Practice of Epidemiology
Ten Largest Racial and Ethnic Health Disparities in the United States based on
Healthy People 2010 Objectives
Kenneth G. Keppel
From the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
Received for publication July 28, 2006; accepted for publication January 17, 2007.
A consistent framework has been developed for measuring health disparities and making comparisons across
indicators with regard to the public health goals of Healthy People 2010. Disparities are measured as the percent
difference from the best group rate, with all indicators being expressed in terms of adverse events. The 10 largest
health disparities for each of five US racial and ethnic groups are identified here. There are both similarities and dif-
ferences in the largest health disparities. New cases of tuberculosis and drug-induced death rates are among the
largest health disparities for four of the five racial and ethnic groups. However, drug-induced death is the only
indicator among the 10 largest disparities that is shared by both Black and White non-Hispanic populations.
ethnic groups; health promotion; minority groups; public health
The second goal of Healthy People 2010 calls for elimi-
nating health disparities among subgroups of the US popu-
lation (1). Progress toward this goal is being evaluated for
498 population-based objectives. The data set compiled for
Healthy People 2010 provides race- and ethnicity-specific
data for indicators representing a very broad array of out-
comes, behaviors, risk factors, and health services. These in-
dicators are used to monitor progress toward meeting targets
for the Healthy People 2010 objectives and eliminating
A consistent framework for measuring health disparities
has been developed for Healthy People 2010 (2). These data
provide an unprecedented opportunity to identify the largest
health disparities for specific racial and ethnic groups in the
MATERIALS AND METHODS
Healthy People 2010 includes more than 900 objectives
and subobjectives, each of which is monitored by a specific
health indicator (3). Approximately half of these indicators
(n ¼ 498) are based on the characteristics of persons in the
population. The remaining objectives and indicators are
based on measures that cannot be used to compare differ-
ences in risk between population groups, or on other units of
analysis such as states or work sites. Race- and ethnicity-
specific data are routinely published for most of these pop-
ulation-based indicators. However, the Healthy People 2010
database (http://wonder.cdc.gov/DATA2010) represents a
unique compilation of information about racial and ethnic
disparities for an extensive array of indicators. Operational
definitions for the indicators used to measure the Healthy
People 2010 objectives are available online (3). A detailed
summary of progress toward the goals and objectives of
Healthy People 2010 has been published in a midcourse
The analytic framework developed for Healthy People
parities among population groups, over time, and across
indicators (2). Disparities are measured as the deviation from
the ‘‘best’’ or most favorable group rate among the groups
associated with a particular characteristic. Therefore, dis-
parities for racial and ethnic groups are measured using
the rate for the racial and ethnic group with the best rate
as the reference point. In order to ensure that a reasonably
Correspondence to Dr. Kenneth G. Keppel, National Center for Health Statistics, 3311 Toledo Road, Room 6314, Hyattsville, MD 20782 (e-mail:
97 Am J Epidemiol 2007;166:97–103
American Journal of Epidemiology
Copyright ª 2007 by the Johns Hopkins Bloomberg School of Public Health
All rights reserved; printed in U.S.A.
Vol. 166, No. 1
Advance Access publication April 26, 2007
by guest on February 25, 2013
1. US Department of Health and Human Services. Healthy
People 2010: understanding and improving health. 2nd ed.
Vols 1 and 2. Washington, DC: US GPO, 2000. (http://www.
2. Keppel KG, Pearcy JN, Klein RJ. Measuring progress in
Healthy People 2010. (Healthy People 2010 statistical notes,
no. 25). Hyattsville, MD: National Center for Health Statistics,
3. US Department of Health and Human Services. Tracking
Healthy People 2010. Washington, DC: US GPO, 2000.
4. US Department of Health and Human Services, Office of
Disease Prevention and Health Promotion. Healthy People
2010 midcourse review. (Electronic article). (http://
5. Keppel K, Pamuk E, Lynch J, et al. Methodological issues
in measuring health disparities. Vital Health Stat 2 2005;141:
6. Keppel KG, Pearcy JN. Measuring relative disparities in terms
of adverse events. J Public Health Manag Pract 2005;11:
7. Office of Management and Budget, Executive Office of the
President. Revisions to the standards for the classification of
federal data on race and ethnicity. Fed Regist 1997;62:58782–
8. Minin ˜o AM, Anderson RN, Fingerhut LA, et al. Deaths: in-
juries, 2002. Natl Vital Stat Rep 2006;54:1–124.
9. Anderson RN, Smith BL. Deaths: leading causes for 2002.
Natl Vital Stat Rep 2005;53:1–89.
10. Rosenberg HM, Maurer JD, Sorlie PD, et al. Quality of
death rates by race and Hispanic origin: a summary of
current research, 1999. Vital Health Stat 2 1999;128:1–13.
11. Centers for Disease Control and Prevention. Sexually trans-
mitted disease surveillance, 2004. Atlanta, GA: Centers for
Disease Control and Prevention, 2005. (http://www.cdc.gov/
12. Low A, Low A. Importance of relative measures in policy on
health inequalities. BMJ 2006;332:967–9.
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