2001. Factor Surveillance Survey, Houston, 2001.
Nearly half of Hispanic or Latino high school Despite the high rates of sexual activity, condom students have had sexual intercourse. Hispanic use is low among Hispanic or Latino adolescents. or Latino adolescents are more likely to have had Condom use rates for White adolescents were not sexual intercourse than Whites. available, so the Black or African American ado- lescent group for reference. Only 59% of sexually active Hispanic or Latino high school students re- ported using condoms, compared to 78% of Blacks or African Americans. PAGE 36 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Summary Health Profile: Blacks or African Americans
The Black or African American population is the Disparities in Health Outcomes second largest minority group in Houston, making up 18% of the population. This group The health status of Blacks or African Americans in has had a consistent and steady presence in Houston shows the most profound disparities. Houston with little demographic change. Only Although other racial/ethnic groups experience worse 6% of Black or African American residents in outcomes in some areas, the Black or African Houston are foreign-born. American population consistently shows the greatest disparities among a comprehensive range of health Disparities in Health Determinants indicators. National data indicate that as a group, Blacks or The Centers for Disease Control and Prevention African Americans are more likely to experience (CDC), Office of Minority Health and Health social inequities such as poverty, lower income, Disparities indicate that Blacks or African Americans and education. Local data supports this finding, are disproportionately affected by health outcomes although the Hispanic or Latino subgroup often such as higher rates of infant mortality, HIV/AIDS, experienced greater inequities. Black or African tuberculosis, diabetes, heart disease, cancer and American residents in Houston/Harris County obesity. Local data supports some of these findings. face the following disparities in health determinants, compared with other racial/ethnic Black or African American residents of Houston/ groups: Harris County face the following disparities in health outcomes, compared with other racial/ethnic groups: On average, Blacks or African Americans have lower levels of educational Highest mortality rates, especially due to attainment, even among those born in HIV/AIDS, homicide, diabetes, kidney the U.S., than Asians or Whites. disease, septicemia, and stroke. Blacks or African Americans have lower Lowest life expectancy for men and women. average levels of income than Asians or Whites. Greatest disparities in maternal/child health. More Black or African American Lower levels of access to adequate and residents adults and children, live in timely prenatal care. poverty than Asians or Whites. Higher rates of stroke and heart disease Blacks or African Americans experience mortality. the highest level of residence racial Greatest burden of diabetes. segregation. Higher prevalence of overweight and obese Black or African American residents adults and children. experience the highest levels of health Highest prevalence of STDs care access. Approximately 18% of Lower levels of recommended physical Blacks or African Americans are activity and nutrition. uninsured and nearly a quarter were unable to seek necessary medical treatment due to cost. Areas of Better Health Black or African American residents in Houston/ Harris County experience better health than other racial/ethnic groups for the following health condi- tions/behaviors:
Higher rates of up-to-date cholesterol checks. Lower levels of alcohol consumption. Lower levels of smoking. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 37
Blacks or African Americans: Mortality
Life expectancy
Black or African American Life Expectancy among males and females in Texas Black or African Americans and White follow the national trend of Texas Residents having the lowest life expectancy compared with any other racial/ethnic group. 85 Black or African American 79.9 males and females, on 80 74.8 74.9 75 average, live 5 years less 69.2 than their White counterparts. 70 Years 65 60 Black or White Male Black or White African African Female American American Male Female
SOURCE: Texas Department of State Health Services, 2003.
Years of Potential Life Lost
Years of Potential Life Lost Years of Potential Life Lost: (YPLL) is another measure of Black or African American and White premature death in a Texas Residents community. It estimates the average amount of time a person would have lived had 100 he/she not died prematurely, 78.01 before 75 years of age. 80 Blacks or African Americans 60 in Texas lose approximately 42.44 78 years of potential life per 40 1,000 residents, nearly twice 20 that of Whites. 0 YPLL per persons 1,000 YPLL Black or African White American
SOURCE: Texas Department of State Health Services, 2003. PAGE 38 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Selected Leading Causes of Death Overall mortality is also higher among the Black or African American Selected Leading Causes of Death Among Black or population group. Black or African African American and White Harris County Residents American residents in Harris County experience the greatest disparities in Cause of Death Black or White HP 2010* Objective the leading causes of death of heart African Mortality Mortality disease, cancer, stroke, and diabetes. American Mortality Blacks or African Americans are three times as likely to die from diabetes as Heart Disease 334 249.5 166 or lower Whites. Thirty percent more Blacks or African Americans die from heart Cancer 258.4 196.3 159.9 or lower disease and cancer as Whites, and 60% more die from strokes. Stroke 97.9 61.4 48 or lower The leading causes of death for this Diabetes 53.8 18.6 45 or lower group, in descending order, are heart disease, cancer, stroke, diabetes, HIV/AIDS 26.5 4.9 0.7 or lower accidents, kidney disease, chronic lower respiratory disease, septicemia, *Rates are age-adjusted deaths per 100,000 persons. HIV/AIDS, influenza/pneumonia, and **Healthy People 2010, see page 23. homicide. SOURCE: Texas Department of State Health Services, Bureau of Vital Statistics, Harris County, 2003.
HIV/AIDS Violence
Death Rates from HIV/AIDS Death Rate from Homicides
18.9 30 26.5 20 25 15 20 15 10 6.1 10 4.9 3 5 0.7 5 0 0 Black or White HP 2010* Black or White HP 2010* Deaths per 100,000 persons* Deaths Deaths 100,000 per persons* African African Am erican American
*Rates are age-adjusted. *Rates are age-adjusted. **Healthy People 2010, see page 23. **Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Bureau of Vital SOURCE: Texas Department of State Health Services, Bureau of Vital Statistics, Harris County, 2003. Statistics, Harris County, 2003. There are extreme disparities in deaths among Blacks or African Americans from HIV/AIDS and violence. Blacks or African Americans are more than five times as likely to die from HIV/ AIDS as Whites. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 39
Blacks or African Americans: Maternal/Child
Infant Mortality
The health of mothers and infants are a measure of health for the whole community. Infant Mortality Rates in Harris Following a national trend, infant mortality for County the Black or African American population is higher than that of other racial/ethnic groups. 14 11.6 Black or African American infants in Harris 12 County are more than twice as likely to die 10 before their first birthday as White infants. 8 5.4 Many factors contribute to infant mortality, 6 4.5 including maternal age, education, income, 4 social support, stress, and health care access. 2 0 Disparities are not only limited to infant Black or White HP2010* Deaths per 1,000 live births mortality. In fact, according to the Texas African Department of State Health Services, the American Black or African American population in Harris County faces the greatest *Healthy People 2010, see page 23. disparities in birth outcomes of any other SOURCE: Texas Department of State Health Services, Harris County, 2003. racial/ethnic group.
Maternal Child Health: Low Birth Weight Premature infants, characterized by Low and Very Low Birth Weight low birth weight and gestational age Infants Born to Harris County Women at delivery, face greater risks of death and development problems. Black or White HP 2010* Besides the short-term complications African that may arise, low birth weight may American also increase the infant’s risk of developing chronic conditions such Very Low Birth Weight: 3.0% 1.3% 0.9% as obesity and diabetes in the future. Percent that weigh less than 3.3 lbs at birth Black or African American infants Low Birth Weight: 13.8% 7.2% 5.0% in Harris County are twice as likely Percent that weigh less to be born at low birth weight or than 5.5 lbs at birth very low birth weight as White infants. *Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Harris County, 2003. PAGE 40 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Prenatal Care
Harris County Women Who Harris County Women Who Received Inadequate Prenatal Received Prenatal Care in the Care First Trimester
30% 25.8% 95% 89% 90% 25% 90% 16.5% 85% 20% 80% 76% 15%
women 75% 10% 70% 5% 65% 0% Percentage of pregnant Percentage of births
Black or African White White African Black or Black American HP2010* American
SOURCE: Texas Department of State Health Services, Harris County, 2003. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Harris County, 2003. Black or African American women in Harris County are more likely to receive inadequate prenatal care as White women. Only 76% of Black or African American women received prenatal care in the first trimester of their pregnancies.
Black or African American women are less likely to have adequate and timely prenatal services than White women.
Adolescent Births
Adolescent births are more common among the Black or African American population in Houston Adolescent Births in Harris than the White. In 2003, nearly 6% of all births County in the Black or African American population were to adolescent mothers under 18 years of age. This percentage is nearly three times that 7% 5.9% of the White population. Furthermore, nearly 1 6% out of every 5 adolescent births in Harris County 5% are to Black or African American females. 4% 3% 1.9% 2% 1%
racial/ethnic group 0% Black or African White Percentage of total births in American
SOURCE: Texas Department of State Health Services, Harris County, 2003. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 41
Blacks or African Americans: Heart Disease
Heart Disease
Houston Adults Diagnosed with Heart Disease Mortality for Heart Disease Harris County Adults
15% 12.6% 400 334.0 10.5% 300 249.5 166 10% 200 100 5% persons* 0 respondents Percentage of Percentage
0% Deaths per 100,000 Black or White HP 2010** Black or African White African American American
SOURCE: Texas Department of State Health Services, Behavioral Risk Factor *Rates are age-adjusted Surveillance System, Harris County, 2005. ** Healthy People 2010, see page 23. Although heart disease and stroke are major On average, Blacks or African Americans in killers in the U.S., they cause disproportionate Houston are less likely than Whites to be deaths among the Black or African American diagnosed with heart disease, but they are more population in Houston. likely to die from it.
Stroke Hypertension
Stroke Mortality for Harris County Houston Adults Diagnosed with Adults High Blood Pressure 40% 35% 120 97.9 35% 29% 100 30% 25% 80 61.4 16% 60 48 20% 15% 40 10% 20 5% 0 0% Percentage of respondents Black or White HP 2010** Black or White HP 2010*
Deaths 100,00 per persons* African African American American
*Rates are age-adjusted. SOURCE: Texas Department of State Health Services, Behavioral Risk ** Healthy People 2010, see page 23. Factor Surveillance System, Harris County 2005. SOURCE: Texas Department of State Health Services, Harris County, 2003. * Healthy People 2010, see page 23. Blacks or African Americans are more likely to be Blacks or African Americans in Harris County are diagnosed with a stroke than Whites and are more more likely to be diagnosed with high blood pres- likely to die from it. sure. PAGE 42 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Blacks or African Americans: Cancer
Cancer Mortality
The leading causes of specific cancer deaths in Harris County Percentage of Total Cancer Mortality are lung, colorectal, breast, pan- creatic, and prostate cancer. In Harris County Most of the cancers in the “Other” category are ill-defined or unspecific; however, ovarian cancer causes 2.4% of cancer Lung, mortality. Uterine and cervical 27.8% cancer each contribute 1.2% to Other*, cancer mortality. 43.9% Colorectal, 9.7% Prostate, 4.8% Breast, Pancreas, 8.4% 5.4%
* “Other” includes cervical, uterine, ovarian, leukemia, and other ill-defined or unspecific cancers. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004.
Blacks or African Americans in Harris Harris County Cancer Mortality County have higher mortality rates from Rates cancer than any other racial/ethnic group. They also experience the greatest disparities 300 in cancer mortality for most specific types of 260.4 cancers. 250 202.3 200 159.9 150 100 50 0
Deaths 100,000 per persons* Black White HP2010**
*Rates are average annual age-adjusted rates. ** Healthy People 2010, see page 23. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of Health and Human Services, 2000-2004. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 43
Lung Cancer
Lung cancer is the leading cause of Average Yearly Lung Cancer cancer deaths in Harris County, making Incidence in Harris County up over a quarter of all cancer deaths. (2000-2004) Although smoking rates among Blacks or African Americans in Houston are lower 85.3 than those of Whites, they have a greater 86 incidence of lung cancer. They are also 84 more likely to die from lung cancer than 82 Whites. 80 77.5 78 76 74 72
Rates per 100,000 persons* Black or African White American
*Rates are average annual age-adjusted rates. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004.
Average Yearly Lung Cancer Mortality in Harris County (2000-2004)
80 71.5 70 60.9 60 44.9 50 40 30 20 10 0 Black or White HP2010** Deaths100,000 per persons* African American
*Rates are average annual age-adjusted rates. ** Healthy People 2010, see page 23. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004. PAGE 44 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Breast Cancer
Breast cancer is the third leading cause of Breast Cancer Mortality in Harris death in Harris County. Although White County women have a greater incidence of breast cancer than Black or African American women, Black or African American women 50 are more likely to die from it. 38.1 40 28.7 30 22.3 20 10 0
Deaths per 100,000 persons* 100,000 per Deaths Black or White HP2010** African American
*Rates are average annual age-adjusted rates. ** Healthy People 2010, see page 23. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004.
Health Care Access: Cancer Screening
Harris County Women Who Women in Harris County Who Reported Receiving a Reported Receiving a Pap Mammogram in the Past 2 Years Smear in the Past 3 Years
100% 84% 100% 98% 69% 70% 80% 95% 60% 90% 86% 40% 85% 20% 0% 80%
Percentage of respondents Black or White HP2010* Black or White African respondents of Percentage African American American
* Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk SOURCE: Texas Department of State Health Services, Behavioral Risk Factor Factor Surveillance System, 2004. Surveillance System, 2004.
There may be disparities in certain types of cancer treatment or screening. Black women in Harris County are less likely to receive a mammogram than White women, but they are more likely to have re- ceived a pap smear. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 45
Cervical Cancer
Cervical Cancer Incidence in Cervical Cancer Mortality in Harris County Harris County
7 15 6.1 13.4 6 5 10 8.3 4 2.7 3 2.0 5 2 1 0 0 Black or White HP2010** Deaths per 100,000 persons* 100,000 per Deaths
Rates 100,000 persons* per Black or African White African American American
*Rates are average annual age-adjusted rates. *Rates are average annual age-adjusted rates. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas ** Healthy People 2010, see page 23. Department of State Health Services, 2000-2004. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004. Although screening rates for cervical cancer are higher for Black women than White women, inci- dence of cervical cancer is 61% higher among Black women, and they are nearly three times as likely to die from it. Access to cancer manage- ment or treatment may be an issue.
Prostate Cancer
Prostate Cancer Incidence in Prostate Cancer Mortality in Harris County Harris County
217.0 70 57.4 250 60 200 164.1 50 40 26.7 28.8 150 30 100 20 10 50 0 0 Black or White HP2010** Black or African White persons* 100,000 per Deaths African Rates per 100,000 persons* American American
*Rates are average annual age-adjusted rates *Rates are average annual age-adjusted rates. SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, TX ** Healthy People 2010, see page 23. DSHS, 2000-2004 SOURCE: Harris County, Cancer Epidemiology & Surveillance Branch, Texas Department of State Health Services, 2000-2004. Black or African American men have the highest incidence of prostate cancer in Harris County, higher than their White counterparts. They are also more than twice as likely to die from it. PAGE 46 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Blacks or African Americans: Diabetes Diabetes Prevalence Diabetes Mortality
Harris County Adult Diabetes Mortality Rate from Diabetes Prevalence 60 53.8 50 45 20% 16.3% 40 15% 30 18.6 8.6% 10% 20 10 5% 0 0% Black or White HP 2010** Black or African White persons* 100,000 per Deaths
Percentage of respondents of Percentage African American American
SOURCE: Texas Department of State Health Services, Behavioral Risk *Rates are age-adjusted. Factor Surveillance System, 2005. ** Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Bureau of Vital Statistics, 2005. Black or African American residents have the highest rate of diabetes in Harris County, so dia- Although diabetes is a manageable disease, Blacks or betes care and management is a critical priority. African Americans in Houston are nearly three times as likely to die from diabetes as their White counter- parts.
Uncontrolled Diabetes Lower Extremity Amputations
Hospital Discharge Rate for Hospital Discharge Rates for Uncontrolled Diabetes Lower Extremity Amputations
180.0 80 57.4 200 60 150 40 15.5 100 46.3 20 50 13.9 persons* persons* 0 0 Black or White Black or White HP2010** Discharges per 100,000 100,000 per Discharges Discharges 100,000 per African African American American
*Rates are age-adjusted. *Rates are age-adjusted. SOURCE: Texas Department of State Health Services, Texas Diabetes ** Healthy People 2010, see page 23. Council, Public Health Region 6, 2000. SOURCE: Texas Department of State Health Services, Texas Diabetes Council, On average, Blacks or African Americans have Public Health Region 6, 2000. the highest rate of hospitalizations for uncontrolled diabetes. Hospital discharge data for Public Health Region 6 indicate that Blacks or African Americans are nearly four times as likely to be hospitalized for uncontrolled diabetes as their White counterparts, and are more than three times as likely to suffer amputations of their lower extremities. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 47
Blacks or African Americans: Diet, Weight, and Exercise
Overweight/Obese Adults and Youth
Overweight or Obese Adult Overweight Adult Residents in Residents in Harris County Harris County
80% 68% 50% 70% 58% 38% 40% 60% 40% 33% 50% 40% 30% 40% 30% 20% 20% 10% 10% 0% 0% Percentage of respondents Black or White HP 2010* Percentage of respondents Black or White HP 2010* African African American American
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk SOURCE: Texas Department of State Health Services, Behavioral Risk Factor Surveillance System, 2005. Factor Surveillance System, 2005.
Overweight and obesity is a growing problem in Black or African American adults are more likely the U.S., particularly among Houston residents. to be obese (BMI greater than 30) than Whites. Being overweight increases one’s risk of devel- Black or African American youth also are at oping other chronic conditions, including diabe- higher risk. More than twice as many Black or tes, stroke, heart disease, hypertension, and can- African American high school students are over- cer. A greater percentage of Black or African weight as White students. American adults in Harris County are either over- weight or obese, compared to other racial/ethnic groups.
Obese Adult Residents in Harris Overweight Students in County Houston
35% 30% 16% 13% 30% 25% 14% 25% 12% 20% 15% 10% 8% 6% 5% 15% 6% 10% 4% 5% 2% 0% 0% Percentage of respondents Percentage of respondents Black or White HP 2010* Black or White HP 2010* African African American American
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk SOURCE: Texas Department of State Health Services, Youth Risk Factor Surveillance System, 2005. Behavior Surveillance Survey, 2001. PAGE 48 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Physical Activity
Blacks or African Americans in Houston are more likely not to have engaged in sufficient Harris County Adults Without physical activity, as recommended by the Sufficient Exercise Centers for Disease and Prevention Control (CDC). These recommendations are moderate 70% 60% physical activity for 5 days a week or vigorous 60% 53% activity for 3 days a week. 50% 40% 30% 30% 20% 10% 0% Percentage of respondents of Percentage Black or White HP 2010* African American
* Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Houston, 2005.
Nutrition
Blacks or African Americans in Houston are less Harris County Adults Without likely than Whites to have consumed the recom- Sufficient Intake of Fruits & mended daily intake of 2 servings of fruit and 3 Vegetables servings of vegetables.
90% 83.3% 80% 74.4% 70% 60% 50.0% 50% 40% 30% 20% 10% Percentage of respondents of Percentage 0% Black or White HP 2010* African American
* Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Risk Factor Surveillance System, 2005. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 49
Blacks or African Americans: Infectious Disease
HIV/AIDS
The greatest disparity in infectious disease is the burden of HIV/AIDS. In 2006, more than HIV/AIDS Incidence in Harris half the population living with HIV/AIDS were County, 2005 Black or African American. Blacks or African Americans in Harris County have the 40 34.0 highest incidence rate of HIV/AIDS, nearly 30 fourteen times that of Whites. Furthermore, 20 they are more than five times as likely to die 10 2.5 1.0 from HIV/AIDS as their White counterparts. persons 0
Rate 100,000 per Black or White HP 2010* African American
* Healthy People 2010, see page 23. SOURCE: Houston HIV Prevention Community Planning Group 2007 Compre- hensive Plan Update, U.S. Census Bureau American Community Survey 2005.
Gonorrhea and Syphilis
Gonorrhea Prevalence in Syphilis Prevalence in Harris Harris County County
500 446.5 12 10.5 400 10 300 8 5.6 200 6 100 27.7 19 4 0 2 Rate per 100,000 persons Black or White HP 2010* 0 Rate per 100,000 persons 100,000 per Rate African Black or African White American American
* Healthy People 2010, see page 23. SOURCE: Centers for Disease Control and Prevention, 2003. SOURCE: Texas Department of State Health Services and Houston Department of Health and Human Services case files, 2000-2004, Houston/ Harris County. Blacks or African Americans in Harris County also experience the greatest disparities in other sexually transmitted diseases as well, such as gonorrhea and syphilis. In fact, Blacks or African Americans are more than sixteen times as likely to have gonorrhea as Whites, and nearly twice as likely to have syphilis. PAGE 50 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Hepatitis B
Although Blacks or African Americans have a lower rate of Hepatitis B than Asians in Harris Hepatitis B Prevalence in County, compared to Whites, the burden of Houston Hepatitis B is still three times greater among Blacks or African Americans. 45 38.7 40 35 30 25 20 13.6 15 10 5
Rate per 100,000 persons 0 Black or African White American
SOURCE: Texas Department of State Health Services & Houston Department of Health and Human Services case files, 2004.
Tuberculosis
Blacks or African Americans in Harris County TB Incidence in Harris County, are at highest risk for TB infection, compared 2005 to any other racial/ethnic group. In 2005, Black or African American residents in Harris 16 14.98 County were nearly 7 times as likely to become 14 infected with tuberculosis than White residents. 12 10 8 6 4 2.17 2 0 Rate per 100,000 persons 100,000 per Rate Black or African White American
SOURCE: Big Cities Health Inventory, 2007, Houston Department of Health and Human Services Bureau of TB Control, U.S. Census Bureau American Community Survey 2005. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 51
Blacks or African Americans: Health Behaviors
Smoking and Alcohol
Houston Adults Who Smoking and alcohol use is less common Currently Smoke among Black or African American residents in Houston, compared to other races/ethnicities. However, the smoking rate among Black or 20% 16% 18% African American adults is still higher than the 15% 12% Healthy People 2010 goal of 12% or lower. Black or African American high school students 10% also have lower smoking rates than their White 5% counterparts. 0% Binge drinking is also less common among the Black or White HP 2010*
Percentage of respondents of Percentage Black or African American population, for both African adults and youth. White adults are more likely American to binge drink than Black or African American adults.
* Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Behavioral Health and Risk Factor Survey, Harris County, 2005.
Sexual Behavior
Houston High School Students Houston High School Students Who Have Ever Had Sexual Who Had Sexual Intercourse Intercourse Before 13 Years of Age 57% 60% 20% 16% 35% 40% 15% 15% 10% 20% 5% 3%
respondents 0% 0% Percentage of of Percentage Black or White HP 2010 Black or White African African Percentage of respondents American American
SOURCE: Texas Department of State Health Services, Youth Behavioral SOURCE: Texas Department of State Health Services, Youth Behav- Risk Factor Surveillance System, Houston, 2001. ioral Risk Factor Surveillance System, Houston, 2001
Sexual activity is one area of high risk behavior Black or African American high school students among Black or African American youth, are also more than six times as likely to report placing them at risk for HIV/AIDS and other they have had sexual intercourse before 13 STDs. More than half of Black or African years of age as their White counterparts. American high school students reported they had sexual intercourse, compared with more than a third of White high school students. PAGE 1 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Section
Health Profile: Asians PAGE 52 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Summary Health Profile: Asians The Asian population is the smallest racial/ Obstacles to Health Data on Asians ethnic minority group in Houston, but is experi- Data on the health status of Asians is scarce for encing great growth. This group is the most several reasons. First, the small statistical size and culturally diverse, with the largest percentages diversity of this group pose challenges for data col- of immigrants coming from Vietnam, India, and lection. For example, population-based surveys China. used by state and local governments do not over- sample this group (to achieve a statistically signifi- cant sample), or have the resources to translate “In today’s world, where the AAPI surveys into the various languages which are (Asian American and Pacific Is- needed. This is particularly important since nearly lander) population is approaching three quarters of Asians in Houston are immigrants and English-speaking ability is limited. Also, since 5 percent of the total U.S. popula- language is a measure of acculturation to American tion, the disconnect between the lifestyles, the health and socio-economic profiles of data and reality is disconcerting.” Asians who speak English and those that do not 1 are very different. -Marjorie Kagawa-Singer, Ph.D. & Data for Asians may not be collected at all, or may 1 Paul M. Ong, Ph.D. be unusable, particularly if it is collected in an anonymous racial category of “Other.”1 Collected data is often not systematically analyzed due to Disparities in Health Determinants lack of political power and invisibility of this popula- 1 National aggregate data indicate that as a tion. Furthermore, the stereotype of Asians as the group, Asians have higher education and “Model Minority” persists, so problems experienced income than the general U.S. population, but by this group, or its constituent subgroups, are 1 have less access to health care than other overlooked. Since Asians represent both ex- racial/ethnic subgroups.1 Local data supports tremes of socio-economic and health status, aggre- this finding. In fact, Asian residents in Houston/ gate data for this population often masks problems Harris County face the following disparities in experienced by disadvantaged groups and pre- 1 health determinants, compared with other racial/ vents them from obtaining necessary resources. ethnic groups: With the paucity of data for Asians, research plays As a group, Asians have higher an important role in providing information. How- education and incomes. However, the ever, the special interests of researchers are insuf- Vietnamese subgroup tends to have ficient to provide comprehensive data on the health lower formal education and income.2 status of Asians. Better data is needed on the Asians are more likely to be uninsured Asian population and its constituent subgroups. and have less access to health care. This will require oversampling of the population, as well as the ability to conduct surveys in different Risk factors for Asians differ according 1 to cultural practices, immigration history, languages. Without data, the health status of acculturation to the U.S., and socio- Asians or Asian subgroups cannot be tracked, nor economic status.1 For example, some can their changing health needs be met as they Asian groups tend to have diets high in become more acculturated in the U.S. sodium (soy sauce, etc.) and nitrates (pickled foods, etc.) which can increase the risk of stomach cancer.1 South Asians tend to have diets higher in cholesterol and fat, leading to greater rates of diabetes and cardiovascular disease.1
1Kagawa-Singer M, Ong PM. The Road Ahead—Barriers and Paths to Improving AAPI Health. AAPI Nexus Vol.3, No. 1 (Spring 2005):vii-xv. 2Klineberg SL. The Houston Area Survey 1982-2005: Public Perceptions in Remarkable Times, Rice University. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 53
Disparities in Health Outcomes Areas of Better Health
National trends report that Asians are Much remains unknown about the health status of disproportionately affected by health outcomes such Asians in Houston. For example, there is no data as higher rates of certain types of cancer, for maternal/child health indicators and cancer tuberculosis, Hepatitis B, tobacco smoke, chronic mortality for this group because they are classified obstructive pulmonary disease, and HIV/AIDS in the category of “Other” race/ethnicity. Thus, (Centers for Disease Control and Prevention [CDC], although Asians appear to have better health Office of Minority Health and Health Disparities). outcomes in some health areas, results may be Nationally, the number one cause of death among misleading due to lack of data. In addition, similar to Asians is cancer. Other sources indicate that this the Hispanic or Latino population, Asians appear to group is disproportionately affected by diabetes, have lower mortality, but death rates may be osteoporosis, and increasing rates of overweight/ misleading since it does not take into account the obesity.1 Local data reference supports some of “salmon” effect of Asians who return to their home these findings. The leading causes of death for countries to die.1 Asians in Harris County, in descending order, are heart disease, cancer, stroke, chronic lower With these data constraints in mind, Asian residents respiratory disease, accidents, and diabetes. in Houston/Harris County appear to have better health than other racial/ethnic groups in the Asian residents of Houston/Harris County face the following areas: following disparities in health outcomes, compared with other racial/ethnic groups: Lower overall mortality. Lower mortality from heart disease, cancer, May have higher rates of cervical cancer stroke, and diabetes. incidence and mortality. Lower self-reported rates of diabetes, high Lower rates of cancer screening (pap blood pressure, and cholesterol among smears, mammograms, colorectal Chinese and Vietnamese community 2 screening, and prostate screening). (although obstacles to health care access Higher rates of diabetes among South and diagnosis may underestimate these Asians.3 results). Higher rates of tuberculosis and hepatitis B. Lower rates of HIV/AIDS and other STDs. Lower levels of recommended physical activity and nutrition.2
Selected Health Indicator: Health Insurance Asian residents are more likely to lack health Residents in Greater Houston Area insurance than Black or African American or Without Health Insurance White residents.
35% A 2004 survey of Asian residents from Brazoria, 31% Fort Bend, Galveston, and Harris County 30% revealed that 20% of the Chinese population and 25% 30% of the Vietnamese population were 20% 2 20% uninsured in 2004. In comparison to 2005, where 9% of Whites in Harris County were 15% uninsured (BRFSS). Results from a different 10% study indicates that 18% of the South Asians in Houston are uninsured.3 5%
Percentage of respondents of Percentage 0% Chinese Vietnamese
SOURCE: Asian American Health Needs Assessment, 2006 Community Report.3
1Kagawa-Singer M, Ong PM. The Road Ahead—Barriers and Paths to Improving AAPI Health. AAPI Nexus Vol.3, No. 1 (Spring 2005):vii-xv. 2Hoang TV, Gor BJ, Hernandez M, Liang J, Esparza A, Detry M, Yi JK, Jones LA. Asian American Health Needs Assessment, 2006 Community Report. Houston (TX): Center for Research on Minority Health, The University of Texas M.D. Anderson Cancer Center; 2006 Nov. 3Misra, R. Diabetes among Indian Americans Study. PAGE 54 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Selected Health Indicators: Asians Mortality Overall mortality for Asian/ Pacific Islanders in Harris Leading Causes of Death Among White & County is lower than for Asian/Pacific Islander (API) Harris County Residents White residents. The leading causes of death Cause of Death API White HP 2010** Objec- are shown on the left. Mortality Mortality tive Mortality However, data for many specific causes of death Heart Disease 107.7 249.5 166 or lower were not available. Cancer 100.2 196.3 159.9 or lower Stroke 34.6 61.4 48 or lower Chronic Lower Respiratory 16.4 43.5 N/A Disease Accidents 9.9 25.6 N/A Diabetes 10.9 18.6 5.0 or lower
*Rates are age-adjusted deaths per 100,000 persons. ** Healthy People 2010, see page 23. SOURCE: Texas DSHS, Bureau of Vital Statistics, Harris County, 2003.
Health Care Access: Cancer Screening
Asian Women in Greater Houston Asian Women in Greater Houston Metropolitan Area Who Reported Metropolitan Area Who Reported Receiving a Mammogram in Past 2 Receiving a Pap Smear in Past 3 Years Years 100% 90% 72% 70% 80% 70% 70% 66% 68% 60% 66% 64% 64% 62% 40% 62% 20% 60% 58% 0% Percentage of respondents of Percentage Percentage of respondents of Percentage Chinese Vietnamese HP2010* Chinese Vietnamese HP2010*
* Healthy People 2010, see page 23. ** Healthy People 2010, see page 23. SOURCE: Asian American Health Needs Assessment, 2006 Community SOURCE: Asian American Health Needs Assessment, 2006 Community Report1 Report1 A 2005 study of Asian residents in Brazoria, Fort In comparison, in 2004, 69% of White women in Bend, Galveston, and Harris Counties indicated Harris County reported receiving a mammogram in the past 2 years, and 86% reported received a pap that the majority of Asian residents did not 2 receive recommended cancer screening.1 This smear in the past 3 years . In a different study, includes screening for breast, cervical, prostate, 57% of surveyed South Asian women reported re- and colorectal cancer. ceiving a mammogram in the last 2 years, and 79% reported receiving a pap smear in the last 3 years.3
1Hoang TV, Gor BJ, Hernandez M, Liang J, Esparza A, Detry M, Yi JK, Jones LA. Asian American Health Needs Assessment, 2006 Community Report. Houston (TX): Center for Research on Minority Health, The University of Texas M.D. Anderson Cancer Center; 2006 Nov. 2Texas Department of State Health Services, Behavioral Risk Factor Surveillance System. 3Misra, R. Diabetes among Indian Americans Study. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 55
Infectious Diseases
Hepatitis B Prevalence in Houston TB Incidence in Harris County, 2005
300 16 14.05 250.2 250 14 12 200 10 150 8 100 6 4 2.17 50 13.6 2 Rate per 100,000 persons 100,000 per Rate Rate per 100,000 persons 100,000 per Rate 0 0 As ian White Asian White
SOURCE: DSHS & HDHHS case files, 2004. SOURCE: Big Cities Health Inventory, 2007, HDHHS Bureau of TB Control, U.S. Census Bureau, American Community Survey 2005. Asian residents in Harris County have the highest Asians in Harris County have the second highest rates of Hepatitis B, compared with any other rates of TB, compared with other racial/ethnic racial/ethnic group. Asian residents are eighteen groups. Asian residents are six times more likely to times more likely to be infected with Hepatitis B be infected with TB than Whites. than Whites.
Health Behaviors
Percent of Texas Adults Who Percent of Smokers in Greater Engage in Moderate or Vigorous Houston Area, 2005 Physical Activity, 2003
16% 14% 60% 49% 14% 12% 50% 12% 10% 40% 10% 31% 30% 30% 8% 20% 6% 4% 10% 2%
Percent of Respondents 0% Percentage of Respondents of Percentage 0% Asian White HP 2010* Chinese Vietnamese HP 2010
* Healthy People 2010, see page 23. * Healthy People 2010, see page 23. SOURCE: Health Disparities in Texas, Annual Report 2004, Health Disparities SOURCE: Asian American Health Needs Assessment, 2006 Community Report.1 Task Force. Asians in Texas are less likely to have engaged in Although smoking rates are lower on average the recommended amount of physical activity. In among Asians than Whites, Vietnamese men report 2005, 62% of surveyed Chinese respondents in the highest smoking rates compared with any other Harris County and surrounding areas indicated that race/ethnic group.1 they had no leisure-time physical activity.1
1Hoang TV, Gor BJ, Hernandez M, Liang J, Esparza A, Detry M, Yi JK, Jones LA. Asian American Health Needs Assessment, 2006 Community Report. Houston (TX): Center for Research on Minority Health, The University of Texas M.D. Anderson Cancer Center; 2006 Nov. PAGE 1 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Section PAGE 56 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Summary Health Profile: Whites
The White population group in Houston is experi- Disparities in Health Outcomes encing little growth and is expected to make up a National trends indicate that Whites are dispro- smaller segment of the Houston population in the portionately affected by health outcomes such as future. Since Whites in Houston are older, on higher rates of hypertension, obesity, heart dis- average, than residents of other race/ethnic ease, chronic lower respiratory disease, Alz- groups, health statistics for this group can be heimer’s, and suicide (Centers for Disease Con- misleading if they do not account for differences trol and Prevention, Office of Minority Health and in health outcomes that would naturally arise Health Disparities). Local data supports some of from these age discrepancies. these findings.
White residents of Houston/Harris County face Health Determinants the following disparities in health outcomes, com- pared with other racial/ethnic groups: National data indicate that as a group, Whites are at both extremes of socio-economic and health Higher mortality rates due to stroke, status. Some are recent immigrants, while chronic lower respiratory disease others have been in the U.S. for many (chronic bronchitis, asthma, emphysema, generations. Whites with lower socioeconomic etc.), Alzheimer’s, and suicide. status often experience many of the same health Higher prevalence of diabetes. problems as other racial/ethnic groups, Higher prevalence of heart disease, high particularly disparities in health care access. blood cholesterol, and high blood pres- sure. Since local data on income, however, was Higher incidence of breast and uterine unavailable, the socio-economic and health cancers. status of Whites in Houston cannot be stratified High prevalence of overweight/obesity. by income. Therefore, we must view the group Low levels of recommended physical as a whole. Local data shows that the White activity and nutrition. population in Houston experiences the following advantages in health determinants: Highest rates of smoking (both adults and youth). On average, Whites have higher levels of Higher rates of binge drinking (both educational attainment. adults and youth). Whites have the highest average levels of income and lowest poverty rates. Areas of Better Health White residents face fewer obstacles to health care access. Whites are less White residents in Houston/Harris County experi- likely to lack health insurance and are ence better health than other racial/ethnic groups more likely to have a regular health care for the following health conditions/behaviors: provider. Highest levels of use of preventive Lower rates of adolescent births. services such as cholesterol checks, Lower rates of infant mortality and ad- cancer screening, and adequate and verse birth outcomes. timely prenatal care. Lower rates of infectious diseases. Better outcomes for diabetes. CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT PAGE 57
Whites: Mortality Disparities Life Expectancy
In order to avoid duplicating the charts in Life Expectancy among White and other sections, data in this section will Hispanic or Latino Texas Residents present information which has not already been presented for the White population, namely mortality. The Hispanic or Latino 82 81.0 79.9 ethnic population is used here for 80 comparison, since they experience better outcomes for mortality than Whites. 78 76.0 74.8 76 Although White residents in Texas have a Years 74 higher life expectancy than Blacks or African 72 Americans, they have a lower life expectancy than Hispanics or Latinos. 70 Hispanic White Male Hispanic White or Latino or Latina Female Male Female
SOURCE: Texas Department of State Health Services, 2003.
Selected Leading Causes of Death
Cause of Death White Hispanic HP 2010** Overall mortality for White Mortality or Latino Objective Mortality residents in Harris County is Mortality higher than for Hispanic or Latino residents. Whites are nearly Heart Disease 249.5 127.3 166 or lower twice as likely to die from heart Cancer 196.3 127.3 159.9 or lower disease than Hispanics or Lati- nos, and are more than three Stroke 61.4 58.6 48 or lower times as likely to die from chronic lower respiratory disease and sui- Chronic Lower 43.5 13.5 N/A cide. Whites are also more than Respiratory twice as likely to die from Alz- Disease heimer’s as Hispanics or Latinos. Alzheimer’s 25.6 9.9 N/A The leading causes of death for Suicide 16.8 5.4 5.0 or lower this group, in descending order, are heart disease, cancer, stroke, *Rates are age-adjusted deaths per 100,000 persons. chronic lower respiratory disease, ** Healthy People 2010, see page 23. SOURCE: Texas Department of State Health Services, Bureau of Vital Statistics, Harris County, 2003. accidents, Alzheimer’s, diabetes, influenza/pneumonia, suicide, septicemia, and kidney disease. PAGE 58 CITY OF HOUSTON HEALTH DISPARITIES DATA REPORT
Appendix A Table 1.1 Health Disparities & Priority Areas Identified by Other Experts Identified Areas of Health Healthy CDC Office AHRQ Boston Alameda New York Minnesota Care Disparities People of Minority County City 2010 Health Socioeconomic Status x x x x x x x Racism/Discrimination x x x x x x x Environmental Conditions x x x x x Health Care Access x x x x x x x Nursing Home/Home Care x Immunizations x x x x Self-Assessed Health x x Mental Health x x x x x Suicide x Mortality x x x x Violence/Homicide x x x x Unintentional Injuries x x Maternal/Infant Health x x Infant Mortality x x x x Adolescent Births x x x Healthy Youth Development x Cancer x x x x x x Breast Cancer x x x Cervical Cancer x x Prostate Cancer x x Lung Cancer x x Heart Disease/Hypertension/ x x x x x x Cardiovascular Disease/ Stroke Chronic Obstructive Pulmo- x nary Disease Respiratory Disease x Asthma x x x Diabetes x x x x x End Stage Renal Disease x Overweight/Obesity x x x x Physical Activity x x x Tobacco Smoke x x x Substance Abuse x x x Sexual Behavior x x Infectious Disease x x x x x x HIV/AIDS x x x x x x Hepatitis B x x Hepatitis C x Tuberculosis x x x JANUARY 2007 PAGE 3
Footnotes: 1 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Federal Register Notice, October 30, 1997, Office of Management and Budget (OMB). 2 Questions and Answers for Census 2000 Data on Race, U.S. Census Bureau, March 14, 2001. 3 The Hispanic Population, Census 2000 Brief, U.S. Census Bureau. 4 Racial and Ethnic Classifications Used in Census 2000 and Beyond, U.S. Census Bureau, April 12, 2000.