Healthy People 2030 includes health disparities data for population-based core objectives with available demographic group data. Health disparities are differences in health that are closely linked to social determinants of health.
Addressing health disparities is key to achieving health equity and realizing the Healthy People vision of improving the health and well-being of all.
How to use disparities data
Watch this video to learn how to interact with Healthy People 2030 objective data, including disparities data.
How we calculate disparities data
Healthy People 2030 assesses disparities data for population-based core objectives with available demographic group data for a given time point. The following are key concepts in the assessment of disparities:
- Highest rate (R_{max})
- Lowest rate (R_{min})
- Reference rate
- Maximal rate difference (MRD)
- Maximal rate ratio (MRR)
- Rate ratio (RR)
- Summary rate ratio (SRR)
- Measures of variability
Notes:
- Not all Healthy People objectives are measured using a rate. The term “rate” is used as shorthand for rate, percentage, proportion, or any other measurement for which disparities can be meaningfully assessed.
- To calculate disparities, demographic group data are needed for at least two subgroups for the same period.
- Whenever possible, disparities are calculated for pre-determined, mutually exclusive (non-overlapping) groups. For example, when “not Hispanic or Latino” race groups are available, racial/ethnic disparities are calculated for the “Hispanic or Latino” group and the race groups listed under “not Hispanic or Latino”.
- Disparities aren’t assessed for objectives measured using counts of cases, units, or events.
- Rate ratios (RR) and summary rate ratios (SRR) are always greater than 1.000.
- All calculations use unrounded estimates and their standard errors (SE). The values on the Healthy People 2030 website may differ from those calculated using the displayed (rounded to 3 decimals) values of the estimated rates and standard errors (SE).
Highest rate (R_{max})
The highest rate (R_{max}) is the highest unrounded group rate for the specified population characteristic — like race and ethnicity or age. Sometimes, the highest group rate is unclear, such as when there’s a numerical tie. When this happens, if the unrounded standard error (SE) is available, the rate with the smaller SE serves as R_{max}. Statistical significance is not used to choose R_{max}, as described in Measures of variability below.
Lowest rate (R_{min})
The lowest rate (R_{min}) is the lowest unrounded group rate for the specified population characteristic — like race and ethnicity or age. Sometimes, the lowest group rate is unclear, such as when there’s a numerical tie. When this happens, if the unrounded standard error (SE) is available, the rate with the smaller SE serves as R_{min}. Statistical significance is not used to choose R_{min}, as described in Measures of variability below.
Reference rate
The reference rate depends on the desired direction for an objective.
Some objectives have a desired increase — like the objective to “Increase the proportion of people with a usual primary care provider.” In this case, the reference rate is the highest rate (R_{max}).
Other objectives have a desired decrease — like the objective to “Reduce the suicide rate.” In this case, the reference rate is R_{min}.
You can find the reference rate in a data table by looking for the “Reference rate” label.
Maximal rate difference (MRD)
The maximal rate difference (MRD) is the difference between the highest rate (R_{max}) and lowest rate (R_{min}) for the specified population characteristic. It’s calculated as:
MRD = R_{max }- R_{min}
Interpreting ratios of rates
Ratios of rates like the MRR, rate ratio (RR), and summary rate ratio (SRR) can be interpreted as percentage differences between 2 rates. For example, if the ratio between rates A and B is 1.432, that means rate A is 1.432 times rate B — or that rate A is 43.2% higher than rate B.
Maximal rate ratio (MRR)
The maximal rate ratio (MRR) is the ratio between the highest rate (R_{max}) and lowest rate (R_{min}) for the specified population characteristic.
For an objective with a desired increase | For an objective with a desired decrease | |
---|---|---|
Formula | MRR = R_{max}/R_{min} | |
Understanding the MRR | The highest group rate R_{max} was MRR times the lowest group rate R_{min}. | |
Meaning of × and ÷ before MRR values in disparities tables | The × emphasizes that the reference rate is R_{max}. This means R_{min} would need to be multiplied by MRR to equal the reference rate R_{max}. | The ÷ emphasizes that the reference rate is R_{min}. This means R_{max} would need to be divided by MRR to equal the reference rate R_{min}. |
Rate ratio (RR)
The rate ratio (RR) compares 2 group rates for the specified population characteristic.
When an increase is desired for the objective, the highest rate (R_{max}) is the reference rate — and is used as the numerator when calculating RR.
When a decrease is desired for the objective, the lowest rate (R_{min}) is the reference rate — and is used as the denominator when calculating RR.
For any group g in a specified population characteristic with K groups, RR is calculated as follows:
For an objective with a desired increase | For an objective with a desired decrease | |
---|---|---|
Formula | RR = R_{max}/R_{g}, g = 1, 2, … K | RR = R_{g}/R_{min}, g = 1, 2, … K |
Understanding the RR | The highest group rate R_{max} was RR times the comparison group rate (R_{g}). | The comparison group rate (R_{g}) was RR times the rate of the lowest group rate (R_{min}). |
Meaning of × and ÷ before RR values in disparities tables | The × emphasizes that the reference rate is R_{max}. This means R_{g} would need to be multiplied by RR to equal the reference rate R_{max}. | The ÷ emphasizes that the reference rate is R_{min}. This means R_{g} would need to be divided by RR to equal the reference rate R_{min}. |
Summary rate ratio (SRR)
The summary rate ratio (SRR) compares a reference rate to an average rate. The average rate (R_{ave}) is the average of all group rates for a population characteristic except for the reference rate. As for the rate ratio (RR), the reference rate is R_{max} and serves as the SRR’s numerator when the objective has a desired increase. Similarly, the reference rate is R_{min} and serves as the SRR’s denominator when the objective has a desired decrease.
The SRR is calculated as follows:
For an objective with a desired increase | For an objective with a desired decrease | |
---|---|---|
Formula | SRR = R_{max}/R_{ave} | SRR = R_{ave}/R_{min} |
Understanding the SRR | The highest group rate R_{max} was RR times the average rate R_{ave} of all other groups. | The average rate R_{ave} of all other groups was RR times the rate of the lowest group rate R_{min}. |
Meaning of × and ÷ before SRR values in disparities tables | The × emphasizes that R_{max} is the reference rate. This means R_{ave} would need to be multiplied by SRR to equal the reference rate R_{max}. | The ÷ emphasizes that the reference rate is R_{min}. This means R_{ave} would need to be divided by SRR to equal the reference rate R_{min}. |
Measures of variability
Individual rates may be subject to uncertainty, as captured by standard errors (SEs), so ordering rates from highest to lowest (or lowest to highest) may also be subject to uncertainty. When available, SEs and 95 percent confidence intervals (95% CIs) are used to account for the uncertainty in the ranking and the interdependence among the ordered values that impact the disparity measures described above. The SEs and 95% CIs are calculated for the highest rate (R_{max}), lowest rate (R_{min}), maximal rate difference (MRD), maximal rate ratio (MRR), rate ratio (RR), and summary rate ratio (SRR) using a resampling/bootstrap procedure because mathematical formulas are not readily available.
The resampling/bootstrap procedure uses the rate and SE for each group within a population characteristic to randomly draw replicate group rates according to a normal distribution. This set of simulated group rates is then used to estimate the relative rankings, reference rate, and disparity measures. Next, the frequency distribution of these estimates is used to estimate the empirical SEs and 95% CIs where the lower limit is the 2.5^{th} percentile and the upper limit is the 97.5^{th} percentile.
Learn More
- NCHS Healthy People
- Healthy People 2020 Overview of Health Disparities, Healthy People 2020 Final Review. 2022.
- Health Disparities Calculator (NCI)
Resources
- Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27, 167–194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103
- Harper, S., King, N. B., Meersman, S. C., Reichman, M. E., Breen, N., & Lynch, J. (2010). Implicit value judgments in the measurement of health inequalities. Millbank Quarterly, 88(1), 4–29. https://doi.org/10.1111/j.1468-0009.2010.00587.x
- Huang, D. T., Bassig, B. A., Hubbard, K., Klein, R. J., & Talih, M. (2022). Examining progress toward elimination of racial and ethnic health disparities for Healthy People 2020 objectives using three measures of overall disparity. Vital Health Statistics (Series 2, No. 195). National Center for Health Statistics. https://doi.org/10.15620/cdc:121266
- Keppel, K., Pamuk, E., Lynch, J., Carter-Pokras, O., Kim, I., Mays, V., Pearcy, J., Schoenbach, V., & Weissman, J. S. (2005). Methodological issues in measuring health disparities. Vital Health Statistics (Series 2, No. 141). National Center for Health Statistics. https://www.cdc.gov/nchs/data/series/sr_02/sr02_141.pdf
- Penman-Aguilar, A., Talih M, Huang D, Moonesinghe, R., Bouye, K., & Beckles, G. (2016). Measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity. Journal of Public Health Management & Practice, 22(1 Supp), S33–S42. https://doi.org/10.1097/phh.0000000000000373
- Talih, M., & Huang, D. T. (2016). Measuring progress toward target attainment and the elimination of health disparities in Healthy People 2020. Healthy People Statistical Notes (No. 27). National Center for Health Statistics. https://www.cdc.gov/nchs/data/statnt/statnt27.pdf