Racial and Ethnic Health Disparities—Before and During the Pandemic

News headlines during the pandemic have highlighted the disproportionate effect of COVID-19 across certain racial and ethnic groups in the United States. Available data from the Centers for Disease Control and Prevention (CDC) show disparities in everything from testing and vaccination rates to cases, hospitalizations, and deaths. For example, as of July, American Indian/Alaska Native people died from COVID-19 at a rate 2.8 times higher than White people, when taking age into account.

While the pandemic has drawn attention to health disparities among racial and ethnic groups, these disparities existed prior to the pandemic. Today’s WatchBlog post looks at our work on racial and ethnic health disparities, which we highlight in our latest Health Care Capsule—a short format report designed to summarize multiple GAO findings on related health policy issues.

Image

What causes health disparities?

We’ve reported that various barriers such as discrimination, economic instability, and lack of health care access can contribute to health disparities.

Implicit biases and misperceptions about people from various racial and ethnic groups can also exacerbate disparities, including access to care. For example, implicit biases may affect the way providers counsel patients about treatment options, which could affect health outcomes.

Socioeconomic factors, such as being uninsured, are also associated with health disparities.

How can health disparities be addressed?

An important challenge with understanding and addressing health disparities is gaps in available data. These gaps affect the federal government’s ability to identify and address health disparities.

For example, COVID-19 data has shown disparities in health outcomes, but the information on race and ethnicity sent by state and local health authorities to CDC has been incomplete. We reported in March that CDC lacked information on patients’ race and ethnicity for almost half of reported COVID-19 cases (47.2%) and vaccinations (46.7%). CDC told us that it does not have the authority to require states and jurisdictions to include race and ethnicity when reporting COVID-19 data.

We’ve made recommendations to CDC, and other federal entities like the Department of Veterans Affairs, on how to improve their collection of race and ethnicity information. Complete reporting of race and ethnicity information by states, jurisdictions, and federal health systems would help the federal government better understand the extent of disparities and take action.

There are also larger policy considerations that could help federal agencies identify and address health disparities. For example, considering racial and ethnic disparities when planning and carrying out federal government programs can help agencies promote health equity.

What health disparities have we identified?

Health disparities are preventable differences in health outcomes and the opportunity to achieve optimal health.

In our work, we’ve identified a number of health disparities, including:  

• COVID-19. Available data show that between March 2020 and June 2021, Hispanic or Latino and non-Hispanic Black people were hospitalized with COVID-19 at a rate 2.8 times higher than non-Hispanic White people, when taking age into account.
• Pregnancy-related deaths. From 2011–2016, Black women living in rural counties experienced 59.3 deaths per 100,000 live births, compared to 19.7 for White women in the same counties, according to CDC data.
• Life expectancy and chronic health conditions. In 2018, the diabetes age-adjusted mortality rate was higher among Black people (49.7 deaths per 100,000 people) and American Indian/Alaska Native people (40.0 deaths) than White people (24.8 deaths).
• Veterans’ health. Black veterans with cancer and cardiovascular-related illnesses had lower survival rates than White veterans.

Learn more about our findings and recommendations for addressing health disparities by reading our latest Health Care Capsule.

• Comments on GAO’s WatchBlog? Contact blog@gao.gov.