Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project

Abstract

Objectives: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States.

Methods: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island.

Results: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead.

Conclusions: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.

FIGURE 1—

Socioeconomic gradients for (a–b) childhood outcomes (% low birthweight, childhood lead poisoning), (c–g) infectious disease and injury (gonorrhea, syphilus, chlamydia, tuberculosis, gunshot wounds), (h–l) cancer incidence (lung, breast, cervical, prostate, colon), and (m–r) mortality for the total population (premature, heart disease, cancer, diabetes, HIV, homicide), with age-standardized rates stratified by census tract poverty and compared with relevant Healthy People 2000 objectives: Massachusetts (all outcomes except childhood lead poisoning) and Rhode Island (childhood lead poisoning only), circa 1990. Note. All rates were age-standardized using the Year 2000 standard million, except for the childhood health outcomes (low birthweight and lead poisoning). In each graph, the height of the bar equals the rate, while the width is proportional to the size of the population in the socioeconomic stratum. Rates based on fewer than 5 cases were suppressed, owing to unreliability of the estimates. The original Healthy People 2000 mortality baseline rates and targets were age-standardized to the 1940 standard million; to make them compatible with rates age-standardized to the Year 2000 standard million, we restandardized the Healthy People 2000 baseline mortality rates to the Year 2000 standard million and applied the percentage reduction used to set the original target rate to generate an equivalent target age-standardized to the Year 2000 standard million. Data on childhood lead poisoning are from Rhode Island, 1994–1996. All other data are from Massachusetts: births, 1989–1991; sexually transmitted infections and tuberculosis, 1993–1998; nonfatal gun-related injuries, 1995–1997; cancer incidence, 1988–1992; mortality, 1989–1991.