Methods

Methods for measuring progress toward target attainment and the elimination of health disparities in Healthy People 2030

This page provides a high-level summary and links to resources for measurement practices for progress toward Healthy People 2030 targets and tracking disparities.  To learn more, refer to “Measuring Progress Toward Target Attainment and the Elimination of Health Disparities in Healthy People 2030,” available from https://dx.doi.org/10.15620/cdc/164019, which highlights the strengths and limitations of the Health People 2030 measurement practices and provides a methodological reference upon which future publications and analyses may expand further. To assess and track disparities consistent with Healthy People 2030 practice and methodology, consider the Health Disparities Tracking Tool, available from Health Disparities Tracking Tool [XLXB – 47MB].

Progress toward Target Attainment

Two measures are used to assess progress toward target attainment in Healthy People 2030:

  1. The “percentage of targeted change achieved” is the difference between the baseline and most recent values as a percentage of the targeted change between the baseline and target values and is calculated for trackable core objectives (measurable objectives with at least two data points) that are moving toward their Healthy People 2030 targets.
  2. The “percentage change from baseline” is the difference between the baseline and most recent values as a percentage of the baseline value and can be calculated for all trackable core objectives regardless of the directionality of the change. (The percentage change from baseline can also be used to assess progress by population subgroups, as explained further below.)

The above two measures are the basis for the four mutually exclusive categories that trackable core objectives can be classified into:

  1. Target met or exceeded – When the desired direction is an increase, an objective is considered to have met or exceeded its target at the most recent timepoint if its most recent value is at or above the Healthy People 2030 target. On the other hand, when the desired direction is a decrease, an objective has met or exceeded its target if its most recent value is at or below the Healthy People 2030 target.
  2. Improving – When the desired direction is an increase, an objective is moving toward its target at the most recent timepoint if its most recent value is higher than the baseline value but remains lower than the Healthy People 2030 target. On the other hand, when the desired direction is a decrease, an objective is moving toward its target if the most recent value is lower than the baseline value but remains higher than the Healthy People 2030 target. An objective that is moving toward but has not met or exceeded its target at the most recent timepoint is classified as improving if the percentage of targeted change achieved is statistically significant (when standard errors [SEs] are available), regardless of the magnitude of the change, or, when statistical significance cannot be tested, if 10% or more of the targeted change is achieved.
  3. Getting worse – When the desired direction is an increase, an objective is moving away from the baseline and target values at the most recent timepoint if its most recent value is lower than the baseline value and the Healthy People 2030 target. On the other hand, when the desired direction is a decrease, an objective is moving away from the baseline and target values if the most recent value is higher than its baseline and target values. An objective that is moving away from its baseline and target values at the most recent timepoint is classified as getting worse if the percentage change from baseline is statistically significant (when SEs are available), regardless of the magnitude of the change, or, when statistical significance cannot be tested, if the change from baseline is 10% or more in magnitude (absolute value).
  4. Little or no detectable change – Objectives that have not met or exceeded their targets at the most recent timepoint are assigned to this category under any of the following scenarios:
  • Movement toward the target is not statistically significant when measures of variability are available.
  • Movement is toward the target, but the objective has achieved less than 10% of the targeted change when measures of variability are unavailable.
  • Movement is away from the baseline and target values and is not statistically significant when measures of variability are available.
  • Movement is away from the baseline and target values, but the objective has moved less than 10% relative to its baseline value when measures of variability are unavailable.
  • There was no change between the baseline and most recent timepoints.

The Appendix of “Measuring Progress Toward Target Attainment and the Elimination of Health Disparities in Healthy People 2030” details the assessment of the statistical significance of the percentage of targeted change achieved and the percentage change from baseline (when measures of variability are available).

Progress by population subgroups

Note that assessment of progress toward target attainment for Healthy People 2030 objectives focuses on the total targeted population—since that is the basis for target setting for each objective. There are limitations to examining progress by population subgroups using the percentage of targeted change achieved, especially for groups that have already met or exceeded the target at baseline. Therefore, it may be more appropriate to assess progress by population subgroups using the percentage change from baseline as an alternate or supplementary measure to the percentage of targeted change achieved, allowing for comparisons between groups regardless of where they started the decade relative to the target. 

Progress toward the Elimination of Health Disparities

The following are important concepts in the assessment of disparities in Healthy People 2030.

  • The term “rate” is used as shorthand for rate, percentage, proportion, or any other measurement for which disparities can be meaningfully assessed. Not all Healthy People objectives are measured using a rate.
  • There is no single, gold-standard measure of health disparities.
  • Healthy People 2030 methodology incorporates a suite of six disparities measures, including absolute and relative, between-group and overall, and maximal and summary measures, all calculated relative to a reference group rate.
  • The reference rate is the highest group rate if the desired direction for the objective is an increase and the lowest group rate if the desired direction for the objective is a decrease.

The suite of health disparities measures used in Healthy People 2030 is as follows.

  • The between-group rate difference and ratio are absolute and relative between-group measures of disparities, respectively, that allow for comparisons of each population subgroup to the reference rate.
  • The maximal rate difference and ratio are absolute and relative overall measures, respectively, that compare the largest and smallest group rates for a given population characteristic (for example, race and ethnicity) and are useful for providing a high-level overview of disparities.
  • Similarly useful for providing a high-level overview, the summary rate difference and ratio are overall measures that compare the reference group rate to the average rate of all other subgroups.

Changes in the above disparities measures over time are assessed primarily on a relative scale (percentage difference) to allow for direct comparisons between the multiple health disparities measures—although changes over time could be assessed on an absolute scale (simple difference) when only considering a single measure. “Measuring Progress Toward Target Attainment and the Elimination of Health Disparities in Healthy People 2030” provides more technical details on measuring disparities and changes in disparities over time in Healthy People 2030.

Health Disparities Tracking Tool

The Health Disparities Tracking Tool was developed by the Health Promotion Statistics Branch at the National Center for Health Statistics to enable end-users to assess and track disparities consistent with Healthy People 2030 practice and methodology. This tool provides end-users with the ability to calculate health disparities from input data, calculate  SEs and 95 percent confidence intervals  (when SEs of the underlying population group rates are available), assess changes in disparities over time, and generate dot plots (also known as equiplots) and trend (line) charts to track disparities.  The tool is available from Health Disparities Tracking Tool [XLSB – 47 MB].