Racial and socioeconomic integration linked to lower health care expenditure disparities

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According to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health, health care spending differences between black and white adults vary significantly with local levels of racial and economic integration and tend to be low or nonexistent in highly integrated communities. .

For their study, the researchers compared health care costs for a nationally representative sample of black and white adults in census tracts across the United States. They found that, at the same level of health, health expenditures for black adults were much lower than for white adults in census tracts with the lowest levels of racial integration but were virtually the same in tracts with the highest levels of integration. The researchers also found that more integrated areas had signs of more equitable health access for black and white adults.

Individual health expenditure is an indicator of people’s health needs and the type of health care they may or may not receive. The findings add to evidence that health disparities between black and white adults are largely attributable to social factors that can be modified.

The study was published online on November 3 Jama Health Forum.

Fixing health care disparities may require both health care and non-health care solutions—ensuring that people have health insurance and the resources they have based on where they live give them the best chance to stay healthy. We already know from previous research that health disparities mostly disappear when black and white adults live in more equitable neighborhoods—; Now we know that extends to health care costs as well.”

Lauren Dean, Scd, Lead author of the study, Associate Professor of Epidemiology at the Bloomberg School

Due to external factors-; Exposure to different levels of poverty, including economic opportunity, access to health care and neighborhood; Life expectancy, disease risk, health outcomes, and other health care-related measures have long been known to differ among whites. and black Americans. Black adults have shorter life expectancy and higher rates of common illnesses, including diabetes, high blood pressure, and kidney disease.

The new study was co-authored by Darrell Gaskin, Ph.D., William C. And a 2011 study by Bloomberg School researchers, including Nancy F. Richardson, professor in the Bloomberg School’s Department of Health Policy and Management, describes racial and socioeconomic differences. Baltimore’s metropolitan area had disparities in rates of high blood pressure, diabetes, and other health conditions far below the national average, and for some measures had disappeared entirely. The study used the term “place, not race” to capture the findings.

In the new study, Dean and colleagues address the closely related issue of whether health care costs vary with levels of racial and socioeconomic integration.

For their analysis, the researchers used data from a 2016 US government survey called the Medical Expenditure Panel Survey (MEPS), which measures Americans’ race, socioeconomic status, health status, access to health care, use of health care, and health care expenditures (including copayments). For a nationally representative sample, the investigators also used community-level data on the racial and socioeconomic integration of each MEPS participant based on the US Census Bureau’s American Community Survey (ACS) for 2013–17.

The analysis included a total of 7,062 adult MEPS participants age 21 or older—; One-third of them are black, two-thirds white-; 2,238 lived in census tracts where the population was at least five percent black.

For each of these census tracts, the researchers used census data to calculate a measure of socioeconomic and black/white integration called the Index of Extreme Density (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 individuals in low-income (<$20,000) households, divided by the total population with known income. Census Tract

The analysis, which adjusted for potential confounding factors such as age, gender, and education level, found that ICE was highest in communities—; Many high-income white adults, low-income black adults-; Racial disparities in health care spending were evident. In these relatively unincorporated communities, black adults spend $2,145 less per year on health care than white adults. These differences may reflect undertreatment for black adults or overuse of health care by white adults. In contrast, in communities where ICE was in a moderate range, indicating the highest levels of racial and socioeconomic integration, these spending disparities mostly disappeared; The calculated difference in overall annual cost is only $79.

In the least integrated communities, where black adults had lower overall health care expenditures, they still had similar levels of physical health as white adults. Their lower overall spending was largely driven by lower doctor-office, prescription drug and dental costs. But in highly integrated areas, differences in individual expenditure categories are reduced. According to MEPS data, the most integrated regions had relatively equitable health care access.

Overall, the researchers say, the results suggest that reducing health care cost disparities between blacks and whites is possible, although reducing socioeconomic and health care access disparities may be much easier to achieve in areas where there is less.

“Health Care Costs for Black and White US Adults Living Under Similar Conditions” co-authored by Lorraine Dean, Yuhan Zhang, Rachel McCleary, Rachel DeWitt, Roland Thorpe, and Darrell Gaskin.

This research was funded by the National Institute on Minority Health and Health Disparities (U54MD000214) and the National Heart, Blood, and Lung Institute (R01HL164116).


Journal Reference:

Dean, LT, etc. (2023). Health care expenditures for black and white US adults living under similar conditions. Jama Health Forum. doi.org/10.1001/jamahealthforum.2023.3798.

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