A study led by researchers at the Johns Hopkins Bloomberg School of Public Health shows that health care spending differences between black and white adults vary widely by local race and the degree of economic integration. large differences, and tend to be lower or absent in highly integrated communities.
In their study, the researchers compared health care spending among nationally representative samples of black and white adults by census tract across the United States. They found that for the same level of health, black adults spent much less on health care than white adults in the least racially integrated census tracts, but nearly the same in the most racially integrated areas. . The researchers also found that more integrated areas also showed signs of more equitable access to health care for black and white adults.
An individual’s health spending is an indicator of people’s health needs and the types of health care they may or may not have access to. These findings add to evidence that health disparities between black and white adults are largely attributable to modifiable social factors.
The study was published online on November 3 in JAMA Health Forum.
“Addressing health care disparities will likely require both health care and non-health care solutions, making sure people have health insurance and making sure the resources they have based on where they live give them the best chance of staying healthy,” said study lead author Lorraine Dean, Ph.D. , associate professor in the Department of Epidemiology at the Bloomberg School. “We already know from previous research that when black and white adults live in more equitable areas, health disparities largely disappear—and now we know this extends to health care spending as well.”
Life expectancy, disease risk, health outcomes, and other health care-related measures have long differed between white and black Americans due to external factors, including varying levels of poverty, economic opportunity, health care access, and community circumstances. Black adults live shorter lives on average and have higher rates of common illnesses such as diabetes, high blood pressure and kidney disease.
A 2011 study was also conducted by Bloomberg School researchers, including Darrell Gaskin, Ph.D., co-author of the new study and the William C. and Nancy F. Richardson Professor in the Bloomberg School’s Department of Health Policy and Management. The study describes racially and socioeconomically diverse areas of Baltimore where disparities in rates of hypertension, diabetes and other health measures are well below the national average and where some measures disappear entirely. The study used the term “place, not race” to describe the findings.
In the new study, Dean and colleagues addressed the question of whether health care spending correlates strongly with race and level of socioeconomic integration.
In their analysis, the researchers used data from a 2016 U.S. government survey called the Medical Expenditure Panel Survey (MEPS), which includes data on race, socioeconomic status, health status, health care access, health care use and health care spending. (including insurance company payments) for a nationally representative sample of Americans. The investigators also used neighborhood-level data on race and socioeconomic integration for each MEPS participant, based on U.S. Census Bureau data. American Community Survey (ACS) 2013-17.
The analysis included a total of 7,062 adult MEPS participants age 21 or older (one-third black and two-thirds white) who lived in 2,238 census tracts in which the black population comprised at least 5 %.
For each census tract, the researchers used census data to calculate a measure of socioeconomic and black/white integration called the Index of Concentration Extremes (ICE). They defined it as the number of non-Hispanic white adults in high-income (≥$100,000) households minus the number of non-Hispanic black adults in low-income (<$20,000) households, divided by the total known income in the household. population. Census tract.
The analysis, which adjusted for potential confounders such as age, gender and education level, found that racial differences in health care spending were larger in neighborhoods with the highest ICE (many high-income white adults, few low-income black adults). In these relatively non-integrated communities, black adults spend $2,145 less per year on health care than white adults. These disparities may reflect undertreatment of black adults or overuse of health care by white adults. By contrast, in communities in the middle range of ICE (indicating the highest levels of racial and socioeconomic integration), these spending differences largely disappeared—with a calculated total annual spending difference of only $79.
In the least integrated neighborhoods, black adults spend less on overall health care, but their physical health levels remain similar to those of white adults. Their overall spending was lower, primarily due to lower spending on doctor’s offices, prescription drugs and dental. But in highly integrated areas, differences in individual spending categories are minimized. According to MEPS data, the most integrated regions also enjoy relatively equitable health care services.
Overall, the findings suggest that closing the health care spending gap between blacks and whites is possible, although it may be easier to achieve in areas where socioeconomic and health care opportunity gaps are minimized, the researchers said.
““Health Care Expenditures among Black and White U.S. Adults Living in Similar Conditions” was co-authored by Lorraine Dean, John Chang, Rachael McCleary, Rahel Dawit, Roland Thorpe, and Darrell Gaskin.
Funding for the study was provided by the National Institute on Minority Health and Health Disparities (U54MD000214) and the National Heart, Blood, and Lung Institute (R01HL164116).
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