Racial health disparities in premature death pervasive in all US states

April 18, 2024 - Even in the best-performing states, racial health disparities have left their mark, with new reporting from the Commonwealth Fund showing serious differences in life expectancy and preventable deaths between races/ethnicities.

Overall, Black and American Indian/Alaska Native (AI/AN) people in the United States are more likely to die from preventable and treatable conditions than other racial/ethnic groups, the report found.

“This report lays bare the persistent disparities people of color experience in accessing and receiving quality care across the U.S.,” Laurie Sephyrin, MD, vice president of Advancing Health Equity at the Commonwealth Fund, said in a statement emailed to PatientEngagementHIT. “We must do better – and we can start by rooting out pervasive racial and ethnic bias and inequities in our health care system to ensure everyone gets the care and coverage they need.”

The report looked at 25 health indicators falling under three domains: health outcomes, healthcare access, and quality and use of healthcare services. The researchers then calculated a summary score out of 100 to do state-by-state and within-state comparisons, helping them to measure the level of racial health disparities.

The researchers found that racial health disparities are a bigger problem in some states than in others. Massachusetts, Minnesota, Rhode Island, and Connecticut are standouts for high-quality care among all racial/ethnic groups.

Still, health disparities are pervasive even among top performers. For example, the 100-point overall health system performance scores for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) people and White people in Massachusetts were near-perfect (99 and 98, respectively). The score for Black people in Massachusetts was 69.

And these are the scores for states that perform the best in health equity. Meanwhile, a state like Washington has a wide gulf in health system performance scores. The score for AANHPI people in Washington was 93, while it was 8 for AI/AN people. There’s a 77-point spread in health system scores for AANHPI and Hispanic people, the report furthered.

Overall, the US is rife with health inequity, with the report shining a light on the racial divide in avoidable death. Preventable death occurs at a higher rate among AI/AN and Black people compared to other racial/ethnic groups.

There are also state-by-state differences in avoidable death, with Arkansas, Mississippi, Louisiana, Tennessee, Kentucky, and Missouri having higher rates for Black and White people than other parts of the country. Rates among Hispanic people spike in southwestern and mountain states, the report added.

In terms of healthcare access, which the Commonwealth Fund measured as insurance coverage, there were other nationwide disparities. AANHPI and White people had the lowest uninsured rates, while AI/AN people had the highest. The greatest state-by-state variation in uninsured rates was for Hispanic people, most likely due to different immigration policies across the nation.

Finally, the report zeroed in on care quality and healthcare utilization, measured by emergency department use and admission for conditions best treated in ambulatory settings.

“Primary care clinicians play an especially critical role in providing people with high-value services, including preventive care like cancer screenings and vaccines as well as chronic disease management,” the researchers explained. “When there are barriers to obtaining primary care, such as costs or a lack of providers, people are more likely to get care in more intense and costly care settings, particularly an emergency department (ED).”

Black people are more likely to have an avoidable ED visit than White people, the report showed. They are also more likely to be admitted for a condition that is typically managed in a primary care setting.

The Commonwealth Fund intends these findings to help guide policymaking, Joseph Betancourt, MD, the president of the Commonwealth Fund, said in a press release.

“The U.S. health care system is not immune from the systemic inequalities that plague all facets of American society,” Betancourt noted.

“Decades of policy choices at the federal, state, and local levels have had a discriminatory impact and contributed to poorer health outcomes for people of color,” he continued. “Just as these policies were deliberately designed in the first place, we can now design policies that promote high-quality, equitable health care for all. This undoubtedly will create healthier, more resilient communities that will ultimately benefit the entire country.”

Proposed solutions range from fortifying insurance coverage, improving primary care delivery, reducing administrative burden on clinicians, and supporting social services that address social determinants of health affecting outcomes.