Race-differentiated outcomes in multiple special healthcare taxing districts

Background: Communities with locally generated special healthcare taxes have demonstrated a generally favorable association with selected population health status outcomes.

Purpose: This research attempted to determine if that positive association with health outcomes is race differentiated.

Methods: Florida counties with multiple special taxing districts were grouped and compared against counties that had either no special healthcare taxing authority or had such authority but were inactive (did not tax). Outcomes of interest were five combined groups and eight cause-specific mortality indicators and five categories of hospitalizations from the 6-year period 2000-2005 analyzed in 2007. Standard mortality ratios and standard hospitalization ratios were calculated separately for white and black populations in four age bands.

Results: Compared to blacks and whites living in communities without special taxing districts, black residents of communities with such districts had larger reductions in mortality for chronic conditions such as cancers, diabetes, stroke, and pneumonia/influenza. The same holds true for hospitalizations for diabetes, congestive heart failure, hypertension, and asthma. These differences were not found in mortality due to HIV, homicide, or motor vehicle crashes. Some differences by taxing district were also age and race differentiated.

Conclusions: In communities with health-related taxing authorities, reductions in health disparities between whites and blacks can be demonstrated. These differences are not uniform and vary by the specific type of outcome, race, and age. These findings support the need for studies that prospectively determine whether implementing new taxing strategies may help reduce health disparities.