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By Tracy Greever-Rice, Associate Director, OSEDA, Amber Moodie-Dyer, Research Assistant, OSEDA

This paper is the fourth in a series published in the Missouri Senior Report that explores the nature and impact of health disparities by seniors’ demographic and socioeconomic status. It provides an update on previous years’ analyses and provides a description of race, ethnicity and gender among seniors (persons 65+) in Missouri.

Health Disparities among Seniors: A Trend Analysis of Race, Ethnicity and Gender

The United States began paying attention to racial and ethnic health disparities among its citizens more than a decade ago and implemented several efforts to address the problem (Gehlert, Mininger, Sohmer & Berg, 2008). In 1998, President Clinton created the “Racial and Ethnic Health Disparities Initiative.” In 2002, the U.S. Department of Health and Human Services launched the “Closing the Health GAP” campaign.

Those initiatives sought to raise awareness about how the following health conditions affect whites, blacks, and Hispanics differently: diabetes, heart disease, stroke, cancer, infant mortality, child and adult immunizations, and HIV/AIDS (DHHS, 2005).

Despite the initiatives, health disparities still exist nationally across racial and ethnic groups in screening, mortality and treatment (Gehlert et al., 2008). The senior population suffers more than any other group from diseases such as diabetes, heart disease, stroke and cancer.

The 2007 Missouri Senior Report examined ethnic and racial health disparities among Missouri seniors using death rate and diagnosis data from 2004 and 2005 (Greever-Rice & Hudson, 2007). More recent data, however, shows trends and changes in disease mortality for Missouri’s white, black, Hispanic and non-Hispanic seniors. Overall, some gains have occurred in the last five years, but health disparities persist. The health conditions used in this analysis include heart disease, cancer, diabetes, Alzheimer’s disease, kidney disease and hypertension.

Findings

Heart disease
Heart disease is the leading cause of death among Missouri seniors and it strikes fairly evenly across racial, ethnic and gender lines. In addition, the total death rate from heart disease shows a trend of decline from 2003 (1770.5 per 100,000) to 2007 (1462.3 per 100,000).

Cancer
Cancer, the second leading cause of death for Missouri seniors, shows more disturbing results in terms of racial and gender disparity. Black male seniors, for example, are almost 40 percent more likely to die from the disease than white male seniors (1844.3 death rate vs. 1109.2 death rate). Yet overall cancer death rates for black seniors (1333.9) are only modestly higher overall compared to white seniors (1109.2), The reason is that cancer death rates are much closer between black female seniors (1025.4) and white female seniors (917.9).

Diabetes
The diabetes death-rate disparity between black and white seniors persists. Rates are almost twice as high for black seniors (275.9) compared to white seniors (134.2). However, diabetes death rates have decreased for both groups over the last five years: for white seniors, from 147.4 in 2003 to 123.7 in 2007; for black seniors, from 297.4 in 2003 to 245.3 in 2007.

But gender plays a significant role in the diabetes death rate for blacks. Black senior men are much more likely to die from diabetes than black senior women; in fact, their death rates surpassed black women’s death rates in both 2006 and 2007.

Kidney disease
The death-rate disparity for kidney disease between black and white seniors also has persisted. Blacks have about a 35 percent higher death rate than whites, regardless of gender.

Hypertension
The biggest reduction in health disparity between black and white seniors has occurred in deaths caused by hypertension. Though the death rate of white seniors has stayed fairly constant over the last five years, about 44 per 100,000, the death rate of black seniors has decreased—from 112.9 in 2003 to 77.2 in 2007. Although a significant disparity still exists, the gap is shrinking.

Alzheimer’s disease
The Alzheimer’s disease death rate affects white seniors and women more dramatically than other groups. For instance, women have higher death rates from Alzheimer’s disease than black or white men. For both races, Alzheimer’s disease death rates are increasing. But the rates have increased 60 percent for blacks , 2003 to 2009, a dramatic jump when compared to a 25 percent increase for whites during the same period. The disease’s dramatic increase among blacks is attributed to black women. However, whites still had a higher overall Alzheimer’s death rate than blacks in 2007: 218.5 per 100,000, compared to 145.8 per 100,000, respectively.

The findings suggest a mixed record on efforts to reduce racial and ethnic health disparities among Missouri seniors in the last five years. Improvements include an overall death-rate decline for seniors in heart disease and diabetes. In addition, hypertension death rates in black seniors have declined, and the diabetes death rate in black women has also decreased. However, disparities still persist and have widened for certain diseases. Black male seniors, for instance, are dying from cancer at a much higher rate than black female seniors and white seniors. In addition, while the diabetes death rate has declined for black women, it has increased for black men. Black men and women still have significantly higher diabetes death rates than white seniors. Another disturbing trend is the Alzheimer’s death-rate increase among black women, though the black death rate remains lower than the Alzheimer’s death rate in the white population overall.

Implications
These findings have substantial implications for Missouri seniors in terms of public policy, disease prevention, screening, and treatment programs. Disparities based on race and gender still persist. Seniors who receive little or no treatment for chronic diseases experience a poorer quality of life. They, and their families and communities, ultimately incur higher health care and long-term care costs. Progress has occurred in the death-rate disparity between whites and blacks on hypertension. Effective policy initiatives that focus on preventative care and lifestyle changes may explain the gain. More studies need to be conducted to understand how prevention and treatment barriers may contribute to the disparities.

References
Gehlert, S., Mininger, C., Sohmer, D., & Berg, K. (2008). (Not so) gently down the stream: Choosing targets to ameliorate health disparities. Health and Social Work, 33(3), 163-167.
Greever-Rice, T., & Hudson, S. (2007). Health Disparities among Seniors. Missouri Department of Health and Senior Services.
U.S. Department of Health and Human Services. (2005). Closing the Health GAP Campaign. Retrieved November 23, 2009 from http://minorityhealth.hhs.gov/templates/content.aspx?ID=2840

Missouri Senior Report is published by the State of Missouri Department of Health and Senior Services (DHSS), MU’s Office of Social and Economic Data Analysis (OSEDA) and University of Missouri Extension.

 
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