Recorded presentation

Sam Harper, MS, Epidemiology, University of Michigan, Center for Social Epidemiology & Population Health, 1214 South University, 2nd Floor, Ann Arbor, MI 48104-2548, 734-615-9227, sbharper@umich.edu, John W. Lynch, PhD, School of Public Health, University of Michigan, 109 Observatory, Room M3116, Ann Arbor, MI 48109-2029, and Trivellore E. Raghunathan, PhD, Biostatistics, University of Michigan, M4218 Sph II, Ann Arbor, MI 48109.

The two goals of Healthy People 2010 are to increase life expectancy and to eliminate health inequalities. However, the extent to which these goals may conflict with one another is understudied. We investigated 1990-2002 state-level changes in obesity and current smoking among education and income groups using BRFSS data. Socioeconomic inequalities were measured using the Health Concentration Index, a measure that accounts for temporal changes in the distribution of socioeconomic groups over time. Data on average rates and socioeconomic inequalities were combined using the Health Achievement Index, which penalizes states with larger socioeconomic inequalities. For example, while Colorado and the District of Columbia ranked 5th and 6th best in total smoking in 2002, Colorado ranked 8th worst and the District 2nd best in educational inequalities in smoking, leading to smoking achievement rankings of 9th best for Colorado and 3rd best for the District. In general, state socioeconomic inequalities in obesity declined and average obesity rates increased, while inequalities in smoking increased and average smoking rates declined. There was only a modest correlation among states between changes in smoking achievement and obesity achievement (r=0.24, p=0.1), indicating that the determinants of population health and health inequalities likely differ for obesity and smoking. While there was little correlation between changes in inequality and health achievement for obesity (r=.03, p=.8), for smoking, states with larger increases in educational inequalities had larger declines in health achievement (r=0.34, p<.01). Combining average health and health inequality may be a useful way of measuring overall health progress.

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