Racial and Ethnic Health Disparities Report Card, 7th Edition

Transcription

1 Racial and Ethnic Health Disparities Report Card, 7th Edition September 2012

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3 Department of Health 1190 South St. Francis Drive Santa Fe, NM Produced by the Office of Health Equity Office of Policy and Accountability (505) To access this document electronically, visit the Department of Health website or to obtain this document in an alternate format, contact the Office of Policy and Accountability. Acknowledgements Many individuals contributed to the production of this report card. The Office of Policy and Accountability wishes to particularly thank the staff of the Epidemiology and Response Division for providing most of the data for the report. Report Card Providers: Marisa Bargsten, Agnes Bartok, Pat Drypolcher, Kelly Gallagher, Dan Green, Wayne Honey, Jeff Lauritsen, Larry Nielsen, Jim Roeber, David Selvage and Brad Whorton

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 seventh 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 pneumonia/influenza deaths 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. Consequently, the Department of Health is very pleased to announce the creation of a new Office of Health Equity with Dr. Carlotta A. Garcia as its first Director. 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 Accountability creates the report card in support of the Department s efforts and specifically the work of the Office of Health Equity in reducing disparities and improving 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 are interested in working with us to address health disparities, please contact Dr. Garcia at (505)

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

7 7 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. 7

8 8 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 s Obesity American Indians Teen Births , , HIV Infections African-American/ Black Homicide American Indian Infant Mortality African-American/ Black , Deaths due to Diabetes American Indian Pertussis s 9.8 African-American/ Black 3.0 Per 3.3 Alcohol-Related Deaths American Indian 97.3 Per African-American/ Black * Disparities are only calculated for groups with at least 20 cases during the time iod. 8

9 9 DISPARITIES BY POPULATION American Indians had the highest (worst) rates for: Adult Obesity Homicide Diabetes Deaths Alcohol-Related Deaths Motor Vehicle Deaths Pneumonia & Influenza Deaths Youth Obesity Late Prenatal Care and Youth Suicide African-Americans/Blacks had the highest (worst) rates for: HIV Infections Infant Mortality Adult Smoking s had the highest (worst) rates for: Chlamydia Teen Births Pertussis Adults with Diabetes Receiving Recommended Services Adults 65+ Ever Receiving Pneumonia Vaccinations s had the highest (worst) rates for: Acute and Chronic Hepatitis B s had the highest (worst) rates for: Suicide Drug Overdose Deaths Fall Related Deaths SUMMARY DISPARITIES SHOWING A CHANGE Disparities Showing an Increase: HIV Infections, Hepatitis B, Chlamydia, Pertussis, Suicide, Homicide, Infant Mortality, Diabetes Deaths, Pneumonia/Influenza Deaths and Adult Obesity Disparities Showing a :, Motor Vehicle Deaths, Drug Overdose Deaths, Late or No Prenatal Care, Youth Suicide, Alcohol-Related Deaths, Adults with Diabetes Receiving Recommended Services, Adults 65+ Ever Receiving Pneumonia Vaccination, Adult Smoking Disparities Showing Little or No Change: Teen Births, Youth Obesity, Fall-Related Deaths 9

10 Per 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 ( 100) Grade African-American A American Indian B s Reference A e: American Indian women continue to have the highest rate with nearly 45 out of 100 receiving no prenatal care or prenatal care after the first trimester. 1 in 3 pregnant women do not begin prenatal care until after the first trimester or do not receive any prenatal care A Trend in Prenatal Care by Race/Ethnicity Trend in Prenatal Care by Race/Ethnicity Af rican-american 60.0 American Indian or Alaska Native Asian or Pacific Total Percent of Births with Late or No Prenatal Care

11 Per MOTHER AND CHILD HEALTH 2. Infant Mortality Race/Ethnicity ( 1,000) Grade African-American F American Indian B s * A Reference e: s infant mortality rate is lower than that of the US. The infant mortality rate for African-Americans is more than 3.5 times that of s. The male infant mortality rate is higher than the female mortality rate. * 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 Trend in Infant Mortality African-American American Indian or Alaska Native Asian or Pacific Infant Mortality Per 1,000 by Gender Population Total Female Male Preliminary NA NA 11

12 Per 1, MOTHER AND CHILD HEALTH 3. Teen Births Ages Race/Ethnicity ( 1,000) Grade African-American D American Indian F s Reference F e: The teen birth rate in New Mexico is nearly 70% higher than the national rate. s 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 African-American American Indian or Alaska Native Asian or Pacific Teen Birth s Per 1,000 Ages

13 Per CHRONIC DISEASES 4. Adults with Diabetes Receiving All Recommended Diabetes Preventive Services Race/Ethnicity African-American Per 100 American Indian s * * Grade Reference A A e: More than half of the individuals with Diabetes do not receive the recommended services. * Survey results based on less than 50 interviews are not presented and disparity ratios not calculated. Please note that changes to the weighting system and addition of cell phone interviews preclude combining data with earlier years Adults with Diabetes Receiving Services by Race/Ethnicity 70 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 56.0 Per 100 of New Mexicans Receiving Diabetes Preventive Services by Gender Total Female Male At or Below Federal Poverty 55.3 Available 13

14 Per 14 CHRONIC DISEASES 5. Diabetes Deaths Race/Ethnicity ( ) Grade African-American C American Indian F s * C e: The rate is higher than the national rate. American Indians have the highest death rates due to diabetes. s and African- Americans have death rates twice that of whites. The diabetes death rate is higher for males Reference * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Diabetes Death s Trend in Diabetes Death s African-American American Indian or Alaska Native Asian or Pacif ic Diabetes Death s Per by Gender Population Total Female Male Final

15 Per CHRONIC DISEASES 6. Obesity Among Adults Race/Ethnicity Per 100 Grade African-American F American Indian F s Reference F F e: 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. Please note that changes to the weighting system and addition of cell phone interviews preclude combining data with earlier Trend in Obesity Among Adults by Race/Ethnicity Trend in Obesity Among Adults African-American American Indian or Alaska Native Asian or Pacif ic Per 100 of Obesity Among New Mexican Adults by Poverty Level Poverty Level Percent Above Federal Poverty Level 24.7 At or Below Federal Poverty Level 29.8 Per 100 of Obesity Among Adults by Gender Total Female Male U.S

16 Per CHRONIC DISEASES 7. Obesity Among Youth Race/Ethnicity African-American A American Indian C s B A e: American Indian youth continue to have the highest rates of obesity. s have the lowest rates of obesity but show an increase since 2009 Males have higher rates of obesity than do females for both the and Reference Trend in Obesity Among Youth by Race/Ethnicity Trend in Obesity Among Youth African-American American Indian or Alaska Native Asian or Pacific Per 100 Obesity Among Youth by Gender Population Total Female Male

17 Per INFECTIOUS DISEASES 8. Had Pneumonia Vaccination (Adults 65+) Race/Ethnicity African-American ( 100) * Grade American Indian A s * A Reference e: American Indians and s were less likely than s to have received a pneumonia vaccination. People at or below the poverty level were less likely than those above the poverty level have received a pneumonia vaccination. Please note that changes to the weighting system and addition of cell phone interview preclude combining data with earlier years * 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 Trend in Adults 65+ Receiving Pneumonia Vaccination Af rican-american American Indian or Alaska Native Per 100 of New Mexicans Receiving Pneumonia Vaccination by Poverty Level Poverty Level Percent Above Federal Poverty Level 27.5 At or Below Federal Poverty Level 37.2 of Receiving Pneumonia Vaccination by Gender Total Female Male U.S

18 Per 18 INFECTIOUS DISEASES 9. Pneumonia and Influenza Deaths Race/Ethnicity African-American ( ) 7.3 Grade American Indian D s A Reference e: The American Indians have the highest rate-more than twice that of s or 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 Trend in Pneumonia and Influenza Deaths African-American American Indian or Alaska Native Asian or Pacific Pneumonia and Influenza Deaths Per by Gender Population Total Female Male Final

19 Per 19 INFECTIOUS DISEASES 10. Chlamydia (Females Ages 15-24) Race/Ethnicity ( ) Grade African-American B American Indian C s enough data enough data D Reference e: females continue to have the highest rate of reported Chlamydia closely followed by American Indian females. There were fewer than 20 cases reported for Asian/ Pacific females so females became the reference group * based on less than 20 events and may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Chlamydia by Race/Ethnicity Trend in Chlamydia Af rican-american 4000 American Indian or Alaska Native 3000 Asian or Pacific (2010 Chlamydia in Females Ages Per 4, ,

20 Per 20 INFECTIOUS DISEASES 11. Hepatitis B (Acute & Chronic) Race/Ethnicity ( ) Grade African-American F American Indian s F Reference A e: s continue to have the highest rates. s have the lowest rates. Approximately 67cases 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 140 Trend in Hepatitis B Af rican-american American Indian or Alaska Native Asian or Pacific * US rates are available only for acute Hepatitis B not for combined Per of Hepatitis B by Gender Population Total Female Male

21 Per 21 INFECTIOUS DISEASES 12. HIV Infections Race/Ethnicity ( ) Grade African-American F American Indian D s * B Reference e: The rate is much lower than the rate. All populations have rates well below national rates except for African-Americans. 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. Trend in Diagnosed Infections Trend in Diagnosed HIV Infections 30 African-American American Indian or Alaska Native Asian or Pacific HIV Infection by Gender for individuals 13 and older Population Total Per Female Male

22 Per 22 INFECTIOUS DISEASES 13. Pertussis (Whooping Cough) Race/Ethnicity African- American ( ) Grade Reference group American Indian D s B F B e: The number of cases fluctuates year by year. There was an increase in cases in. s for females are higher than rates for males. Approximately 62 cases had race/ethnicity designated as unknown/missing/multi-race. * based on less than 20 events and may fluctuate greatly from year to year so disparity ratios not calculated Pertussis Trend by Race/Ethnicity Trend in Pertussis Af rican-american American Indian or Alaska Native Asian or Pacific Pertussis by Gender Population Total Per Female Male

23 Per 23 VIOLENCE AND INJURY 14. Motor Vehicle Deaths Race/Ethnicity African- American ( ) *8.6 Grade American Indian C s * 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 Af rican-american American Indian or Alaska Native Asian or Pacific Motor Vehicle Death s Per by Gender Population Total Female Male Final

24 Per 24 VIOLENCE AND INJURY 15. Fall-Related Deaths (Adults Age 65+) Race/Ethnicity African- American ( ) *23.8 Grade American Indian Reference s * A B 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. Trend in Fall-Related Deaths Trend in Fall Related Deaths Af rican-american American Indian or Alaska Native Asian or Pacific Fall Related Deaths Per by Gender Population Total Female Male

25 Per 25 VIOLENCE AND INJURY 16. Suicide Race/Ethnicity African-American ( ) *8.6 Grade American Indian A s * Reference B e: The rate is nearly 65% 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. Trend in Suicide s by Race/Ethnicity Trend in Suicide s Af rican-american American Indian or Alaska Native Asian or Pacific Suicide Per by Gender Population Total Female Male Final

26 Per 26 VIOLENCE AND INJURY 17. Youth Suicide Race/Ethnicity African- American ( ) *10.1 Grade American Indian B e: The rate is more than double the rate. American Indian youth continue to have the highest rate. Male rates are 4 times the female rates. s * Reference A * 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 Af rican-american American Indian or Alaska Native Asian or Pacific Youth Suicide Per by Gender Population Total Female Male Final

27 Per 27 VIOLENCE AND INJURY 18. Homicide Race/Ethnicity ( ) Grade African-American F American Indian F s * C Reference e: The homicide rate is more than 43 % 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 Trend in Homicide Af rican-american American Indian or Alaska Native Asian or Pacific Homicide Per by Gender Population Total Female Male Final

28 Per RISK BEHAVIORS 19. Smoking Among Adults Race/Ethnicity ( 100) Grade African-American B American Indian A s Reference A A e: 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. Please note that changes to the weighting system and addition of cell phone interview preclude combining data with earlier years Trend in Smoking Among Adults by Race/Ethnicity Trend in Smoking Among Adults Af rican-american American Indian or Alaska Native Asian or Pacific s Per 100 of Smoking by Poverty Level Poverty Level Percent Above Federal Poverty Level 15.3 At or Below Federal Poverty Level 28.9 s Per 100 of Smoking by Gender Total Female Male U.S

29 Per 29 RISK BEHAVIORS 20. Drug Overdose Deaths Race/Ethnicity ( ) Grade African-American B American Indian s *6.6 Reference C D e: s rates are twice that of the national rate. Deaths caused by prescription drugs continue to increase. In recent years the highest drug overdose deaths have been for s * based on less than 20 events may fluctuate greatly from year to year, so no disparity ratio calculated. Trend in Drug Overdose Deaths by Race/Ethnicity Trend in Drug Overdose Deaths Af rican-american American Indian or Alaska Native Asian or Pacific Drug Overdose Death s by Gender Population Total Female Male

30 Per 30 RISK BEHAVIORS 21. Alcohol Related Deaths Race/Ethnicity ( ) African-American Grade Reference American Indian D s * 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 Af rican-american American Indian or Alaska Native Asian or Pacific Alcohol Related Death s by Gender Population Total Female Male (2009)

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32 Change in A disparity 32 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 African-American American Indian No Change No change No Change Index of Racial/Ethnic 1,000 Infant Mortality ,000 Change Using African-American Increase American Indian No Change 1.6* * 6.4 * Increase No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. 32

33 Change in A disparity 33 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 African-American American Indian No Change Increase No Change Index of Racial/Ethnic 1,000 Infant Mortality ,000 Change Using African-American No Change American Indian * * 4.5 * Increase No Change Index of * based on less than 20 events, so no disparity ratio calculated. 33

34 34 MOTHER AND CHILD HEALTH Racial/Ethnic Teen Births * ,000 1,000 Change Using African-American Increase American Indian Increase No Change No Change Index of Increase * Reference group changed from s to in so disparity change measured between only these time iods 34

35 35 CHRONIC DISEASES Adults with Diabetes Receiving All Recommended Diabetes Preventive Services Racial/Ethnic Change Using African-American * * * * American Indian No Change * * * * Index of * Survey results based on less than 50 events are not reported. Diabetes Deaths Racial/Ethnic Change Using African-American No Change American Indian Increase 29.5 * 22.4 * No Change No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. 35

36 36 CHRONIC DISEASES Obesity Among Adults Racial/Ethnic Change Using African-American Increase American Indian Increase No Change Increase Increase Index of Increase Obesity Among Youth 2003 Racial/Ethnic Change Using African-American American Indian Increase Increase No Change Index of

37 37 INFECTIOUS DISEASES Had Pneumonia Vaccination Racial/Ethnic Change Using African-American * * American Indian * * No Change Index of * Survey results based on less than 50 interviews are not reported. Pneumonia and Influenza Deaths Racial/Ethnic Change Using African-American 22.4 * 7.3 * American Indian Increase 5.5 * 18.4 * No Change No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. 37

38 38 INFECTIOUS DISEASES Racial/Ethnic *Chlamydia (Females Year Olds) Change Using African-American 3, Increase American Indian 2, Increase * * enough data 3, , Increase Index of Increase * based on less than 20 events so reference group changed for from Asians to s. Hepatitis B (Acute and Chronic) Racial/Ethnic Change Using African-American 7.9 * American Indian 3.3 * 1.5 * s Increase No Change Index of Increase * based on less than 20 events, so no disparity ratio calculated. 38

39 39 INFECTIOUS DISEASES Racial/Ethnic HIV/AIDS Change Using African-American 9.7 * ** American Indian Increase 1.2 * 1.7 * 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 African-American No Change American Indian Index of Increase * based on less than 20 events, so no disparity ratio calculated. 39

40 40 VIOLENCE AND INJURY Motor Vehicle Deaths Racial/Ethnic Change Using African-American 8.6 * 8.6 * American Indian * * 8.9 * No Change Index of * based on less than 20 events, so no disparity ratio calculated. Elderly Fall-Related Deaths Racial/Ethnic Change Using African-American 39.2 * 23.8 * American Indian No Change 66.3 * 22.6 * Increase Index of Increase * based on less than 20 events, so no disparity ratio calculated. 40

41 41 VIOLENCE AND INJURY Suicide Racial/Ethnic Change Using African-American 5.2 * 8.6 * American Indian Increase 6.5 * 9.7 * No Change Increase Index of Increase * based on less than 20 events, so no disparity ratio calculated. Youth Suicide Racial/Ethnic Change Using African-American 10.7 * 10.1 * American Indian * 21.4 * Increase Index of * based on less than 20 events, so no disparity ratio calculated. 41

42 42 RISK BEHAVIORS Homicide Racial/Ethnic Change Using African-American 10.7 * American Indian Increase 3.3 * 2,2 * No Change No Change Index of Increase * based on less than 20 events, so no disparity ratio or disparity change calculated Smoking Among Adults Racial/Ethnic Change Using African-American American Indian No Change Index of

43 43 RISK BEHAVIORS Drug Overdose Deaths Racial/Ethnic Change Using African-American 15.6 * American Indian No Change 3.1 * 6.6 * Increase Index of * based on less than 20 events, so no disparity ratio calculated. Alcohol-Related Deaths Racial/Ethnic Change Using African-American No Change American Indian * 16.3 * Index of * based on less than 20 events, so no disparity ratio calculated. 43

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