Data Highlight Pervasive Racial/Ethnic Disparities in Health Care

“Advancing equity in health and health care should be a top priority of health care leaders and policymakers. A good start would be to identify policies that impede progress toward this goal,” according to the authors of the report.

Inequities in access to high-quality care have influenced persistent racial and ethnic disparities in health-related outcomes across the United States, according to findings from a health disparities report published by The Commonwealth Fund.¹

According to the authors, factors both inside and outside of health care systems may be driving racial and ethnic disparities in health care. For example, data suggest that individuals who are Black, Hispanic, American Indian, or Alaska Native have a lower likelihood of receiving insurance than other groups; they are also more likely to delay care due to costs and accumulate more medical debt.² Prior research has highlighted inequities in the quality of care and patient safety across different diseases and conditions, including heart disease, cancer, stroke, maternal health outcomes, and surgery.

The report assessed health care inequities across 3 primary domains: health outcomes, health care access, and quality and use of health care services.

Outcomes Related to Health

The authors stated that Black patients were most likely to die early due to avoidable causes compared with other populations, which included those who are Asian American, Native Hawaiian, and Pacific Islander or Hispanic.

The rate of premature deaths from avoidable causes for individuals who are Black was as high as 716.8 deaths per 100,000 in the District of Columbia. Among American Indian or Alaska Native individuals, there were as many as 1394 deaths per 100,000 in South Dakota.

Findings suggested regional patterns associated with premature avoidable mortality. Specifically, the rates of preventable mortality were increased for Black and White populations in Southern states such as Arkansas, Mississippi, and Louisiana. Additionally, premature mortality rates for Hispanic individuals were found to be higher in southwestern and mountain states including New Mexico, Colorado, Arizona, and Oklahoma.

With respect to cancer, the authors wrote that Black patients were more likely than other groups to have a breast cancer diagnosis at later stages.³ Additionally, the rate of age-adjusted death rates due to breast cancer was higher for Black patients compared with others across most states.

Access to Health Care

According to the authors, a key contributor to disparities in health care access may be a lack of comprehensive insurance coverage, which has led to outcomes such as Hispanic populations having the highest uninsured rates.

Despite policy changes intended to expand health insurance following the Affordable Care Act (ACA), the highest uninsurance rates were reported among Black, Hispanic, and American Indian or Alaska Native populations.⁴ Among adults who are 19 to 64 years old, as many as 19.3% of Black individuals in Texas did not have state insurance. The rates of state uninsurance were as high as 40.2% for American Indian or Alaska Native populations in South Dakota and 43.3% for Hispanic individuals in Tennessee.

The authors stated that immigration-related obstacles may contribute to issues with receiving subsidized health care coverage through Medicaid or the ACA for some Hispanic or Asian American, Native Hawaiian, and Pacific Islander groups. Additionally, Black, Hispanic, and American Indian or Alaska Native individuals have a higher likelihood of experiencing delays in their care or financial toxicity due to a lack of insurance.

Health Care Use & Quality

Overall, individuals who are White tended to receive higher quality health care compared with Black; Hispanic; American Indian or Alaska Native; and Asian American, Native Hawaiian, or Pacific Islander populations.

Specifically, beneficiaries of Medicare who are Black had a higher probability of undergoing admission to a hospital or receiving care in an emergency department for conditions that could be managed via primary care compared with White individuals. Regarding the rate of admissions for ambulatory care-sensitive conditions, as many as 75.2 per 1000 Black Medicare beneficiaries in Indiana underwent admission, while the highest proportion for White individuals was 41.4 per 1000 Medicare beneficiaries in West Virginia. For emergency department visits that were avoidable, as many as 300.1 Black Medicare beneficiaries in Connecticut had an admission compared with 177.8 per 1000 White Medicare beneficiaries in West Virginia.

According to the authors, government policymakers and leaders in the health care sector may pursue a variety of potential options for mitigating the racial and ethnic disparities in health outcomes highlighted in the report. Ensuring affordable and equitable health care coverage, improving primary care and delivery of services, and reducing inequitable administrative burdens that may affect patients and providers were some of the possible strategies that the authors highlighted.

“Advancing equity in health and health care should be a top priority of health care leaders and policymakers. A good start would be to identify policies that impede progress toward this goal,” David C. Radley, PhD, MPH, a senior scientist for the Commonwealth Fund’s Tracking Health System Performance initiative and director of data and analytics at the Center for Evidence-Based Policy at Oregon Health and Science University, and coauthors wrote.¹ “Leaders at the federal, state, and local levels could consider evaluating existing and emerging laws and regulations for their implications for the health of people of color. And they could pursue reforms to remedy the longstanding disparities described in this report.”

References

1. Radley DC, Shah A, Collins SR, Powe NR, Zephyrin LC. Advancing racial equity in U.S. health care: The Commonwealth Fund 2024 State Health Disparities Report. The Commonwealth Fund. April 18, 2024. Accessed May 1, 2024. https://tinyurl.com/4ph4b9u7
2. Mahajan S, Caraballo C, Lu Y, et al. Trends in differences in health status and health care access and affordability by race and ethnicity in the United States, 1999-2018. JAMA. 2021;326(7):637-648. doi:10.1001/jama.2021.9907.
3. Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. Adv Exp Med Biol. 2019;1152:31-49. doi:10.1007/978-3-030-20301-6_3.
4. Baumgartner JC, Collins SR, Radley DC. Inequities in health insurance coverage and access for Black and Hispanic adults: the Impact of Medicaid expansion and the pandemic. The Commonwealth Fund. March 16, 2023. Accessed May 1, 2024. https://tinyurl.com/3ypsrdd4