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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