The COVID-19 pandemic has brought the issue of disparities in health and health care into sharp focus. The pandemic’s impacts have been uneven, with people of color bearing the heaviest burden in terms of negative impacts on health and well-being as well as economic impacts. However, health and health care disparities are not new. They have been documented for decades and reflect longstanding structural and systemic inequities rooted in racism and discrimination. While inequities in access to and use of health care contribute to disparities in health, inequities across broader social and economic factors that drive health, often referred to as social determinants of health, also play a major role.

Using data to identify disparities and the factors that drive them is important for directing resources and efforts to address them and assessing progress toward achieving greater equity over time. To provide insight into the status of racial disparities in health and health care, this analysis examines how people of color fare compared to White people across measures of health coverage, access, and use; health status, outcomes, and behaviors; and social determinants of health. Where possible, we present data for six racial/ethnic groups: White, Asian, Hispanic, Black, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI). People of Hispanic origin may be of any race, but we classify them as Hispanic for this analysis. We limit other groups to people who identify as non-Hispanic. All differences described in the text are statistically significant. We use the most recent data available from a broad range of federal survey and administrative datasets, which largely represent experiences prior to the COVID-19 pandemic (see Data Sources). This analysis finds:

  • Black, Hispanic, and AIAN people fare worse than White people across the majority of examined measures (Figure 1). This pattern is consistent across measures related to health coverage, access, and use; health status, outcomes, and behaviors; and social determinants of health. Notably, these groups do not fare better than their White counterparts for any examined measures of social determinants of health. Black people do have better experiences than White people for some cancer screening and cancer incidence measures, although they have higher rates of cancer mortality. Hispanic people fare better than White people across some health outcome measures, including life expectancy, some chronic diseases, and most measures of cancer incidence and mortality. These findings may, in part, reflect variation in outcomes among subgroups of Hispanic people, with better outcomes for some groups, particularly recent immigrants to the U.S. AIAN people similarly fare better than White people for selected health measures, particularly related to cancer, and are less likely to be noncitizens or to not speak English well, reducing the likelihood of facing barriers accessing health coverage and care due to immigration status or language.
  • Asian people in the aggregate do not fare worse than White people across most examined measures. They fare the same or better compared to White people for most examined measures, while they fare worse along some measures, including receipt of some routine care and screening and some social determinants of health, including home ownership, crowded housing, and childhood experiences with racism. They also have higher shares of people who are noncitizens and do not speak English well, which can contribute to barriers accessing health coverage and care. Moreover, the data may mask underlying disparities among subgroups of the Asian population. The rise in anti-Asian hate crimes and increased discrimination resulting from the COVID-19 pandemic may have also negatively affected Asian people’s experiences with health and health care.
  • Data gaps largely prevent the ability to identify and understand health disparities for NHOPI people. For over half of the examined measures, data were insufficient or not disaggregated for NHOPI people. Where data are available, NHOPI people fare worse than White people for at least half of measures. No difference is identified for the remaining measures where data are available, but this is largely due to the smaller sample size for NHOPI people in many datasets which limits the power to detect statistically significant differences.

Together these data show that, prior to the pandemic, people of color fared worse compared to White people across a broad range of measures related to health and health care, particularly Black, Hispanic, and AIAN people. However, patterns vary across measures and there are variations in experiences within the broad racial and ethnic classifications used for this analysis. Many of these underlying disparities placed people of color at increased risk for negative health and economic impacts from the COVID-19 pandemic. Moreover, the pandemic has exacerbated many of these disparities and may contribute to widening disparities in the future. Data show that people of color are at higher risk for COVID-19 infection, hospitalization, and death compared to their White counterparts and have suffered more significant negative social and economic impacts. Despite being disproportionately affected by the pandemic, Black and Hispanic people have been less likely than White people to receive COVID-19 vaccines, although these differences have narrowed over time, and this gap has closed for Hispanic people.

The data highlight the importance of efforts to address disparities in health and health care and show that it will be key for such efforts to address factors both within and beyond the health care system. Addressing these inequities is not only important for mitigating the disparate impacts of the COVID-19 pandemic but also for preventing further widening of disparities going forward. While these data provide insight into the status of disparities, ongoing data gaps and limitations hamper the ability to get a complete picture of disparities, particularly for smaller population groups. Further, data reported by these broad racial and ethnic categories often masks disparities among subgroups of the populations. As the share of people who identify as multiracial grows, it also will be important to develop improved methods for classifying and understanding their experiences. Going forward, reassessment of how data are collected and reported by race/ethnicity will be important for providing more nuanced understanding of disparities and, in turn, improved efforts to address them.

Background: Racial Diversity within the U.S. Today

As of 2019, 43% of the total population in the United States were people of color (Figure 2). This group included 20% who were Hispanic, 13% who were Black, 6% who were Asian, 1% who were American Indian or Alaska Native (AIAN), less than 1% who were Native Hawaiian or Other Pacific Islander (NHOPI), and 3% who identified as another racial category, including individuals who identified as more than one race. The remaining 57% of the population were White. The share of the population who are people of color has been growing over time, with the largest growth occurring among those who identify as Hispanic or Asian.

Certain areas of the country, particularly the South, are more racially diverse than others (Figure 3). Overall, the share of the population who are people of color ranges from below 10% in Maine, Vermont and West Virginia to over half of the population in California, District of Columbia, Hawaii, Maryland, Nevada, New Mexico, and Texas. Most people of color live in the South and West, with more than half (59%) of the Black population residing in the South while, overall, nearly eight in ten Hispanic people live in the West (39%) and in the South (38%). Over three quarters of the NHOPI population (77%), almost half (47%) of the AIAN population, and 44% of the Asian population live in the Western region of the country.

People of color are younger compared to White people. Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). Roughly half of Black (49%), AIAN (49%), and NHOPI (51%) people are below age 34, compared to 44% of Asian people and 39% of White people.

Health Coverage and Access to and Use of Care

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