180073 Are Local Health Department Expenditures Related to Racial Disparities in Mortality?

Monday, October 27, 2008: 8:30 AM

David Grembowski, PhD , Health Services, University of Washington, Seattle, WA
Betty Bekemeier, PhD, MPH, RN , Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA
Douglas Conrad, PhD, MHA , Health Services, University of Washington, Seattle, WA
William Kreuter, MPA , Health Services, University of Washington, Seattle, WA
Aims. To estimate whether annual per capita expenditures of local health departments are associated inversely with annual local disparities in mortality rates for Black and White racial/ethnic groups, and to estimate whether changes in expenditures are associated with changes in those disparities over time.

Methods. The population was 883 local jurisdictions with age-adjusted, all-cause mortality rates for Black and White racial groups in 1990 and 1997 from the Centers for Disease Control and Prevention Wonder Data Base/National Center for Health Statistics, which were linked with local health department expenditures for 1989-1990 and 1996-1997 from the National Association of County and City Health Officials, along with county characteristics from the Census and the Area Resource File, Centers for Medicare and Medicaid Services, and Department of Agriculture. Health production function regression models and instrumental variables (to address potential reverse causation between local department expenditures and mortality disparities) estimated relationships between the changes in 1990-1997 expenditures and changes in 1990-1997 Black-White mortality ratios for 528 jurisdictions with complete data. Cross-sectional associations were estimated also.

Findings. Ratio of Black mortality-to-White mortality was 1.30 in 1990 and 1.32 in 1997, and average difference in 1990 and 1997 Black-White mortality ratios was -0.01 (SD 0.25). Median health department expenditures per capita were $22 in 1990 and $30 in 1997 (both 1997 dollars), with a median increase of $7.32 from 1990 to 1997. Regression results reveal no significant associations between expenditures and mortality disparities.

Conclusions. Gross changes in local health expenditures may not affect racial/ethnic disparities in age-adjusted, all-cause mortality rates. Further studies are needed to examine whether associations exist for male and female Black-White mortality ratios, for Black-White infant mortality ratios, for absolute changes in Black-White mortality, and whether local health department services are related to mortality disparities.

Funded by HCFO/RWJ Foundation Grant No. 59949

Learning Objectives:
1) Describe whether the amount of local health department expenditures are related to reduced disparities in Black-White mortality. 2)Describe how the lessons learned from these study findings can be used as an evidence base for the funding of local health departments. 3) Describe next steps for further research to examine historical patterns in the funding of local health departments and how funding might be related to health disparities.

Keywords: Public Health Research, Public Health Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: The Impact of Public Health Funding on Health Disparities
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