While access to health insurance has long been considered a "great equalizer among patients," a new study published by NORC found that racial and ethnic identifiers are greater indicators of health than insurance status.

Disparities in chronic conditions and access to care

For the study, researchers analyzed self-reported data from individuals enrolled in an employer-sponsored health plan from 2017 to 2019. In total, they analyzed data from 12,372 individuals reported to the federal National Health Interview Survey; 3,103 individuals reported to the federal National Health and Nutrition Examination Survey; and 14,580 individuals reported to the federal National Survey of Drug Use and Health.

Morgan Health, JPMorgan Chase & Co.'s initiative to reshape the employer-based health insurance market sponsored the report.

The study found that rates of chronic conditions varied among insured Black, Asian, Hispanic, and white patients.

For example, Black people were more likely to have high blood pressure than white, Hispanic, and Asian individuals. Overall, 46.5% of enrollees had high blood pressure, compared with 60.4% of Black enrollees.

In addition, Asian, Hispanic, and Black individuals were more likely to have diabetes than white patients. Overall, 10.2% of enrollees had diabetes, compared with 14.1% of Asian, 13.4% of Black, and 13.3% of Hispanic enrollees.

When researchers defined obesity using BMI, 42.8% of enrollees were obese. Notably, 56.2% of Black enrollees were obese, while just 16.2% of Asian enrollees were obese. After adjusting for age and sex, Black enrollees were more likely to be obese than white enrollees by 13.6 percentage points, and Asian enrollees were less likely to be obese than white enrollees by 26.2 percentage points.

The study also found that Black, Asian, and Hispanic enrollees with low-risk pregnancies were at least 3 percentage points more likely to have a C-section than white enrollees.

According to the American College of Obstetricians and Gynecologists, C-sections have a higher risk of maternal morbidity and mortality than vaginal delivery for low-risk pregnancies. C-sections are also associated with a higher risk of infection, longer hospital stays, and hospital readmissions.

"These are people that are connected to the healthcare system, and they all have low-risk pregnancies," said Caroline Pearson, study author and SVP of health care strategy at NORC. "Why are we performing C-sections at much higher rates in people of color? We should not be."

The study also analyzed the prevalence of serious psychological distress, anxiety, and depression among enrollees.

According to the study, white enrollees of all genders and sexual orientations were more likely than Black, Hispanic, and Asian enrollees to experience serious psychological distress.

Meanwhile, lesbian, gay, and bisexual enrollees reported higher levels of serious psychological distress, anxiety, and depression than those who were heterosexual. For instance, over 23% of LGBTQ individuals reported experiencing serious psychological distress, compared with just 8.8% of heterosexual patients.

Overall, 30% of enrollees reported heavy alcohol use. Notably, white and Hispanic enrollees had the highest rates of heavy alcohol use, with 31.7% and 33.2%, respectively. In addition, 18.8% said they used illicit drugs and 19.8% said they used tobacco products.

While most enrollees said they have access to a regular source of care, the study found differences in how frequently different racial, ethnic, and income groups used the emergency department (ED). In their analysis, study authors cited ED use as an indicator of reliable access to care.

According to the study, Black patients were more likely to visit an ED than white patients, and Asians were less likely to visit an ED than white individuals. Enrollees in the lowest income bracket—who earned under $50,000 a year—were 7.1 percentage points more likely to have visited an ED than those in the highest income bracket—who earned at least $150,000 a year.

Commentary

According to Pearson, the findings suggest that socioeconomic disparities alone do not drive differences in health outcomes among different racial and ethnic groups.

"When you do research and report results on race and ethnicity, inevitably someone says, 'How much of this is accounted for by income differences?'" Pearson said. "One of the things that was really exciting about our study was that we were able to control for differences in age, gender, income, and by race and ethnic group. Health disparities persist even after those adjustments. It really suggests that health disparities are deeply rooted in our healthcare system."

The study also established a national benchmark employers can use to study how their workers' health compares with the national average, Pearson noted. She said that companies must think about how to create health and wellness benefits to address health disparities.

"They should think about what are the actual things that are driving the disparities in this study, as opposed to just paying for them," Pearson said.

"These findings are a wake-up call for business leaders on the severe health disparities that exist across the country's workforce," added Dan Mendelson, Morgan Health CEO. "The business community has a responsibility to understand and recognize these disparities, and more importantly, act to eliminate them. This will require active engagement with health plans and providers to close gaps and improve health outcomes." (Tepper, Modern Healthcare, 7/25; Morgan Health/NORC news release, 7/25; Morgan Health/NORC, Health Disparities in Employer-Sponsored Insurance report, 7/25)