Addressing disparities

Bruce Behringer

Co-ChairTennessee Comprehensive Cancer Control

Coalition

Assistant Vice President, Division of Health Sciences

East Tennessee State University

Defining Disparities… understanding differences in

incidence, prevalence, mortality and burden of disease and other

adverse conditions in a population group…

Ranked # 44 in age-adjusted

all cancer incidence, 2000-4

Ranked # 20 in age adjusted

all cancer incidence, 2005

Ranked # 6 in age-adjusted

all cancer mortality, 2000-4

Ranked # 3 in age adjusted

all cancer mortality, 2005

Tennessee Males, 2005

# 13 new cases # 5 deaths

TN 17.5% higher than US

# 27 new cases # 4 deaths

TN 10.5 % higher than US

Tennessee Females, 2005

Tennessee Black Cancer Mortality Disparities are Dramatic and Devastating

29.1% higher than white Tennessee female mortality, 2005

43.3% higher than white Tennessee male mortality, 2005

Tennessee’s national cancer rankings by type of

cancer, 2005 New cases Deaths

All cancers # 20 # 3

Lung # 4 # 3

Breast # 17 # 8

Colorectal # 12 # 10

Prostate # 36 # 15

Cervix # 6 # 6

Melanoma # 14 # 14

Why did incidence rate

change so radically from

2000-4 to 2005?

Why is there such a large difference in

state ranking between

incidence and mortality?

Why did state mortality ranking

worsen from 2000-4 to 2005?

The eternal community questions

Why is there so much cancer?

Is here any worse than other places?

How to define health disparity issues: the product of multiple

factors Population

Health Outcomes

Characteristics of health delivery system

Characteristics of

population at risk

Aday LA. At Risk in America, 2nd ed. San Francisco, CA: Jossey-Bass, 2001.

Is it time to acknowledge

Tennessee as a statewide disparities

population?

Types of issues raised in disparity research

Is it patient/ population health literacy OR Provider/health system cultural

competence? Is it lack of access to care in health

services OR Patient underuse of services, even

when barriers are removed?

Types of issues raised in disparity research

Is it low use of cancer screening services OR Lack of a direct provider recommendation

for screening? Is it cultural sense of fatalism about cancer

that resists acceptance of aggressive treatment

OR Family experience, lack of navigational skills

and community history of poor cancer outcomes?

Types of issues raised in disparity research

How do population socio-economic factors

INTERACT WITH Environmental factors as causes of

cancer? How do health care policies that guide

investments, services reimbursement, research and quality improvement

DIFFUSE EQUALLY For the benefit of all providers,

populations and communities?

Amazing amount of cancer control activity in Tennessee

- Community education and screening programs

- High percent of public insurance coverage

- State public health activities- 33 cancer centers - Cancer advocacy organizations- Fundraising, events and benefits to

help families, friends and neighbors- Support through local prayer calls

and donations

Do we have sufficient resources to address cancer

disparity?

How to target investments? How to use programs that

work? How to promote collaboration?

Its not the effort

What will help us to be more effective?

What can we learn from ourselves about doing things

better?

What can we learn from others states

that get better rankings?

What can we learn now from our certified cancer

registry to help us target our efforts to reduce disparities?

Which counties?What cancers?

Which genders, ages and races?

Cancer is a health disparity

for all of Tennessee

We need the framework to work together to target and use effective

cancer education, risk reduction, prevention, screening, and

treatment strategies

That is the function of the Tennessee

Comprehensive Cancer Control Coalition

and State Comprehensive Cancer

Plan

The TCCCC Challenge

Who has cancer?– Which people?– What places?

What are the reasons?– Which types of cancer?– At what steps in cancer continuum?

How can we make progress in the fight?– What intervention effectively address the

issues?– How do gather the resources needed to make a

difference?

#44age adjusted

all cancer incidence, 2000-4

#20age adjusted

all cancer incidence, 2005

# 3age adjusted

all cancer mortality, 2005

# 6age adjusted

all cancer mortality, 2000-4

17.5%

higher

Tennessee Male Mortality, 2005

10.5 %

higher

Tennessee Female Mortality, 2005

43.3% higher

Tennessee Black male mortality, 2005

Rate differences for all genders, ages and races, 2005

United States Tennessee

458.4 Incidence 468.92.2% higher

184.1 Mortality 209.613.9% higher

Age adjusted mortality rates per 100,000

Rate differences by genders, 2005

United States Tennessee

533.8 IncidenceMales

560.85.0% higher

405.9 Incidence, Females

406.5Not higher

226.2 MortalityMales

265.917.5% higher

155.4 Mortality Females

171.810.5% higher

Tennessee Rate differences by race, 2005

Whites Blacks

543.9 IncidenceMales

653.020.1% higher

401.1 Incidence Females

365.78.8% lower

260.2 MortalityMales

373.043.3% higher

165.2 Mortality Females

213.429.1% higher