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Trends in Health Care Use Among Black and White Persons in the US, 1963-2019
IMPORTANCE: In the US, Black people receive less health care than White people. Data on long-term trends in these disparities, which provide historical context for interpreting contemporary inequalities, are lacking. OBJECTIVE: To assess trends in Black-White disparities in health care use since 196...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198752/ https://www.ncbi.nlm.nih.gov/pubmed/35699954 http://dx.doi.org/10.1001/jamanetworkopen.2022.17383 |
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author | Dickman, Samuel L. Gaffney, Adam McGregor, Alecia Himmelstein, David U. McCormick, Danny Bor, David H. Woolhandler, Steffie |
author_facet | Dickman, Samuel L. Gaffney, Adam McGregor, Alecia Himmelstein, David U. McCormick, Danny Bor, David H. Woolhandler, Steffie |
author_sort | Dickman, Samuel L. |
collection | PubMed |
description | IMPORTANCE: In the US, Black people receive less health care than White people. Data on long-term trends in these disparities, which provide historical context for interpreting contemporary inequalities, are lacking. OBJECTIVE: To assess trends in Black-White disparities in health care use since 1963. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed 29 US surveys conducted between 1963 and 2019 of noninstitutionalized Black and non-Hispanic White civilians. EXPOSURES: Self-reported race and ethnicity. MAIN OUTCOMES AND MEASURES: Annual per capita visit rates (for ambulatory, dental, and emergency department care), inpatient hospitalization rates, and total per capita medical expenditures. RESULTS: Data from 154 859 Black and 446 944 White (non-Hispanic) individuals surveyed from 1963 to 2019 were analyzed (316 503 [52.6%] female; mean [SD] age, 37.0 [23.3] years). Disparities narrowed in the 1970s in the wake of landmark civil rights legislation and the implementation of Medicare and Medicaid but subsequently widened. For instance, the White-Black gap in ambulatory care visits decreased from 1.2 (95% CI, 1.0-1.4) visits per year in 1963 to 0.8 (95% CI, 0.6-1.0) visits per year in the 1970s and then increased, reaching 3.2 (95% CI, 3.0-3.4) visits per year in 2014 to 2019. Even among privately insured adults aged 18 to 64 years, White individuals used far more ambulatory care (2.6 [95% CI, 2.4-2.8] more visits per year) than Black individuals in 2014 to 2019. Similarly, White peoples’ overall health care use, measured in dollars per capita, exceeded that of Black people in every year. After narrowing from 1.96 in the 1960s to 1.26 in the 1970s, the White-Black expenditure ratio began widening in the 1980s, reaching 1.46 in the 1990s; it remained between 1.31 and 1.39 in subsequent periods. CONCLUSIONS AND RELEVANCE: This study’s findings indicate that racial inequities in care have persisted for 6 decades and widened in recent years, suggesting the persistence and even fortification of structural racism in health care access. Reform efforts should include training more Black health care professionals, investments in Black-serving health facilities, and implementing universal health coverage that eliminates cost barriers. |
format | Online Article Text |
id | pubmed-9198752 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-91987522022-07-05 Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 Dickman, Samuel L. Gaffney, Adam McGregor, Alecia Himmelstein, David U. McCormick, Danny Bor, David H. Woolhandler, Steffie JAMA Netw Open Original Investigation IMPORTANCE: In the US, Black people receive less health care than White people. Data on long-term trends in these disparities, which provide historical context for interpreting contemporary inequalities, are lacking. OBJECTIVE: To assess trends in Black-White disparities in health care use since 1963. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed 29 US surveys conducted between 1963 and 2019 of noninstitutionalized Black and non-Hispanic White civilians. EXPOSURES: Self-reported race and ethnicity. MAIN OUTCOMES AND MEASURES: Annual per capita visit rates (for ambulatory, dental, and emergency department care), inpatient hospitalization rates, and total per capita medical expenditures. RESULTS: Data from 154 859 Black and 446 944 White (non-Hispanic) individuals surveyed from 1963 to 2019 were analyzed (316 503 [52.6%] female; mean [SD] age, 37.0 [23.3] years). Disparities narrowed in the 1970s in the wake of landmark civil rights legislation and the implementation of Medicare and Medicaid but subsequently widened. For instance, the White-Black gap in ambulatory care visits decreased from 1.2 (95% CI, 1.0-1.4) visits per year in 1963 to 0.8 (95% CI, 0.6-1.0) visits per year in the 1970s and then increased, reaching 3.2 (95% CI, 3.0-3.4) visits per year in 2014 to 2019. Even among privately insured adults aged 18 to 64 years, White individuals used far more ambulatory care (2.6 [95% CI, 2.4-2.8] more visits per year) than Black individuals in 2014 to 2019. Similarly, White peoples’ overall health care use, measured in dollars per capita, exceeded that of Black people in every year. After narrowing from 1.96 in the 1960s to 1.26 in the 1970s, the White-Black expenditure ratio began widening in the 1980s, reaching 1.46 in the 1990s; it remained between 1.31 and 1.39 in subsequent periods. CONCLUSIONS AND RELEVANCE: This study’s findings indicate that racial inequities in care have persisted for 6 decades and widened in recent years, suggesting the persistence and even fortification of structural racism in health care access. Reform efforts should include training more Black health care professionals, investments in Black-serving health facilities, and implementing universal health coverage that eliminates cost barriers. American Medical Association 2022-06-14 /pmc/articles/PMC9198752/ /pubmed/35699954 http://dx.doi.org/10.1001/jamanetworkopen.2022.17383 Text en Copyright 2022 Dickman SL et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Dickman, Samuel L. Gaffney, Adam McGregor, Alecia Himmelstein, David U. McCormick, Danny Bor, David H. Woolhandler, Steffie Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title | Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title_full | Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title_fullStr | Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title_full_unstemmed | Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title_short | Trends in Health Care Use Among Black and White Persons in the US, 1963-2019 |
title_sort | trends in health care use among black and white persons in the us, 1963-2019 |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198752/ https://www.ncbi.nlm.nih.gov/pubmed/35699954 http://dx.doi.org/10.1001/jamanetworkopen.2022.17383 |
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