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Racial and Ethnic Minorities
For decades, public health, health services research, and medical studies have shown evidence that racial and ethnic minority groups1 experience healthcare disparities that can lead to dramatic differences in health outcomes. The care they receive as patients can cause increased rates of illness and shorter lifespans. The Census Bureau projects that minority groups will account for more than half of the U.S. population by 2045, so focusing on improving minority health and working to eliminate disparities is a critical effort for the Nation.
The poorer outcomes among minority populations may be attributable to such healthcare-related risk factors as provider biases, poor provider-patient communication, lower levels of health literacy, and systemic racism and bias.
A large body of research has shown that compared with the White population, racial and ethnic minority groups experience disparities in access to care and healthcare quality, including effectiveness of treatment, timeliness, patient safety, and preventive screening. For example, stark disparities exist for preventive screening, such as for lipid disorders, which is recommended to identify potential lipid disorders and prevent heart disease. A recent study found that 67 percent of non-Hispanic White women reported prior screening compared with 43 percent of non-Hispanic Black women.2
Asian Americans have also been shown to experience disparities in care. For example, a 2020 study found that Asian Americans, including Asian ethnic groups, reported lower rates of provider-patient communication regarding breast and cervical cancer screening compared with White Americans.3
Clinician attitudes can affect quality of care for racial and ethnic minority groups. In a 2022 study, 19 percent of American Indian or Alaska Native individuals living in rural areas reported experiencing discrimination from a doctor or health clinic compared with 3 percent for White Americans.4
The 2022 National Healthcare Quality and Disparities Report presents evidence that disparities for most measures are not changing. The table below shows the number of quality measures for which racial or ethnic minority groups experienced better, same, or worse quality of care than non-Hispanic White groups in the most recent data year.
| Racial or Ethnic Group | Better | Same | Worse |
|---|---|---|---|
| AI/AN (n=110) | 13 | 50 | 47 |
| Asian (n=172) | 48 | 76 | 48 |
| Black (n=190) | 19 | 86 | 85 |
| NHPI (n=73) | 13 | 33 | 27 |
| Hispanic (n=190) | 33 | 84 | 73 |
Key: n = number of measures; AI/AN = American Indian or Alaska Native; NHPI = Native Hawaiian/Pacific Islander.
Note: The most recent data year varies for each measure and may be 2017, 2018, 2019, or 2020. The number of measures with data available varies by group.
Health disparities result from inequities in the determinants of health, including social, environmental, healthcare, and genetic factors. Health equity has been defined as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.5
Social determinants of health are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.6 Addressing social determinants of health is another AHRQ priority.
Examples of AHRQ’s work to reduce and document disparities in healthcare and work toward health equity includes:
- AHRQ Disparities topic page: https://www.ahrq.gov/topics/disparities.html.
- 2022 National Healthcare Quality and Disparities Report: https://www.ahrq.gov/research/findings/nhqrdr/nhqdr22/index.html.
- Chartbook on Healthcare for Asians and Native Hawaiians/Pacific Islanders: https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/asian-nhpi/index.html.
- Chartbook on Healthcare for Hispanics: https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/2014-hispanic-health-chartbook.pdf.
- Chartbook on Health Care for Blacks: https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/blackhealth/index.html.
- Social Determinants of Health website: https://www.ahrq.gov/sdoh/index.html.
Notices of Funding Opportunities related to disparities and health equity include:
- Special Emphasis Notice: AHRQ Announces Interest in Health Services Research to Advance Health Equity (OPEN): https://grants.nih.gov/grants/guide/notice-files/NOT-HS-21-014.html.
- Dissemination and Implementation of Equity-Focused Evidence-Based Interventions in Healthcare Delivery Systems (R18) (OPEN); https://grants.nih.gov/grants/guide/rfa-files/RFA-HS-23-002.html.
- Reducing Racial and Ethnic Healthcare Disparities in Chronic Conditions by Dissemination and Implementation of Patient Centered Outcomes Research (PCOR) Evidence(R18) (CLOSED).
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1. Centers for Medicare & Medicaid Services. Health Equity. Last modified October 2022. https://www.cms.gov/pillar/health-equity. Accessed March 27, 2023.
2. Centers for Disease Control and Prevention. Social Determinants of Health at CDC. Last reviewed December 2022. https://www.cdc.gov/about/sdoh/index.html. Accessed March 27, 2023.
3. Findling MTG, Blendon RJ, Benson JM, Miller C. The unseen picture: issues with health care, discrimination, police and safety, and housing experienced by Native American populations in rural America. J Rural Health. 2022;38(1):180-86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290671/. Accessed March 27, 2023.
4. Racial and ethnic minority groups include American Indian and Alaska Native, Asian, Black, Hispanic, and Native Hawaiian/Pacific Islander individuals.
5. Mszar R, Gopal DJ, Chowdary R, Smith CL, Dolin CD, Irwin ML, Soffer D, Nemiroff R, Lewey J.. Racial/ethnic disparities in screening for and awareness of high cholesterol among pregnant women receiving prenatal care. J Am Heart Assoc. 2021 Jan 5;10(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955491/. Accessed March 27, 2023.
6. Jun J. Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. Ethn Health 2020;25(7):960-81. https://pubmed.ncbi.nlm.nih.gov/29792075/. Accessed March 27, 2023.
