Health disparities exist in every state: Stark racial divide in premature deaths
Massachusetts, Minnesota, and Connecticut stand out for their relatively high performance for all ethnic groups, yet these states have considerable health disparities between white and nonwhite residents, says a new report.
The study, “Advancing Racial Equity in U.S. Health Care: The Commonwealth Fund 2024 State Health Disparities Report,” is part of a decades-long effort to track health disparities. It takes a close look at how health care systems perform in every state, focusing on disparities in health care across racial and ethnic groups. Its findings echo what has been found repeatedly in this country: the U.S. has “deep-seated racial and ethnic disparities,” which persist in the areas of access, quality, and outcomes. In addition, there is a stark racial divide in premature deaths.
“Even in states that have historically performed well in Commonwealth Fund state rankings, racial and ethnic health disparities can be dramatic. For example, Massachusetts, Minnesota, and Connecticut stand out for their relatively high performance for all racial and ethnic groups, yet these states have considerable health disparities between white and nonwhite residents,” the study said.
“Profound” inequities
The study called the disparity of care “profound.” The data was broken into ethnic groups and listed by state; and across the board white citizens and Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups scored better.
In the case of premature deaths—deaths before age 75 from preventable causes per 100,000 people, the best score was for Asian American and Native Hawaiian/Pacific Islander (AANHPI) at 104, followed by Hispanic citizens at 225, whites also at 225, Blacks at 347, and American Indians and Alaska Natives (AIAN) at 479.
Data for infant mortality found that AANHPI and whites again had the best numbers (4 per 100,000), followed by Hispanic at 5, AIAN at 8, and Black at 11.
Hospital readmission rates (65 and older, per 1,000) were:
- 26 for whites and
- 44 for Blacks (other group data was not available).
Breast cancer deaths averaged:
- 12 per 100,000 for AANHPI,
- 13 for Hispanic,
- 14 for AIAN,
- 20 for whites, and
- 27 for Blacks.
Colorectal cancer deaths were:
- 9 per 100,000 for AANHPI,
- 11 for Hispanic,
- 13 for both AIAN and whites, and
- 17 for Blacks.
Access also saw stark disparities. Adult uninsured rates were highest among Hispanics (23%), followed by AIAN (22%), Blacks (12%), whites (8%), and AANHPI (7%). Adults who went without care because of cost were led by Hispanics (19%), followed by AIAN (14%), Blacks (13%), and both AANHIP and whites (8%).
Lack of insurance a key factor
The study found that a lack of comprehensive insurance coverage was a big part of disparities in access. The researchers noted that the number of people with insurance has climbed steadily in the U.S. since the passage of the Affordable Care Act, but 25 million Americans remain uninsured today. Even those with coverage, usually through employers, face high deductibles and cost sharing, which can lead to negative outcomes.
“While the ACA’s insurance expansions led to coverage gains across all racial and ethnic groups, coverage disparities remain,” the report said. “In nearly all states, uninsured rates continue to be higher for Black, Hispanic, and AIAN residents than they are for white and AANHPI residents.”
The report suggested a range of possible solutions: expanding ACA premium subsidies would bring insurance to more Americans across the board; expansions to Medicaid in states that have not yet done so would be helpful to lower-income Americans; reducing deductibles and out-of-pocket costs would help those currently insured and increase utility of health care services; and lowering immigration-related barriers to coverage could help the more than 3 million uninsured adults who cannot enroll in government plans because of immigration status.
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Other steps could include better reimbursement and financial incentives to providers, expanded training of health workers, and efforts to diversify the workforce. Reducing administrative burdens is another suggestion the report gave, noting that Americans face a much more complicated system than residents of other high-income nations.
“The U.S. health care system is not immune from the systemic inequities that plague all facets of American society,” said Joseph Betancourt, M.D., president of Commonwealth Fund. “Decades of policy choices at the federal, state, and local levels combined with underinvestments in equity among local health care systems has had a discriminatory impact and contributed to poorer health outcomes for people of color. Just as these were deliberate choices, we can now be deliberate about promoting high-quality, equitable health care for all. This undoubtably will create healthier, more resilient communities that will ultimately benefit the entire country.”