Using routinely collected data to monitor and investigate health inequalities.

The purpose of this research was to critically review methods for measuring and monitoring health inequalities, and to demonstrate the utility of routinely collected public health data for monitoring health inequality trends and generating hypotheses about the causes of race/ethnic, geographic and socioeconomic health inequalities. Changes in health inequalities were investigated in three analyses: (1) a decomposition of the change in the black-white life expectancy gap from 1990-2001; (2) an assessment of state trends in socioeconomic inequalities in health behaviors from 1990-2002; and (3) a decomposition of national trends in social inequalities in smoking and obesity from 1960-2000. From 1990 to 2001 the black-white gap in life expectancy among females decreased from 5.81 to 4.75 years. Most of the decline was due to relative mortality improvement among black females in cardiovascular diseases (23.9%), cancers (12.7%), and homicide (9.4%). The decline in the black-white life expectancy gap was larger among males, declining from 8.19 to 6.47 years, and was primarily due to relative improvement in mortality from homicide (22.2%), cancers (15.5%), cardiovascular diseases (8.6%), and HIV (7.9%). State trends in socioeconomic inequalities in health behaviors were largest for physical inactivity and smoking and smallest for binge alcohol use. Over time socioeconomic inequalities increased for smoking and physical inactivity, and declined for obesity and seat belt use, but there were wide variations among states. Nationally, from 1965-2003 absolute and relative inequalities in smoking across education groups increased dramatically. Declines in rates of smoking (especially among the college educated) accounted for 84% of this increase, but population growth (primarily among the college educated) accounted for 16%. Relative social inequalities declined since 1978 across all groups for obesity. Inequality declines were particularly for evident for education, where the rates of obesity growth were largest among the better educated. If used carefully, routinely collected public data can be an important resource for monitoring health inequalities and for understanding the causes of changes in health inequalities over time, and may help to clarify the path toward a more equal distribution of health in U.S. society.PhDHealth and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125093/2/3186642.pd