Small-Area Analysis Can Show Hidden Disparities


WASHINGTON — It doesn't surprise most physicians to hear that populations in certain cities—especially cities with a high percentage of minorities—have higher rates of chronic disease. But small-area analysis can help pinpoint exactly which areas of a city suffer from a higher disease burden, Robert Bonow, M.D., said.

For example, Dallas is a complicated area when it comes to cardiovascular mortality, said Dr. Bonow at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

He and Sean Cleary, Ph.D., associate professor of epidemiology and statistics at George Washington University, Washington, performed small-area analysis on the city using data from state Vital Statistics offices and the 2000 U.S. Census. The study showed that there are disparities in mortality from cardiovascular disease not only between minority and nonminority populations, but also within minority neighborhoods themselves.

The question is, Why would that be true? “Is one area more Hispanic, and one area more African American?” asked Dr. Bonow chief of the division of cardiology at Northwestern Memorial Hospital, in Evanston, Ill. Of course, there could be other factors driving differences in mortality, such as differing opportunities for exercise, lesser or greater availability of fresh fruits and vegetables, or more fast-food restaurants in one community than in another, he added.

Dr. Bonow noted that the maps produced by small-area analysis could be a lobbying tool for health care advocates. “Imagine walking into [a Congressman's office] with a map showing that minority areas in his district have very high rates of cardiovascular disease,” he said. And if the analysis also found that there were very few neighborhood health centers in the area, advocates could argue that services are not being offered where they are needed.

Dr. Bonow hopes to eventually get data for all the Zip codes in the United States. “The results hopefully will inform community-based intervention and treatment programs targeting higher-risk uninsured areas,” he said.

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