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Study Highlights Racial Inequity in Health Care Access, Quality

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Photo credit: Hush Naidoo.

For Immediate Release

Vanessa Volpe

A recent study finds states that exhibit higher levels of systemic racism also have pronounced racial disparities regarding access to health care. In short, the more racist a state was, the better access white people had – and the worse access Black people had.

“This study highlights the extent to which health care inequities are intertwined with other social inequities, such as employment and education,” says Vanessa Volpe, corresponding author of the study and an assistant professor of psychology at North Carolina State University. “This helps explain why health inequities are so intractable. Tackling health care inequities will require us to address broader social systems that significantly benefit white people – and that makes them difficult to change.”

Previous research has examined how people’s individual experiences with racism affect the quality of their health care. There is also research that examines relationships between structural racism and health outcomes. The recent study from Volpe and her collaborators looks at structural racism at the state level, people’s individual experiences with racism, the extent to which those things affected the ability of Black people to access health care, and the quality of that health care. The researchers also examined the ability of white people to access health care and the quality of their health care.

For their study, the researchers drew on the Association of American Medical Colleges’ Consumer Survey of Health Care Access for the years 2014 to 2019. The survey, of adults who needed care within the previous year, included measures of self-reported health care access, quality, and provider racial discrimination. The survey included 2,110 Black adults and 18,920 white adults. The researchers also used publicly available state-level data from the Census Bureau and the U.S. Department of Justice to create an index of state-level racial disparities that serve as a proxy for structural racism. The researchers used the index to determine racism scores for all 50 states and the District of Columbia.

The researchers found that the higher the level of racism in a given state, the less access Black people in that state had to health care. There was no statistically significant relationship between a state’s racism index score and quality of health care. However, Black people who reported experiencing racism with their health care providers also reported lower quality of care.

Meanwhile, the higher the level of racism in a given state, the more access white people had to health care. In addition, the worse the state’s racism score, the higher the quality of care white people reported receiving.

“These state-level inequities are symptoms of racism baked into laws, policies and practices that ensure there is not a level playing field,” Volpe says. “It underscores the need to address inequities in a meaningful, structural way, not just assume that racism is solely an interpersonal phenomenon. And it’s important to use data-driven approaches like the ones we used here, so laws or regulations can be developed by policymakers to more effectively even the playing field.”

The paper, “State- and Provider-Level Racism and HealthCare in the U.S.,” is published in the American Journal of Preventive Medicine. The paper was co-authored by Sam Cacace, Perusi Benson and Noely Banos of NC State; and by Kristen Schorpp of Roanoke College.

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Note to Editors: The study abstract follows.

“State- and Provider-Level Racism and HealthCare in the U.S.”

Authors: Vanessa V. Volpe, Sam C. Cacace, G. Perusi Benson and Noely C. Banos, North Carolina State University; and Kristen M. Schorpp, Roanoke College

Published: June 24, American Journal of Preventive Medicine

DOI: 10.1016/j.amepre.2021.03.008

Abstract:
Introduction: This study examines associations between state-level and provider sources of racism and healthcare access and quality for non-Hispanic Black and White individuals.
Methods: Data from 2 sources were integrated: (1) the Association of American Medical Colleges’ Consumer Survey of Health Care Access (2014–2019), which included measures of self-reported healthcare access, quality, and provider racial discrimination, and (2) administrative data compiled to index state-level racism. State-level racism composite scores were calculated from federal sources (U.S. Census, Department of Labor, Department of Justice). The data set comprised 21,030 adults (n=2,110 Black, n=18,920 White) who needed care within the past year. Participants were recruited from a national panel and the survey employed age–insurance quotas. Logistic and linear regressions were conducted in 2020, adjusting for demographic, geographic, and health-related covariates.
Results: Among White individuals, more state-level racism was associated with 5% higher odds of being able to get care and 6% higher odds of sufficient time with provider. Among Black individuals, more state-level racism was associated with 8% lower odds of being able to get care. Provider racial discrimination was also associated with 80% lower odds of provider explaining care, 77% lower odds of provider answering questions, and 68% lower odds of sufficient time with provider.
Conclusions: State-level racism may engender benefits to healthcare access and quality for White individuals and decrement access for Black individuals. Disparities may be driven by both White advantage and Black disadvantage. State-level policies may be actionable levers of healthcare inequities with implications for preventive medicine.

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