Healthcare Disparities Have Largely Worsened in Recent Years

Marcia Frellick

June 28, 2019

The white-black gap in health equity has narrowed, but several other key measures have worsened, a 25-year analysis of health equity has found.

"[T]he overall pattern is one of stagnation mixed with unambiguous decline," write Frederick J. Zimmerman, PhD, and Nathaniel W. Anderson, BA, of the Department of Health Policy & Management at the University of California, Los Angeles.

The researchers analyzed data (1993–2017) from more than 5.4 million respondents to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Although the disparities gap between black and white patients improved during that 25-year span, other measures of health equity and justice (the measure of how outcomes relate to income, race/ethnicity and sex) declined.

Zimmerman and Anderson looked at two key self-reported markers: how people felt about their general health on a 5-point scale (from poor to excellent) and the average number of physically and mentally healthy days they had in the past month. They also looked at health disparities across three income groups.

Study Findings

The black-white gap showed significant improvement (year coefficient: healthy days, 0.021; 97.5% confidence interval [CI], 0.012 - 0.029; P < .001; self-reported health, 0.030; 97.5% CI, 0.025 - 0.035; P < .001).

For both self-reported health and healthy days, average health has been declining over time (year coefficient: healthy days, −0.023; 97.5% CI, −0.032 to −0.015; P < .001; self-reported health, −0.017; 97.5% CI, −0.029 to −0.006; P = .005).

Income disparities rose across the study period, and the change over time was greater compared with within-year variation across states.

Although other studies have tracked racial/ethnic and income disparities over years, they typically focus on single diseases or mortality — components that may give an incomplete picture.

Looking at trends through the lens of a single disease may "obscure larger patterns that may be indicative of systemic forces," the researchers write.

The authors look at health equity with this definition: "Everyone has a fair and just opportunity to be as healthy as possible."

That separates the context in this analysis from other studies on differences in life expectancy and access to health services. It also matches more closely the way policymakers think about health equity, Zimmerman and Anderson note.

Health equity is a key goal of public health and is one of the four overarching goals of the US Department of Health and Human Services initiative Healthy People 2020 .

Zimmerman and Anderson conclude that "meaningful progress on health equity in the United States will require greater effort, new approaches, or both."

The authors note the study has limitations. "Even with its large sample size, the present analysis is not able to specifically identify additional measures important to the understanding of health equity, such as those involving religious, sexual, or immigration-status minorities or those dimensions that arise from intersectionality."

Anderson's participation in this research was supported by a grant from the National Institutes of Health/National Center for Advancing Translational Science UCLA Clinical and Translational Science Institute. Zimmerman reports grants from the Robert Wood Johnson Foundation during the conduct of the study.

JAMA Network Open. Published online June 28, 2019. Full text

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