Closing the Gap on Health Inequality

Although the US healthcare system is the envy of much of the world, it is troubling that persistent and well-documented health disparities still exist between different racial and ethnic populations.

But evidence is emerging that as a nation, we are beginning to make inroads into achieving health equity and eliminating health disparities by investing in prevention and wellness.

A study conducted by Quest Diagnostics and published in a recent issue of Diabetes Care¹ found that people in states that expanded Medicaid under the Affordable Care Act (ACA) are far more likely to be newly diagnosed with diabetes than those in states that elected not to expand the program. Based on an analysis of de-identified test results of 434,288 Americans from Quest’s uniquely large database, we found that diagnoses of newly identified diabetes in Medicaid patients surged 23% in expansion states in the first few months after the ACA went into effect, but increased just 0.4% in those states that opted out of Medicaid expansion during the same time period.

While we did not examine demographics beyond age and state, it is likely that many of the newly identified individuals from the Quest study are part of a racial or ethnic minority, given that African Americans and Hispanic/Latino Americans are at a sharply increased risk of diabetes than non-Hispanic whites. And with new US Census Bureau data² showing the uninsured rate among blacks, Hispanics and Asians all declined by more than 4 percentage points between 2013 and 2014, attributable to Medicaid expansion, our findings suggest that increasing access to healthcare could serve as a catalyst for improved health statuses for all Americans, but particularly minorities.

Early diagnosis and treatment of diabetes can lead to fewer complications and more effective disease management--and potentially, lower long-term costs. Too often, people don’t know they have the disease or are at risk of developing it, which is why it is critical they receive a blood test called an A1C to help diagnose it. Our study suggests that increased access to care helps people get this simple blood test, receive a diagnosis, and hopefully take measures, like improving their diet or medication, to arrest further disease progression.

The Quest study also suggests that preventive screening under the ACA may produce the same impact on chronic diseases and conditions beyond diabetes, including hypertension and chronic kidney disease. For many of these conditions, the gap in health status by race, ethnicity, and socioeconomic status has widened over the last decade. National Health Disparities Reports, produced by the federal Agency for Healthcare Research and Quality, have demonstrated that racial and ethnic minorities often receive poorer quality of care and face more barriers in seeking care, including preventive services, acute treatment, or chronic disease management, than do non-Hispanic white patients. Minority groups experience rates of preventable hospitalizations that are, in some cases, almost double that of non-Hispanic whites. Today, a person who is black has a 1.5-times greater rate of heart disease death and a 1.8-times greater rate of fatal stroke than a white person. Increased access to preventive care will help close this gap and improve health outcomes.

We see great potential in using nationally representative de-identified laboratory data to reveal important insights into population health. The US Health and Human Services’ Action Plan to Reduce Racial and Ethnic Health Disparities calls for increasing the availability, quality, and use of data to improve the health of minority populations. This surveillance and monitoring should be implemented broadly across a variety of sectors in both the public and private sector, to ensure that we are identifying where health disparities exist and how they are being addressed. These efforts will help us progress toward equality of care for all Americans.

References

1. Kaufman HW, Chen Z, Fonseca VA, McPhaul MJ. Surge in newly identified diabetes among Medicaid patients in 2014 within Medicaid expansion states under Affordable Care Act. Diabetes Care. 2015;38(5):833-837.

2. Income, poverty, and health insurance coverage in the United States: 2015 [press release]. Suitland, MD: US Census Bureau; September 16, 2015. https://www.census.gov/newsroom/press-releases/2015/cb15-157.html.