Measuring health disparities: a comparison of absolute and relative disparities.

Ramal Moonesinghe,Gloria L.A Beckles

doi:10.7717/peerj.1438

Abstract

Monitoring national trends in disparities in different diseases could provide measures to evaluate the impact of intervention programs designed to reduce health disparities. In the US, most of the reports that track health disparities provided either relative or absolute disparities or both. However, these two measures of disparities are not only different in scale and magnitude but also the temporal changes in the magnitudes of these measures can occur in opposite directions. The trends for absolute disparity and relative disparity could move in opposite directions when the prevalence of disease in the two populations being compared either increase or decline simultaneously. If the absolute disparity increases but relative disparity declines for consecutive time periods, the absolute disparity increases but relative disparity declines for the combined time periods even with a larger increase in absolute disparity during the combined time periods. Based on random increases or decreases in prevalence of disease for two population groups, there is a higher chance the trends of these two measures could move in opposite directions when the prevalence of disease for the more advantaged group is very small relative to the prevalence of disease for the more disadvantaged group. When prevalence of disease increase or decrease simultaneously for two populations, the increase or decrease in absolute disparity has to be sufficiently large enough to warrant a corresponding increase or decrease in relative disparity. When absolute disparity declines but relative disparity increases, there is some progress in reducing disparities, but the reduction in absolute disparity is not large enough to also reduce relative disparity. When evaluating interventions to reduce health disparities using these two measures, it is important to consider both absolute and relative disparities and consider all the scenarios discussed in this paper to assess the progress towards reducing or eliminating health disparities.

Highlights

Disparities in health status and health care in the United States have been widely examined
The Department of Health and Human Services (HHS) National Disparities Action Plan operationalizes the national goals in the Healthy People 2020 initiative and increases its potential to be effective by using key provisions of the Affordable Care Act (ACA) and other cutting edge initiatives (US Department of Health and Human Services, 2011)
The probability of an increase in absolute disparity tends to 50% when the prevalence of disease in each group is almost identical, but this probability increases with increasing difference between the prevalence of the two groups

Summary

Introduction

Disparities in health status and health care in the United States have been widely examined. Many of these disparities have increased within the last 50 years (Institute of Medicine, 2002). These provisions in the ACA could raise awareness among policymakers and the public about the existence and persistence of health disparities and the need for interventions to reduce disparities (Andrulis et al, 2010). Few studies have attempted to estimate the economic burden of health disparities, and evidence of effective and cost-effective interventions that reduce the magnitude of disparities is scarce (LaVeist, Gaskin & Richard, 2011; Lorenc et al, 2013)

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Conclusion