Looking to Data to Address Systemic Racism in Healthcare
This month, just over a year after a massive, nationwide social justice movement shook the landscape of the country, the United States will celebrate the 156th anniversary of Juneteenth. And while the commemoration of this important day will no doubt be marked by renewed commitments to equality and recognition of progress made, it is important to acknowledge that racial inequity remains a major problem – including in healthcare.
Social determinants of health and racial inequity continue to be a driver of unequal disease burden for people of color, and the factors driving these disparities are systemic and far-reaching.
Even after years of efforts to increase access to care, minority communities are more likely to be uninsured, experience worse health outcomes, and bear a disproportionate disease burden. Data from 2010 to 2018 indicated that Black Americans remained 1.5 times more likely to be uninsured than white Americans, and the uninsured rate among Hispanic Americans was over 2.5 times higher than the rate for the white population. What’s more, these same underserved populations were less likely to have employer-paid leave , marking an additional barrier to care even for those with insurance.
That type of inequity creates not only a chasm of healthcare access, but less data is available about these populations and their interactions with the healthcare system. With limited visibility into real-world patient journeys, the healthcare industry experiences a vacuum of information – the lack of which ripples into decision-making and further exacerbates these deep disparities in care.
A Zip Code Should Not be a Death Sentence
Racial and socioeconomic inequities in healthcare have been displayed prominently during the COVID-19 pandemic. According to CDC data, Black people are 2.9 times more likely to be hospitalized and 1.9 times more likely to die from COVID-19 than white people; and Hispanic people are 2.8 times more likely to be hospitalized and 2.3 times more likely to die from COVID-19 compared to white populations. Despite these higher rates of infection and hospitalization, Black and Hispanic people have received smaller shares of vaccinations.
These trends are likely driven by the fact that minority populations in the U.S. are more likely to suffer from comorbidities, perform essential work, and lack access to the medical system.
Komodo dug further into this phenomenon and found strong links between the racial composition of a neighborhood and the likelihood of getting COVID-19 and getting vaccinated. Specifically, we found that people living in predominantly Black or Hispanic zip codes are 42% more likely to be diagnosed with COVID-19, yet they are 75% less likely to get vaccinated.
Disease Management is Not Created Equal
While COVID-19 has brought healthcare disparities to the mainstream national conversation, these problems are far from new – and present across a wide range of conditions. Chief among these disparities is where and how often people of color seek more serious care for chronic conditions. In a recent analysis we conducted in conjunction with the Asthma and Allergy Foundation of America (AAFA), we found that cities with the highest concentration of Black residents had 36% higher emergency department (ED) visits for asthma-related health issues compared to predominantly white cities. This increased ED visit volume in Black majority cities suggests poorer disease management and a pattern of patients accessing the ED as a source of primary care for their asthma.
Another stark example is the state of sickle-cell disease, a genetic disorder in the red blood cell formation that prevents oxygen from being carried effectively throughout the body and can cause damage to the heart, lungs, brain, and spleen. It affects approximately 100,000 patients per year, with a heavily disproportionate impact on Black Americans. Our data points to poor disease management for sickle-cell disease patients, resulting in acute critical treatment rather than consistent, preventive medicine. We found that 64% of sickle-cell disease patients had to visit the ED (compared to about 44% of the general population), and 64,000 sickle-cell disease patients received blood transfusions in 2019.
The disparities don’t stop at race. While telehealth became a saving grace during the COVID-19 pandemic, it was younger, wealthier patients who benefited the most. During the height of the COVID-19 outbreak in the Spring of 2020, we found that providers in the 10% of U.S. counties with the highest median income were 47% more likely to offer telemedicine than those in the bottom 10% of U.S. counties by median income level.
Looking Ahead – With a Complete Picture of U.S. Healthcare
As stakeholders try to close these gaps and glean insights into historically underserved patient populations, we need to empower providers, population health officials, health plans, and the Life Sciences community with the tools to zero in on these gaps in care. Without a comprehensive view of patient journeys, the task is harder.
As we look ahead to a day celebrating liberation from entrenched oppression, we cannot ignore the inequity in the U.S. healthcare system that continues to leave distinct demographic groups behind. As the COVID-19 pandemic wanes in the U.S. and we evaluate the aftermath of this emergency, the next decade of healthcare will be defined by how we fight back against these disparities, and the inroads we make along the way. While the task may be daunting, it’s a battle worth waging.