Study finds persistent racial and ethnic health disparities over decades

There has been little to no progress in eliminating racial and ethnic disparities in some key health indicators over the past two decades, according to a Yale study.

Using data collected by the National Health Interview Survey from 1999 to 2018, researchers found that the proportion of people who reported having poor or fair health did not change significantly in 20 years, regardless of their race or ethnicity. Furthermore, during this time Black and Latino/Hispanic people persistently had the highest rates of poor or fair health.

The study was published on August 17 in the Journal of the American Medical Association.

“There were also staggering findings when stratifying by income,” said Dr. Cesar Caraballo-Cordovez, a postdoctoral associate in the Yale-based Center for Outcomes Research and Evaluation (CORE). “We found that, over the two decades we analyzed, Black individuals with low income had the highest estimated prevalence of poor or fair health status – 29.1% in 1999 and 24.9% in 2018 – while white individuals with middle and high income had the lowest – 6.4% in 1999 and 6.3% in 2018.” Caraballo-Cordovez co-led the study with Dr. Shiwani Mahajan, an internal medicine resident at Yale School of Medicine.

CORE is a research center based at Yale and Yale New Haven Hospital that applies scientific methods and develops scientific approaches to address the clinical and healthcare policy challenges.

The Yale team also measured trends in insurance coverage during those years. While they found that there were significant reductions in the number of uninsured individuals among all four racial and ethnic groups studied, Black and Latino/Hispanic individuals were persistently more likely to be uninsured and to lack a usual source of care.

There were also persistent disparities in health care affordability. In both 1999 and 2018, for instance, Black respondents were more likely than white respondents to report having foregone or delayed medical care due to cost. The difference between the two groups did not change significantly over the 20-year study span.

“What is most striking is that during the years we analyzed, a time when there has been a tremendous increase in healthcare spending and important national efforts to eliminate disparities, we detected no progress in these key health metrics and no improvement in health equity. The return on our healthcare investment in improving health and eliminating disparities is practically non-existent” said senior author Dr. Harlan M. Krumholz, Harold H. Hines Jr. Professor of Medicine at Yale and professor of investigative medicine and of public health (health policy) at the Yale School of Public Health and director of CORE.

The study team also included Yuan Lu, Javier Valero-Elizondo, Daisy Massey, Amarnath R. Annapureddy, Brita Roy, Carley Riley, Karthik Murugiah, Oyere Onuma, Marcella Nunez-Smith, Howard P. Forman, Khurram Nasir, and Jeph Herrin.