Evidence of racial disparities in health care reported in every US state: New report

Racial and ethnic disparities in health care are evident in every state, even those with robust health systems, according to a new analysis from the Commonwealth Fund.

In the analysis from the organization, which is aimed at promoting equitable health care, researchers found health system performance is markedly worse for many people of color compared to white people.

"Even among high performing states, we see significant disparities," Joseph Betancourt, M.D., President of the Commonwealth Fund, said in a report on the organization’s updated findings.

Six states were found to have better-than-average health system performance among all racial or ethnic groups, including Rhode Island, Massachusetts, Connecticut, Hawaii, New Hampshire and New York. However, even among these high-scoring health systems, racial disparities were observed.

"This report demonstrates that if you don't look under the hood, you won't identify where you're failing people and where you're leaving people behind," Betancourt said.

Particularly when looking at health outcomes, large disparities in premature deaths from avoidable causes are apparent in all states. Black, and American Indian and Alaska Native (AIAN) people are more likely to die before age 75 from preventable and treatable causes, including, but not limited to, some infections such as appendicitis and certain cancers, than white populations, according to the analysis.

There are also large disparities in health care access between white people and other racial or ethnic groups across all states. Despite coverage expansion by the Affordable Care Act in recent years, states' uninsured rates are generally higher and more variable for Black, Hispanic, and AIAN adults compared to Asian American, Native Hawaiian, and Pacific Islander (AANHPI) and white adults, according to the analysis. In particular, Hispanic people had the highest uninsured rates and cost-related difficulties in accessing care in almost all states.

"These groups have more problems accessing care and if quality of care is lower, then they have worse health outcomes compared to white people in many states," Senior Scientist David Radley, Ph.D., of the Commonwealth Fund, said in the report.

The analysis, which was done using publicly available databases reporting outcomes from more than 328,000,000 people during the years 2021 and 2022, concluded that achieving health equity requires policy action and health system action, including:

• Ensuring affordable, comprehensive, and equitable health insurance coverage for all
• Strengthening primary care
• Improving health care quality and delivery
• Health systems and providers prioritizing and centering equity
• Investing in social services
• Improving the collection and analysis of racial and ethnic data to identify gaps
• Developing equity-focused measures to inform and evaluate policy

"Some of the major takeaways of this work is that we still have a lot of work to do," Senior Scholar and Commonwealth Fund Vice President Sara R. Collins said in the organization’s report. "Maybe in a decade we'll look at this data and we'll see some of these gaps closing.”

Dr. Laurie Zephyrin, a senior vice president for the Commonwealth Fund, said undertaking the prescribed action will likely help.

"The reality is we can't improve healthcare if we're not accurately measuring and tracking these outcomes and experiences and using real data as a guidepost to ensure that we are advancing towards equity. ... All these comprehensive actions are truly a start. It really can help us move forward to advance health equity and address many of the inequities that we talked about today," she said in the report.

The Commonwealth Fund’s State Scorecard on Health System Performance series evaluated each state’s health care system and is a tool developed to understand health inequities and disparities. It uses 25 data indicators to designate a "State Health Equity Score," which indicates each state health system’s performance based on health care access, quality, service use and health outcome. Scores were also determined for each of five racial or ethnic groups (Black, AIAN, AANHPI and Latinx/Hispanic) during the years 2021 and 2022, notably incorporating post-pandemic effects on health disparities.

Dr. Ashley Yoo, M.D., is a member of the ABC Medical News Unit and an Internal Medicine Resident at George Washington University Hospital in Washington, D.C.