Key Facts on Health and Health Care by Race and Ethnicity

Health Status

Across racial and ethnic groups, most measures of health status were stable or improved compared to prior to the ACA (Figure 22), but most groups of color continued to fare worse than Whites across indicators of health status post-ACA (Figure 23). Compared to prior to the ACA, AIDS diagnosis rates, heart disease and cancer death rates, and smoking rates decreased for most groups. Most other measures remained stable or could not be assessed over time due to data limitations. The smaller number of improvements in measures of health status and outcomes compared to measures of coverage, access, and use, may reflect that a broad array of factors, including social and environmental factors outside the health care system, affect health and that it may take additional time for measureable changes in health to occur in response to improvements in coverage, access, and use. Blacks and AIANs continued to fare worse than Whites across most examined health status indicators post-ACA. Findings for Hispanics were mixed, but they continued to face large disparities for certain measures. Disparities in teen birth rates, infant mortality rates, and HIV or AIDS diagnosis and death rates were particularly striking for Blacks, Hispanics, and AIANs. Asians fared better than Whites on the majority of examined indicators, but, as discussed earlier, the data may mask disparities among subgroups of Asians. Large data gaps limit examination of health status for NHOPIs.

Figure 22: Changes in Measures of Health Status Since Implementation of the Affordable Care Act

Figure 23: Post-ACA Health Status among Groups of Color Compared to Whites

Self-Reported Health Status

Between 2013 and 2018, there were no changes in the share of nonelderly adults reporting fair or poor health status across groups of color (Figure 24). As of 2018, Blacks, Hispanics, and AIANs were more likely than Whites to report fair or poor health status, while Asians were less likely to indicate fair or poor health. The share of nonelderly adults reporting a physical limitation increased for Whites, Hispanics, and Asians over the period, but there were no changes for other groups. As of 2018, Black, Hispanic, and Asian nonelderly adults were less likely than Whites to report a physical limitation, while AIANs were more likely to report a physical limitation.

Figure 24: Percent of Nonelderly Adults Reporting Fair/Poor Health Status and a Physical Limitation by Race/Ethnicity, 2013 and 2018

There were limited changes in the share of nonelderly adults reporting 14 or more physically or mentally unhealthy days within the past 30 days between 2013 and 2018 (Figure 25). Rates of both measures increased for nonelderly adult Whites. Asians were less likely than Whites to report frequent physically and mentally unhealthy days as of 2018, while AIANs had higher rates compared to Whites.

Figure 25: Percent of Nonelderly Adults with 14 or More Physically or Mentally Unhealthy Days in the Past 30 Days by Race/Ethnicity, 2013 and 2018

Birth Risks and Outcomes

Groups of color were at higher risk for certain birth risks and outcomes compared to Whites as of 2017 (Figure 26). Specifically, among Blacks, Hispanics, AIANs, and NHOPIs, a higher share of births were preterm, low-birthweight, or among mothers that received late or no prenatal care compared to Whites. Asians were also more likely than Whites to have low-birthweight births and births that received late or no prenatal care, but less likely than Whites to have a preterm birth. Due to changes in methodology, 2017 data could not be compared to data prior to the ACA.

Figure 26: Percent of Births with Selected Risk Factors by Race/Ethnicity, 2017

As of 2017, Blacks, Hispanics, AIANs, and NHOPIs had a higher teen birth rate than Whites (Figure 27). In contrast, the teen birth rate among Asians was lower than the rate for Whites. Preliminary 2018 data shows that the teen birth rates continued to decrease from 2017 to 2018 for Whites, Blacks, and Hispanics. Due to changes in methodology, 2017 data could not be compared to data prior to the ACA.

Figure 27: Birth Rate (per 1,000) for Teen Girls Ages 15-19 by Race/Ethnicity, 2017

As of 2017, Blacks, Hispanics, AIANs, and NHOPIs had higher infant mortality rates relative to Whites (Figure 28). These disparities were particularly large for Blacks and AIANs whose infant mortality rates were roughly two times higher than Whites. Due to changes in methodology, 2017 data could not be compared to data prior to the ACA.

Figure 28: Infant Mortality Rate (per 1,000) by Race/Ethnicity, 2017

HIV and AIDS Diagnosis and Death Rates

Despite small declines in HIV and AIDS diagnosis rates among Black and Hispanic teens and adults, these groups continued to face major disparities in 2017 (Figure 29). Compared to Whites, Blacks had an over eight times higher HIV diagnosis rate and a nearly ten times higher AIDS diagnosis rate, and the HIV and AIDS diagnosis rates for Hispanics were more than three times the rates for Whites. In contrast to the decreases experienced by Blacks and Hispanics, the HIV diagnosis rate for AIANs increased between 2013 and 2017, and their HIV diagnosis rate was nearly twice as high as the rate for Whites as of 2017. HIV and AIDS diagnosis rates for NHOPIs also were higher than those for Whites in 2017.

Figure 29: HIV or AIDS Diagnosis per 100,000 Among Teens and Adults by Race/Ethnicity, 2013 and 2017

Similar to diagnosis rates, death rates for individuals with HIV decreased for Black and Hispanic teens and adults between 2013 and 2016, but their death rates remained higher than Whites (Figure 30). Blacks had a more than seven times higher death rate for individuals with an HIV diagnosis and the death rate for Hispanics was nearly double the rate for Whites as of 2016. Death rates for individuals with HIV are deaths due to any cause, not only from HIV-related illness.

Figure 30: Death Rate for Individuals with HIV Diagnosis per 100,000 by Race/Ethnicity, 2013 and 2016

Health Conditions

There were limited changes in rates of asthma, diabetes, and heart attacks or heart disease among nonelderly adults between 2013 and 2018 (data not shown; see Appendix Table 2). As of 2018, groups of color varied in the likelihood of having these conditions compared to Whites. AIANs were more likely than Whites to have asthma, diabetes, and a heart attack or heart disease (Figure 31). Blacks, Hispanics, and NHOPIs also were more likely to have diabetes than Whites. In contrast, Asians were less likely to have asthma and less likely to have a heart attack or heart disease compared to Whites.

Figure 31: Percent of Nonelderly Adults with Selected Health Conditions by Race/Ethnicity, 2018

The share of White children with asthma decreased between 2013 and 2018 (Figure 32). As of 2018, asthma rates were higher for Black and Hispanic children compared to White children, while Asian children were less likely than White children to have asthma. Data do not allow for separate measures of Asians and NHOPIs; there were insufficient data for AIAN children.

Figure 32: Percent of Children Ages 0-17 Who Have Asthma by Race/Ethnicity

Groups of color generally had lower cancer rates than Whites as of 2016 (Figure 33). Across the examined indicators, cancer rates were generally lowest for AIANs and Asians and Pacific Islanders. Data do not allow for separate measures of Asians and NHOPIs. Statistically significant differences between Hispanics and Whites cannot be identified due to overlapping samples between these groups.

Figure 33: Age-Adjusted Rate of Cancer Incidence Per 100,000 by Race/Ethnicity, 2016

Death rates associated with heart disease and cancer decreased for nearly all groups between 2013 and 2017, but only Hispanics saw a decrease in diabetes-related death rates (data not shown; see Appendix 2). Blacks had a higher risk of death for all three diseases compared to Whites as of 2017 (Figure 34). Hispanics and AIANs also had higher diabetes death rates than Whites, but lower rates of heart disease and cancer deaths. Asians and Pacific Islanders had the lowest death rates for these conditions. Data do not allow for separate measures of Asians and NHOPIs.

Figure 34: Age-Adjusted Death Rates per 100,000 for Selected Diseases by Race/Ethnicity, 2017

Smoking, Obesity, and Substance Use

Between 2013 and 2018, smoking rates declined for White, Black, Hispanic, and Asian nonelderly adults, while obesity rates increased among White, Black, Hispanic, and Asian adults (Figure 35). Hispanics and Asians had lower smoking rates than Whites as of 2018, while AIANs were more likely than Whites to smoke. Blacks, Hispanics, AIANs, and NHOPIs had higher obesity rates than Whites, while Asians were less likely than Whites to be obese.

Figure 35: Smoking and Obesity Rates Among Nonelderly Adults by Race/Ethnicity, 2013 and 2018

Obesity rates for children remained stable across groups between 2011-2012 and 2015-2016. As of 2015-2016 rates were higher among Black and Hispanic children compared to White children (Figure 36). There were insufficient data for AIAN and NHOPI children.

Figure 36: Percent of Children Ages 2-19 Who are Obese by Race/Ethnicity

As of 2018, there were few differences across groups in alcohol or illicit drug dependence or abuse (Figure 37). Asians were less likely than Whites to report alcohol or illicit drug dependence or abuse. Due to changes in methodology, 2018 data could not be compared to data prior to the ACA.

Figure 37: Alcohol and/or Illicit Drug Dependence or Abuse in the Past Year Among Teens and Adults Age 12 and Older by Race/Ethnicity, 2018

Coverage, Access to, and Use of Care Conclusion