Understanding Health Disparities in Texas

Maureen Rubin, Ph.D., MSWAssistant Professor

Department of Social WorkUniversity of Texas at San Antonio

Nazrul HoqueAssistant Professor

Department of DemographyCollege of Public Policy

University of Texas at San Antonio

1

Factors that contribute to varied health care needs

• population change in Texas, specifically in Bexar County, that contributes to diverse health care needs.

• lack of access and availability of services and how that impacts service utilization.

• social, economic, racial, environmental factors that contribute to health disparities.

2

Presentation outline

• Definition• Population in US - changes• Race ethnicity – TX• Language• Education • Income / poverty level• Health care: insurance, projected age distribution, physical and mental

health• Access and availability of services• Social, economic and environmental factors and disparities

• What do we need to do?

3

Health Disparity - defn

• “…..differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities and sexual orientation” (Dept. of Health and Human Services Healthy People 2010, 2000)

• “the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates” (Minority Health and Health Disparities Research and Education Act of 2000)

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Health disparities contd.

• ‘“. . . there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population,”’ (Texas Health Disparities Task Force, 2008, p. 1).

• Health disparities primarily affect African Americans, Hispanics, those in geographically underserved regions, and low-income individuals and families (TX Health Disparities Task Force, 2008).

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Fastest Growing States, 2000-2010

2000Population*

2010Population*

NumericalChange

2000-2010

PercentChange

2000-2010

United States 281,424,602 308,745,538 27,323,632 9.7

Texas 20,851,820 25,145,561 4,293,741 20.6%California 33,871,648 37,253,956 3,382,308 10.0%

Florida 15,982,378 18,801,310 2,818,932 17.6%

Georgia 8,186,453 9,687,653 1,501,200 18.3%

Arizona 5,130,632 9,535,483 1,486,170 18.5%

Virginia 7,078,515 8,001,024 1,261,385 24.6%

Population values are decennial census counts for April 1 for 2000 and 2010.

Source: U.S. Bureau of the Census

6

15.7% of numerical change in U.S.

Estimated Unauthorized Immigrant Population by State of Residence: January 2009 and 2000

Source: U.S. Department of Homeland Security. 7

Percent ChangeDue to

Year* PopulationNumerical

ChangeNatural

IncreaseNet

MigrationPercentChange

NaturalIncrease

NetMigration

1950 7,711,194 -- -- -- -- -- --

1960 9,579,677 1,868,483 1,754,652 113,831 24.2 93.91 6.09

1970 11,196,730 1,617,053 1,402,683 214,370 16.9 86.74 13.26

1980 14,229,191 3,032,461 1,260,794 1,771,667 27.1 41.58 58.42

1990 16,986,510 2,757,319 1,815,670 941,649 19.9 65.85 34.15

2000 20,851,820 3,865,310 1,919,281 1,946,029 22.8 49.65 50.35

2010 25,145,561 4,293,741 2,304,208 1,989,533 20.6 53.70 46.30

* All values for the decennial dates are for the indicated census year. Values for 2009 is for July 1 as estimated by the U.S. Bureau of the Census.

Source: Derived from U.S. Bureau of the Census Estimates for dates indicated by the Texas State Data Center, University of Texas at San Antonio.Note: Residual values are not presented in this table.

Total Population and Components of Population Change in Texas, 1950-2009

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Percent of Population of Race/Ethnicity in 2000 and Net Change Due to Each Racial/Ethnic Group 2000-2010

0

50,000

100,000

150,000

200,000

250,000

2000 to 2001

2001 to 2002

2002 to 2003

2003 to 2004

2004 to 2005

2005 to 2006

2006 to 2007

2007 to 2008

2008 to 2009

International

State-to-State

Source: U.S. Bureau of the Census 2009 Estimates

Estimated Annual Net Migration to Texas, 2000 to 2009

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Estimated Number and Percent of Migrants to Texas between 2000 and 2009 by Race and Ethnicity

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    White Hispanic Black Other TotalNet domestic migration          

  Number of migrants 371,150 238,866 195,024 43,663 848,702   Percent of Row Total 44% 28% 23% 5% International migration        

  Number of migrants 224,820 469,591 73,140 165,532 933,083   Percent of Row Total 24% 50% 8% 18% Total            Number of migrants 595,970 708,457 268,163 209,195 1,781,785   Percent of Row Total 33% 40% 15% 12% 

Sources: Percentages of domestic and international migrants by race and ethnicity derived from the 2006-2008 American Community Survey. Total numbers of domestic and international migrants between 2000-2009 are from Table 4. Cumulative Estimates of the Components of Resident Population Change for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2009, U.S. Census Bureau

67% of all migrants

 52% of all migrants were international

Texas Racial and Ethnic Composition, 2000 and 2009

Source: U.S. Census Bureau. 2000 Census count and 2009 Population Estimate

Estimate percent non-Hispanic Anglo and Hispanic by County, 2009

13

Estimated Percent Non-Hispanic Anglo, 2009LE 10%

GT 10% - LE 25%

GT 25% - LE 50%

GT 50%

Estimated Percent Hispanic, 2009LE 10%

GT 10% - LE 25%

GT 25% - LE 50%

GT 50%

non-Hispanic Anglo Hispanic

Source: U.S. Census Bureau Population Estimates

0.010.020.030.040.050.060.070.080.090.0

1980-1990 1990-2000 2000-2007 2000-2040

Anglo Black Hispanic Other

Percent of Population Growth and Projected Population Growth by Race/Ethnicity, Texas

Source: U.S. Census Counts, and Texas State Data Center 2008 Population Projections, 0.5 Scenario14

0%

10%

20%

30%

40%

50%

60%

70%

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

2032

2034

2036

2038

2040

AngloBlackHispanicOther

Source: Texas State Data Center 2008 Population Projections , 2000-2007 Migration Scenario 15

Projected Racial and Ethnic Percent, Texas, 2000-2040

Percent of the population 5 and over who speak English less than very well by state, 2009

Source: American Community Survey, 2009

Percent of the population 5 and over who speak Spanish at home, 2009

Source: American Community Survey, 2009

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Percent of Households that are Linguistically Isolated, by County, 2005-2009

Source: U.S. Census Bureau, American Community Survey, 5-Year Sample 2005-2009

Pct of HH that are LIHH PHHLI

0-5%

5.1-10%

10.1-15%

15.1-25%

25.1-40%

Pecos

Brewster

Webb

Hudspeth

PresidioTerrell

Culberson

Reeves

Val Verde

Crockett

Hill

Duval

Harris

Frio

Bell

Kerr

Polk

Starr

Clay

Edwards

Irion

Hall

Ellis

Jeff Davis

Sutton

Uvalde

Bee

Hale

Dallam

Leon

Bexar

Gaines

Hidalgo

Upton

Hartley

King

Erath

Jack

Kinney

Kent

Zavala

GrayOldham

Tyler

Dimmit

CassLynn HuntWise

La Salle

Rusk

Kimble

Kenedy

Lamb

Medina

Floyd

Terry

Brazoria

Coke

Llano

Liberty

Ector

Andrews

Milam

LeeTravis

Knox

Mills

Smith

Falls

Ward

Collin

Jones

Nolan

Potter

Burnet

Cottle

Taylor

Zapata

Real

Bowie

Coryell

Brown

Motley

YoungGarza

Lamar

Martin

DallasFisher

Moore

Baylor Archer

Scurry

Cooke

Mason

Parker

Castro

Navarro

Brooks

Hardin

Bailey

Deaf Smith

DeWitt

Lavaca

Donley

Atascosa

Hays

Goliad

Denton

Fannin

El Paso

Wharton

Crane

Carson

Tarrant

Crosby

Borden

Schleicher

Haskell

Gillespie

Randall

Shelby

Foard

BriscoeParmer

Mitchell

Wood

Menard

Panola

Walker

Kleberg

Winkler

Nueces

Harrison

Eastland

Loving

Bandera

Wichita

Willacy

Hood

Reagan Houston

Maverick

Jasper

Coleman

Tom Green

Bosque

Concho

Runnels

Fayette

Newton

Live Oak

Sterling

Jim Hogg

Wilson

Victoria

McMullen

Roberts

Trinity

Howard

Bastrop

Grayson

San Saba

Midland

Hockley Dickens

Swisher

Matagorda

Gonzales

Anderson

Dawson

Grimes

Wheeler

Cherokee

Jefferson

Colorado

Lubbock

Red River

Karnes

Refugio

Austin

Hemphill

Williamson

Jackson

Blanco

Ochiltree

McCulloch

Sherman

Wilbarger

Hansford

Callahan

McLennan

Yoakum

Angelina

Hopkins

Lipscomb

StephensPalo Pinto

Stonewall

Hamilton

Montague

Cameron

Cochran

Jim Wells

Limestone

Kaufman

Fort Bend

Titus

Comal

Armstrong

Kendall

Freestone

ComancheGlasscock

JohnsonHenderson

Montgomery

Brazos

Van Zandt

Robertson

Waller

Upshur

Sabine

Hutchinson

Shackelford

Childress

Burleson

Nacogdoches

Lampasas

Collingsworth

Hardeman

Throckmorton

Guadalupe

Caldwell Chambers

Marion

San Patricio

Madison

San Jacinto

Delta

Washington Orange

Calhoun

Rains

Gregg

Morris

San Augustine

Galveston

Franklin

Aransas

Somervell

Rockwall

Calhoun

Calhoun

Kenedy

Galveston

Kleberg

Aransas

Nueces

Willacy

Cameron

Calhoun

Educational Attainment in Texas, 2009

Level of Educational Attainment

Percent of persons aged 25 years and older

State Ranking

High school diploma or equivalency

79.9% 50

Bachelors 25.5% 31

Graduate 8.5% 33

19Source: U.S. Census Bureau, American Community Survey, 2009.

Educational attainment of persons 25+ years of age by ethnicity, Texas, 2009

20Source: American Community Survey, 2009

Percent of the Population Less than 18 Years of Age, Living Under Poverty for During Past 12 Months, 2006-2008

Source: U.S. Census Bureau, American Community Survey, 3-Year Sample 2006-2008

5-20%

20-30%

30-40%

40-55%

$18,000-30,000

$ 30,000-35,000

$ 35,000-40,000

$40,000-50,000

$ 50,000-76,000

Median Household Income by County, 2006-2008

Source: U.S. Census Bureau, American Community Survey, 3-Year Sample 2006-2008

Insurance Coverage and No Insurance byType for Ethnic Groups, 2008

23

Projection of Ethnicity of Texas PopulationAged 65 Years and Older, 2000 to 2040

Source: Texas State Data Center, 2000-2004 Projection Scenario

Physicians per 1,000 Population Aged 65 Years and Older by County, 2008

25

Physcians per 1,000 persons aged 65+'Age 65p County$'.Physper1k65p

0

GT 0 - LE 5

GT 5 - LE 10

GT 10 - LE 20

GT 20

Source: U.S. Census Bureau. 2008Population Estimate (population), and Texas Medical Board (physicians).

Projected Increase in Obesity in Texas by Ethnicity, 2006 to 2040

26Source: Texas State Data Center Projections

Projected Percent of the Adult Population with Diabetes in Texas

by Race and Ethnicity, 2010, 2040

2720402010

Projected Number of Adults with Diabetes by Race and Ethnicity, Texas, 2010-2040

28

Projected Percent of the Adult Population with Diabetes by County, 2010 and 2040

29

LE 15%

15-20%

20-25%

25-30%

30-37.5%

2010 2040

Health Disparity

• Bexar county – Metro Health– Refer to handout

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Access and Availability

• Population change in Texas and Bexar county.• How will the population change influence

health care needs?• With more number of minority people in the

border area and few physicians in the area, how could this influence care?

31

Social, economic and environmental factors

• Social:– Friends– Neighbors– Support systems– Poverty – Unemployment– Single parents– Teenage pregnancy– Female headed households– School drop outs

32

Social, economic and environmental factors

• Economic– Jobs– Jobs with benefits (insurance & retirement)– Education helping jobs– Working conditions

33

Social, economic and environmental factors

• Environmental– Living conditions / housing– Drug/alcohol use/abuse– Violence in the neighborhood– House/car break-ins, theft– Access to public transportation– Access to healthy food– Distance to medical/behavioral care– Safe child care

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What is the need?

• Cultural competence in understanding person-in-environment

• Educating community on early identification and intervention • Linking services to needs of the population • Providing services that are accessible • Providing culturally appropriate services• Building infrastructure based on the needs of the community• Advocate for policies that embrace diversity• Plan for the growing needs of TX and Bexar county

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Contact

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• Acknowledgement– Thanks to Dr. Lloyd Potter, State Demographer

– Data, graphs and tables provided by Office of the State Demographer and the Texas State Data Center. University of Texas at San Antonio