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[Preprint]. 2020 Nov 4:2020.10.30.20223487.
doi: 10.1101/2020.10.30.20223487.

Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018

Shiwani Mahajan  1   2 , César Caraballo  1   2 , Yuan Lu  1   2 , Dorothy Massey  1 , Karthik Murugiah  1   2 , Amarnath R Annapureddy  1   2 , Brita Roy  3   4 , Carley Riley  5   6 , Oyere Onuma  7 , Marcella Nunez-Smith  3 , Javier Valero-Elizondo  8   9 , Howard P Forman  10   11 , Khurram Nasir  8   9 , Jeph Herrin  2 , Harlan M Krumholz  1   2   11
Affiliations

Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018

Shiwani Mahajan et al. medRxiv. .

Update in

Abstract

Importance: Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking.

Objectives: To evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades.

Design: Cross-sectional.

Setting: National Health Interview Survey data, years 1999-2018.

Participants: Adults aged 18-85 years.

Exposure: Race/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic).

Main outcome and measures: Proportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes.

Results: We included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1-20.4) and 41.1% (95% CI 38.7-43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5- 11.7) and 31.2% (95% CI 30.3-32.1) among White individuals. Notably, between 1999-2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (-0.07% per year, 95% CI -0.16-0.01) and Hispanic (-0.03% per year, 95% CI -0.07- 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1-0.4) and Hispanic (+0.3% per year, 95% CI 0.1-0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep.

Conclusions and relevance: The marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.

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Figures

Figure 1.
Figure 1.
Annual age-adjusted proportion of individuals reporting poor/fair health status among adults in the US, by race/ethnicity.
Figure 2.
Figure 2.
Annual age-adjusted proportion of individuals with severe psychological distress among adults in the US, by race/ethnicity.
Figure 3.
Figure 3.
Annual age-adjusted proportion of individuals with functional limitation among adults in the US, by race/ethnicity.
Figure 4.
Figure 4.
Annual age-adjusted proportion of individuals with insufficient sleep among adults in the US, by race/ethnicity.
See this image and copyright information in PMC

References

    1. Heckler M. Report of the Secretary’s task force on Black & minority health. US Department of Health and Human Services; 1985.
    1. U.S. Department of Health and Human Services. About the Office of Minority Health. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=1. Accessed October 27, 2020.
    1. Centers for Disease Control and Prevention (CDC). Health disparities and strategies report. https://www.cdc.gov/minorityhealth/chdir/index.html. Accessed October 27, 2020.
    1. Agency for Healthcare Research and Quality. National healthcare quality and disparities report. https://nhqrnet.ahrq.gov/inhqrdr/. Accessed October 27, 2020.
    1. U.S. Department of Health and Human Services. Healthy people. Foundation health measures archive: disparities. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disp.... Accessed October 27, 2020.

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