Racial and Ethnic Health Disparities Report Card, 6th Edition

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1 Racial and Ethnic Health Disparities Report Card, 6th Edition September 2011

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3 Acknowledgements Many individuals contributed to the production of this report card. The Office of Policy and Performance wishes to particularly thank the staff of the Epidemiology and Response Division for providing the data for the report. Thanks also to the members of the disparities report card work group who helped select the indicators and content of the report. Report Card Workgroup Team Members: Maggi Gallaher, Lois Haggard, Wayne Honey, Vicky Howell, Nicole Katz, Elizabeth Kennedy, Michael Landen, and Larry Nielsen Report Card Providers: Marisa Bargsten, Pat Drypolcher, Kelly Gallagher, Dan Green, Wayne Honey, Larry Nielsen, Mianling Qiao, and Jim Roeber

4 Major Sources of Birth System: Bureau of Vital Records and Health Statistics, Epidemiology and Response Division Death System: Bureau of Vital Records and Health Statistics, Epidemiology and Response Division Behavioral Risk Factor Surveillance System (BRFSS): Survey Unit, Epidemiology and Response Division Youth Risk and Resiliency Survey (YRRS): Survey Unit, Epidemiology and Response Division, and Public Education Department Infectious Disease Surveillance: Bureau of Infectious Disease Epidemiology, Epidemiology and Response Division and Sexually- Transmitted Disease Program, Public Health Division Infectious Disease: Centers for Disease Control and Prevention (CDC), National Center for HIVAIDS, Viral Hepatitis, STD, and TB Prevention Births: CDC, National Center for Health Statistics, National Vital Statistics System: Deaths: CDC, National Center for Health Statistics, National Vital Statistics System: index.html BRFSS: YRBS:

5 Foreword The Department of Health is pleased to present the sixth edition of the Racial and Ethnic Health Disparities Report Card. Health disparities are the differences in health status and impact of diseases on different race and ethnic populations. Health disparities are relative, based on comparisons of the health status, access to services and/or health outcomes of population groups. For example, a disparity such as for Hepatitis B may increase even if rates are improving generally if one group s rate improves more or less rapidly than others. The mission of the Department of Health is to provide leadership to guide public health and protect the health of the citizens of. As part of this mission, one of the goals of the department is to eliminate health disparities while ensuring care to all New Mexicans. This report card addresses many of the key health issues of concern including deaths related to substance abuse and injuries, as well as disparities in the burden of chronic disease. The Department of Health cannot address these issues alone and values the contribution of many partners at the state and community levels in developing strategies to address health disparities. The Department s Office of Policy and Performance creates the report card as part of its role of coordinating the Department s efforts to reduce disparities and improve communication with s many diverse populations. We continue to work to improve the quality of this report card and invite your input and suggestions. If you have comments, are interested in working with us to address health disparities, or would like more information on the Health Disparities Report Card, please contact Vicky Howell, Ph.D., at (505) or vicky.howell@state.nm.us.

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7 Table of Contents Legend... 1 Summary Mother and Child Health Prenatal Care-Late or No Care... 4 Infant Mortality... 5 Teen Births... 6 Chronic Diseases Adults with Diabetes Receiving Recommended Services... 7 Diabetes Deaths... 8 Obesity Among Adults... 9 Obesity Among Youth Infectious Diseases had Pneumonia Vaccination (Adults 65+) Pneumonia and Influenza Deaths Chlamydia Hepatitis B Acute and Chronic HIV/AIDS Pertussis (Whooping Cough) Violence and Injury Motor Vehicle Deaths Fall-Related Deaths (Adults 65 +) Suicide Youth Suicide Homicide Risk Behaviors Smoking Among Adults Drug Induced Deaths Alcohol Related Deaths Change in

8 UNDERSTANDING THE REPORT CARD LEGEND Grade Meaning/Interpretation A Little or no disparity. B A disparity exists and should be monitored and may require intervention. C The disparity requires intervention. D Major interventions are needed. F >=3.0 Urgent interventions are needed. Reference The group with the best rate (and 20 or more cases). It is the group to which all other groups are compared and therefore will not receive a rating. s with less than 20 events during time iod. ratios and ratings are not calculated for populations with less than 20 events during the comparison time iod. DISPARITY GRADE The disparity grade column reflects how well the health system is doing in eliminating the differences among populations by comparing each group to the population with the best rate. The reference group in this column will indicate that it is the population to which all others are compared. Please note that ratings are only related to the differences among populations (disparity ratio) and are not an indication of how well or poorly, overall, is doing in relation to the indicators. RATES AND THE DISPARITY RATIO s are used to allow direct comparisons between populations of differing sizes. s are derived by taking the number of events occurring during a given time iod and dividing by the population at risk and multiplying by a constant, so that the rate is expressed as a whole number. The disparity ratio is a way to look at the severity of health problems by comparing racial/ethnic groups to one another. It is calculated by dividing the rate for each population by the reference group population rate. ratios are not calculated for populations with less than 20 cases during the time iod. 1

9 SUMMARY LARGEST DISPARITIES The indicators with the greatest differences between populations in are in order of disparity: Indicator * Population with Worst (Highest) Worst (Highest) * Reference - Population with Best (Lowest) Best (Lowest) Acute and Chronic Hepatitis B Chlamydia 2, HIV/AIDS / Black Teen Births , , Homicide American Indian Deaths due to Diabetes American Indian Alcohol-Related Deaths American Indian / Black Infant Mortality / Black , , * Disparities are only calculated for groups with at least 20 cases during the time iod. 2

10 DISPARITIES BY POPULATION American Indians had the highest (worst) rates for: Homicide Diabetes Deaths Alcohol-Related Deaths Motor Vehicle Deaths Pneumonia & Influenza Deaths Youth Obesity Adult Obesity Receiving Pneumonia Vaccination (Adults 65+) Late Prenatal Care and Youth Suicide s/blacks had the highest (worst) rates for: HIV/AIDS Infant Mortality and Smoking s had the highest (worst) rates for: Chlamydia Teen Births Drug-Induced Deaths Pertussis and Adults with Diabetes Receiving Recommended Services had the highest (worst) rates for: Acute and Chronic Hepatitis B s had the highest (worst) rates for: Suicide and Fall Related Deaths SUMMARY DISPARITIES SHOWING A CHANGE Disparities Showing an Increase: HIV/AIDS, Suicide, and Homicide Disparities Showing a Decrease: Pertussis, Motor Vehicle Deaths, Infant Mortality, Diabetes Deaths, Drug-Induced Deaths, Late or No Prenatal Care, Teen Births, Hepatitis B, Youth Suicide, Smoking, Adults Receiving Pneumonia Vaccination, Individuals with Diabetes Receiving Recommended Services Disparities Showing Little or No Change: Alcohol-Related Deaths, Fall-Related Deaths, Chlamydia, Pneumonia & Influenza Deaths, Youth Obesity 3

11 MOTHER AND CHILD HEALTH 1. Prenatal Care - Late or No Care (Care beginning after the 3rd month of pregnancy or no care during pregnancy) Race/Ethnicity Grade A American Indian B ( 100) A A Reference e: American Indian women continue to have the highest rate with nearly 1 of 2 receiving no prenatal care or prenatal care after the first trimester. Comparable data is available only for the 27 states using the same methodology for determining the timing of prenatal care initiation. The new methodology produces higher rates of late prenatal care than did the previous one. Trend in Prenatal Care by Race/Ethnicity Trend in Prenatal Care by Race/Ethnicity Per American Indian or Alaska Native Asian or Pacific (based on 27 states) Total Percent of Births with Late or No Prenatal Care

12 MOTHER AND CHILD HEALTH 2. Infant Mortality Race/Ethnicity Grade D American Indian A ( 1,000) * A Reference e: s infant mortality rate is lower than that of the US. The infant mortality rate for s is more than 2.5 times that of s. The male infant mortality rate is higher than the female mortality rate in both NM and the US. * based on less than 20 events and may fluctuate greatly from year to year, so disparity ratios not calculated. Trend in Infant Mortality by Race/Ethnicity Per Trend in Infant Mortality American Indian or Alaska Native Asian or Pacific Infant Mortality Per 1,000 by Gender Population Total Female Male Preliminary NA NA 5

13 MOTHER AND CHILD HEALTH 3. Teen Births Ages Race/Ethnicity Grade B American Indian D ( 1,000) Reference F e: The teen birth rate in New Mexico is 45% higher than the national rate. and s have rates much lower than those of other populations. teens continue to have the highest rates. American Indians also have high rates A Trend in Teen Birth s Ages by Mother s Race/Ethnicity Trend in Teen Birth s Ages Per 1, American Indian or Alaska Native Asian or Pacific Preliminary 2009 Teen Birth s Per 1,000 Ages

14 CHRONIC DISEASES 4. Adults with Diabetes Receiving All Recommended Diabetes Preventive Services Race/Ethnicity Grade American Indian A ( 100) A * * Reference e: Unlike previous years, s were more likely to receive recommended services than were s or American Indians. More than half of American Indians, s and s with diabetes do not receive the recommended services. * Survey results based on less than 50 interviews are not presented and disparity ratios not calculated. Adults with Diabetes Receiving Services by Race/Ethnicity Per Trend in Adults with Diabetes Receiving Recommended Services American Indian or Alaska Native Per 100 of New Mexicans Receiving Diabetes Preventive Services by Poverty Level Poverty Level Percent Above Federal Poverty Level 51.2 At or Below Federal Poverty Level Per 100 of New Mexicans Receiving Diabetes Preventive Services by Gender Total Female Male Available

15 CHRONIC DISEASES 5. Diabetes Deaths Race/Ethnicity Grade B American Indian F ( ) * C Reference e: The rate is more than 50% higher than the national rate. American Indians have the highest death rates due to diabetes. s have death rates twice that of whites. The diabetes death rate is higher for males. * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Diabetes Death s Per Trend in Diabetes Death s American Indian or Alaska Native Asian or Pacific Diabetes Death s Per by Gender Population Total Female Male Preliminary NA NA 8

16 CHRONIC DISEASES 6. Obesity Among Adults Race/Ethnicity Grade C American Indian C ( 100) Reference C A e: s rate of obesity remains lower than the national rate. American Indians passed s to have the highest rates of obesity. s, American Indians and s have rates of obesity higher than the national rate. Individuals at or below the poverty level have higher rates of obesity. Trend in Obesity Among Adults by Race/Ethnicity Per Trend in Obesity Among Adults American Indian or Alaska Native Asian or Pacific Per 100 of Obesity Among New Mexican Adults by Poverty Level Poverty Level Percent Above Federal Poverty Level 25.0 At or Below Federal Poverty Level 34.7 Per 100 of Obesity Among Adults by Gender Total Female Male U.S

17 CHRONIC DISEASES 7. Obesity Among Youth Race/Ethnicity B American Indian C A B Reference e: For the first time, the New Mexico rate is higher than the rate. American Indian youth have the highest rate of obesity. All populations in New Mexico show an increase from Males have higher rates of being overweight than do females for both the United States and. Trend in Obesity Among Youth by Race/Ethnicity Per Trend in Obesity Among Youth American Indian or Alaska Native Asian or Pacific Per 100 Obesity Among Youth by Gender Population Total Female Male

18 INFECTIOUS DISEASES 8. Had Pneumonia Vaccination (Adults 65+) Race/Ethnicity Grade A American Indian B ( 100) A * Reference e: American Indians and s were less likely than s to have received a pneumonia vaccination. Men were less likely than women and people at or below the poverty level were less likely than those above the poverty level have received a pneumonia vaccination. * Survey results based on less than 50 interviews and are not presented and no disparity ratios calculated. Trend in Adults 65+ Receiving Pneumonia Vaccination by Race/Ethnicity Per Trend in Adults 65+ Receiving Pneumonia Vaccination American Indian or Alaska Native data unavailable. Per 100 of New Mexicans Receiving Pneumonia Vaccination Poverty Level Percent Above Federal Poverty Level 31.1 At or Below Federal Poverty Level 40.0 of Receiving Pneumonia Vaccination by Gender Total Female Male U.S

19 INFECTIOUS DISEASES 9. Pneumonia and Influenza Deaths Race/Ethnicity Grade American Indian C ( ) 24.3 * A Reference e: The pneumonia and influenza death rate is higher than the rate. American Indians have the highest rate- more than twice that of s s for males are higher than rates for females. * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratios calculated. Trend in Pneumonia and Influenza Deaths by Race/Ethnicity Per Trend in Pneumonia and Influenza Deaths American Indian or Alaska Native Asian or Pacific Pneumonia and Influenza Deaths Per by Gender Population Total Female Male Preliminary NA NA 12

20 INFECTIOUS DISEASES 10. Chlamydia (Females Ages 15-24) Race/Ethnicity Grade 2, F American Indian 2, F ( ) Reference 2, F e: females continue to have the highest rate of reported Chlamydia. As is true nationally, Asian/ Pacific have the lowest rates. The rate for African- Americans is lower than previous rates reported in the Report Card. 1, F Trend in Chlamydia by Race/Ethnicity Trend in Chlamydia Per 4,000 3,000 2,000 1,000 American Indian or Alaska Native Asian or Pacific (2009) Chlamydia in Females Ages Per 3, ,

21 INFECTIOUS DISEASES 11. Hepatitis B (Acute & Chronic) Race/Ethnicity Grade F American Indian ( ) 2.0* F Reference A e: continue to have the highest rates. s have the lowest rates. Approximately 68 cases did not have race/ethnicity recorded. * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Hepatitis B by Race/Ethnicity Trend in Hepatitis B Per American Indian or Alaska Native Asian or Pacific * US rates are available only for acute Hepatitis B not for combined acute and chronic. Per of Hepatitis B by Gender Population Total Female Male

22 INFECTIOUS DISEASES 12. HIV/AIDS Race/Ethnicity Grade F American Indian C ( ) * B Reference e: The rate is much lower than the rate. All populations have rates well below national rates except for s. The rate for males remains higher than the rate for females. * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratio calculated. Per HIV/AIDS Trend by Race/Ethnicity Trend in HIV/AIDS American Indian or Alaska Native Asian or Pacific HIV/AIDS by Gender Population Total Per Female Male

23 INFECTIOUS DISEASES 13. Pertussis (Whooping Cough) Race/Ethnicity African- American American Indian ( ) *0.6 *2.0 *0.9 Grade A Reference e: The number of cases fluctuates year by year. s are low and numbers are small except for s and s. For rates for females are higher than rates for males. Approximately 66 cases had race/ethnicity designated as unknown/missing/multi-race. * based on on less than than events and may fluctuate greatly from from year year to to year year, so disparity so disparity ratios ratios not calculated not calculated. Pertussis Trend by Race/Ethnicity Trend in Pertussis Per American Indian or Alaska Native Asian or Pacific Pertussis by Gender Population Total Per Female Male

24 VIOLENCE AND INJURY 14. Motor Vehicle Deaths Race/Ethnicity African- American Grade American Indian C ( ) *8.3 * A Reference e: The rate is higher than the national rate. The American Indian motor vehicle death rate remains more than double the rate. However for both American Indian and s rates are decreasing. The rates for males are twice that of females. * based on less than 20 events and may fluctuate greatly from year to year, so disparity ratios not calculated. Trend in Motor Vehicle Deaths by Race/Ethnicity Trend in Motor Vehicle Deaths Per American Indian or Alaska Native Asian or Pacific Motor Vehicle Death s Per by Gender Population Total Female Male Preliminary NA NA 17

25 VIOLENCE AND INJURY 15. Fall-Related Deaths (Adults Age 65+) Race/Ethnicity African- American Grade American Indian A ( ) *30.8 * Reference A e: Falls are the leading cause of injury deaths for adults age 65 and older. s have the highest rate of fall-related deaths. The rate is high compared to the latest national rate. Women have higher rates than do men. * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratio calculated. Per Trend in Fall-Related Deaths Trend in Fall Related Deaths American Indian or Alaska Native Asian or Pacific Fall Related Deaths Per by Gender Population Total Female Male (latest available)

26 VIOLENCE AND INJURY 16. Suicide Race/Ethnicity Grade American Indian A ( ) *10.0 * Reference B e: The rate is 60% higher than the national rate. s have the highest rates but s and American Indians also have rates higher than the national rate. The male rate is more than three times the female rate. * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratio calculated. Per Trend in Suicide s by Race/Ethnicity Trend in Suicide s American Indian or Alaska Native Asian or Pacific Suicide Per by Gender Population Total Female Male Preliminary NA NA 19

27 VIOLENCE AND INJURY 17. Youth Suicide Race/Ethnicity African- American Grade American Indian B ( ) * * Reference A e: The rate is more than double the rate. American Indian youth continue to have the highest rate. Except for youth, all groups in NM have higher rates than the national rate. Male rates are 5 times the female rates. * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratios calculated. Trend in Youth Suicide by Race/Ethnicity Trend in Youth Suicide Per American Indian or Alaska Native Asian or Pacific Youth Suicide Per by Gender Population Total Female Male Preliminary NA NA 20

28 VIOLENCE AND INJURY 18. Homicide Race/Ethnicity Grade American Indian F ( ) * * C Reference e: The homicide rate is more than 38% higher than the national rate. The American Indian rate is nearly 4 times the rate. s also have rates double the rate. Male rates are much higher than female rates * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Homicide s by Race/Ethnicity Per Trend in Homicide American Indian or Alaska Native Asian or Pacific Homicide Per by Gender Population Total Female Male Preliminary NA NA 21

29 RISK BEHAVIORS 19. Smoking Among Adults Race/Ethnicity Grade B American Indian A ( 100) A A Reference e: The smoking rate is slightly higher than the national rate. People at or below the federal poverty level are more likely to smoke than are people above the poverty level. Men continue to be more likely than women to smoke. Trend in Smoking Among Adults by Race/Ethnicity Trend in Smoking Among Adults Per American Indian or Alaska Native Asian or Pacific s Per 100 of Smoking by Poverty Level Poverty Level Percent Above Federal Poverty Level 16.6 At or Below Federal Poverty Level 28.7 s Per 100 of Smoking by Gender Total Female Male U.S

30 RISK BEHAVIORS 20. Drug Induced Deaths Race/Ethnicity Grade B American Indian ( ) *6.2 Reference C C e: has been among the top 3 states for drug-induced deaths since Deaths caused by prescription drugs continue to increase. s continue to have the highest rates. * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Drug Induced Deaths by Race/Ethnicity Trend in Drug Induced Deaths Per American Indian or Alaska Native Asian or Pacific Drug Induced Death s by Gender Population Total Female Male Preliminary NA NA 23

31 RISK BEHAVIORS 21. Alcohol Related Deaths Race/Ethnicity Grade Reference American Indian D ( ) * B A e: alcoholrelated death rates remain high. American Indians continue to have an alcohol-related death rate substantially above the rates for other populations. Male rates are more than double female rates. * based on less than 20 events and may fluctuate greatly from year to year so disparity ratio not calculated. Trend in Alcohol Related Deaths by Race/Ethnicity Trend in Alcohol Related Deaths Per American Indian or Alaska Native Asian or Pacific Alcohol Related Death s by Gender Population Total Female Male (latest available data 2007)

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33 Change in A disparity change score is the difference in the relative disparity of two sub-populations between two time iods. It is based on the fact that a relative disparity equal to one means there is no disparity between the sub-populations. The higher the disparity change score, the greater the change. The index of disparity is the average of differences from the best rate.it provides a way to determine whether the disparity between several groups is getting larger or smaller relative to the best group rate. MOTHER AND CHILD HEALTH Prenatal Care/Late or No Care Racial/Ethnic Change Using Change Score Increase or Decrease Decrease American Indian No Change Increase Decrease No Change Index of Decrease Racial/Ethnic 1,000 Infant Mortality ,000 Change Using Change Score Increase or Decrease No Change American Indian Decrease 1.6* * 4.5 * Increase No Change Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 25

34 Change in MOTHER AND CHILD HEALTH A disparity change score is the difference in the relative disparity of two sub-populations between two time iods. It is based on the fact that a relative disparity equal to one means there is no disparity between the sub-populations. The higher the disparity change score, the greater the change. The index of disparity is the average of differences from the Teen best rate Births.It provides a way to determine whether the disparity between several groups is getting larger or smaller relative to the best group rate * MOTHER AND CHILD HEALTH Change Racial/Ethnic Using Increase or 1,000 Prenatal Care/Late 1,000 or No Care Change Score Decrease Decrease American Indian Change Decrease Racial/Ethnic Using Increase or Change 0.0 Score No Decrease Change Decrease Decrease American Indian No Decrease Change Index of Decrease Increase * Reference group changed from s to in so disparity change measured between only these time iods Decrease No Change Index of Decrease Racial/Ethnic 1,000 Infant Mortality ,000 Change Using Change Score Increase or Decrease No Change American Indian Decrease 1.6* * 4.5 * Increase No Change Index of Decrease * based on less than 20 events, so no disparity ratio calculated

35 CHRONIC DISEASES Adults with Diabetes Receiving All Recommended Diabetes Preventive Services Racial/Ethnic Change Using Change Score Increase or Decrease * * * * American Indian No Change * * * * Decrease Decrease Index of Decrease * Survey results based on less than 50 events are not reported. Diabetes Deaths Racial/Ethnic Change Using Change Score Increase or Decrease Decrease American Indian Decrease 29.5 * 34.8 * Decrease No Change Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 27

36 CHRONIC DISEASES Obesity Among Adults Racial/Ethnic Change Using Change Score Increase or Decrease Decrease American Indian Decrease ` No Change Decrease =0.3 Decrease Index of Decrease Obesity Among Youth Racial/Ethnic Change Using Change Score Increase or Decrease No Change American Indian Decrease Increase Decrease No Change Index of Decrease 28

37 INFECTIOUS DISEASES Racial/Ethnic 100 Had Pneumonia Vaccination Change Using Change Score Increase or Decrease Decrease American Indian Decrease * * Decrease No Change Index of Decrease * Survey results based on less than 50 interviews are not reported. Pneumonia and Influenza Deaths Racial/Ethnic Change Using Change Score Increase or Decrease 22.4 * American Indian Increase 5.5 * 25.9 * Increase No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. 29

38 INFECTIOUS DISEASES Racial/Ethnic *Chlamydia (Females Year Olds) Change Using Change Score Increase or Decrease 2, , Increase American Indian 2, , Increase No Change 3, , Decrease 2, , Decrease Index of Increase * Reference group changed for from s to Asians/Pacific so disparity change measured only between these time iods. Hepatitis B (Acute and Chronic) Racial/Ethnic Change Using Change Score Increase or Decrease 7.9 * 11.3 * American Indian 3.3 * 2.0 * Increase No Change Decrease Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 30

39 INFECTIOUS DISEASES Racial/Ethnic HIV/AIDS Change Using Change Score 9.7 * ** Increase or Decrease American Indian Increase 1.2 * 0.9 * Increase No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. ** enough cases in earlier iod to compare disparity. Pertussis (Whooping Cough) Racial/Ethnic Change Using Change Score Increase or Decrease * American Indian * * * Decrease Decrease Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 31

40 VIOLENCE AND INJURY Motor Vehicle Deaths Racial/Ethnic Change Using Change Score Increase or Decrease 8.6 * 8.3 * American Indian Decrease * * 7.6 * No Change No Change Index of Decrease * based on less than 20 events, so no disparity ratio calculated. Fall-Related Deaths Racial/Ethnic Change Using Change Score Increase or Decrease 39.2 * 30.8 * American Indian No Change 66.3 * 25.0 * Decrease No Change Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 32

41 VIOLENCE AND INJURY Suicide Racial/Ethnic Change Using Change Score Increase or Decrease 5.2 * 10.0 * American Indian Increase 6.5 * 8.0 * No Change Increase Index of Increase * based on less than 20 events, so no disparity ratio calculated. Youth Suicide Racial/Ethnic Change Using Change Score Increase or Decrease 10.7 * 24.8 * American Indian Decrease 18.1 * 6.0 * Decrease Increase Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 33

42 RISK BEHAVIORS Homicide Racial/Ethnic Change Using Change Score Increase or Decrease 10.7 * 9.8 * American Indian Increase 3.3 * 3.5 * Increase No Change Index of Increase Smoking Among Adults Racial/Ethnic Change Using Change Score Increase or Decrease =0.5 Decrease American Indian Decrease No Change Decrease Decrease Index of Decrease 34

43 RISK BEHAVIORS Drug Induced Deaths Racial/Ethnic Change Using Change Score Increase or Decrease 14.0 * American Indian No Change 0.8 * 6.2 * Decrease Decrease Index of Decrease * based on less than 20 events, so no disparity ratio calculated. Alcohol-Related Deaths Racial/Ethnic Change Using Change Score Increase or Decrease No Change American Indian Decrease 20.3 * 13.7 * Decrease Decrease Index of Decrease * based on less than 20 events, so no disparity ratio calculated. 35

44 Department of Health Office of Policy and Performance 1190 S. St. Francis Dr., S4253 Santa Fe, Phone: FAX:

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