The overarching goal of the proposed study is to examine the nature and determinants of health disparities not only between but also within racial/ethnic groups (non-Latino whites, Latinos, African-Americans, Asians, American Indians/Alaskan Natives) in the US. We focus on community size (e.g., urban vs. rural) as a potential determinant of disparities. Data for the study will come from the 1994-2008 waves of the national Behavioral Risk Factor Surveillance System (BRFSS). To measure health using the BRFSS, we propose to construct indices of individual quality of health. These indices will be based on a 5-category self-assessed health status measure and other binary ill-health indicators (e.g., diabetes, obesity, asthma etc.), supplemented by several objective determinants of overall health including different diseases/risk factors and socio-demographic characteristics. The first goal of the study is to estimate and compare quality of health by racial/ethnic group, by state, and by community size. Our second goal is to estimate three types of health inequality?total health inequality, income related health inequality, and racial/ethnic inequality in health?using the Gini coefficient, concentration index, and disparity index, respectively. We also will examine these comparisons by year, to determine whether racial/ethnic and urban/rural differences in quality of health are worsening or improving over time. Finally, our third aim is to decompose both total and income related health inequalities into socio-demographic and community-level factors using Oaxaca-Blinder type decompositions for non-linear models. This approach will be used to quantify the separate contributions of group differences in measurable characteristics such as education, income, work status and disability on health disparity (which we call indirect discrimination), and also due to the difference in the health generating processes of different groups (which we call direct discrimination).
The proposed project is intended to generate new, policy-relevant information on health disparities based on the most recent national data available. Rather than focusing public health initiatives towards specific minority groups or regions broadly, the proposed study will inform policy designs to target subgroups within such groups and regions for more fine-tuned public policy interventions.
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