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Epi Special Seminar

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Tuesday, March 29, 2011
William H. Foege Genome Sciences Building (GNOM) S060
3:30 to 4:50pm

Monitoring Disparities in Chronic Conditions: The MDCC Study


Ali Mokdad, PhD
Professor, Global Health
Adjunct Professor, Epidemiology

Dr. Ali Mokdad leads the survey and surveillance activities at the Institute for Health Metrics and Evaluation (IHME)



Disparities in health outcomes, health determinants, access, and quality of health care are ongoing policy priorities in the United States. Studies have shown disparities across multiple domains for a wide range of chronic conditions, including cardiovascular diseases, respiratory diseases, diabetes, cancers, psychiatric disorders, and musculoskeletal conditions. Behavioral risk factors, such as tobacco smoking, physical inactivity, and poor diet, are likely to play a big role in health disparities. However, health disparities are also reflected in differing levels of access to health care and the quality of medical care.

To track disparities in chronic diseases and the effectiveness of health policies in reducing them, national data alone are not sufficient. More clinically detailed and localized information is required to understand how differences in risk factors, quality of care, access to interventions, and other factors impact health at the US-county level.

The primary aim of the Monitoring Disparities in Chronic Conditions (MDCC) Study is to design and test a population-based surveillance system that integrates multiple data sources to track disparities in chronic diseases at the local level. This system will capture the complete spectrum of relevant information, from socioeconomic and health risk factors to disease incidence and the consequent cascade of hospitalizations, outpatient visits, and use of and adherence to interventions. This study will allow us to determine the prevalence of diagnosed and undiagnosed conditions at the local level. In addition, it will allow us to provide estimates of effective coverage depending on appropriate provider practices as well as patient adherence to recommended therapies and interventions.

This project represents what we hope will be a pilot for a much larger, nationally relevant system. It is important to pilot this in a relatively data-rich environment with a heterogeneous population. King County, Washington, is our pilot location, and the project focuses on three racial and ethnic groups for which there are demonstrated disparities in health outcomes nationally: white non-Hispanics, white Hispanics, and black non-Hispanics. The study is intended to resolve a series of outstanding technical measurement issues, develop operational protocols, and produce results relevant to health policy formulation.

Suggested reading:

1) Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. Murray CJ, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, Ezzati M. PLoS Med. 2006 Sep;3(9):e260. Erratum in: PLoS Med. 2006 Dec;3(12):e545.

2) The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. Ezzati M, Friedman AB, Kulkarni SC, Murray CJ. PLoS Med. 2008 Apr 22;5(4):e66. Erratum in: PLoS Med. 2008 May 27;5(5). doi: 10.1371/journal.pmed.0050119.


Updated on March 4, 2011