Healthcare Disparities in the U.S.

Healthcare access, quality of care received, and social factors (like income, housing, and food insecurity) all impact the health outcomes of U.S. residents. Growing evidence has pointed to wellness gaps and disparities among the different racial and ethnic populations that make up our country.1 We took a closer look at what groups are the most uninsured across the U.S., including healthcare quality and life expectancy across races.

• The uninsured rate among all Americans is at an all-time low of 7.7%.
• White people have the lowest percentage of uninsured individuals across the U.S.
• Republican states typically have more uninsured residents than their Democratic counterparts.
• American Indian and Alaska Natives (67.9 years) and Black individuals (72.8 years) have the lowest life expectancy among the U.S. population.
• Among all races, Black children have the lowest vaccination rate.

We took data from the U.S. Census American Community Survey, National Healthcare Quality and Disparities Report, and Centers for Disease Control and Prevention (CDC) to identify numerous factors that could be impacted by systemic and institutional racism in our healthcare system.

Federal survey data tells us that in early 2023, the uninsured rate among all U.S. residents reached an all-time low of 7.7%.2 Despite overall improvements in rates across the board, we examined the statistics to see which states had the most uninsured citizens. Then, we explored the correlations between race or ethnicity and this issue.

Texas has the highest percentage of uninsured residents by far (16.6% of the population), while Massachusetts has the lowest (2.4%). Across the nation, the numbers paint an interesting picture when considering race, ethnicity, region, and healthcare coverage. White people have the lowest percentage of uninsured individuals in all states, which is significant considering they make up the largest population group in the U.S. by a landslide.3 In contrast, Native Hawaiians and other Pacific Islanders are the most uninsured race in the country.

When breaking down where the most uninsured residents of each race and ethnicity reside in the U.S., we found the following trends across the midwestern and southern states.

• Native Hawaiian and other Pacific Islander residents: Kansas (65.6% uninsured)
• Black residents: North Dakota (22.2% uninsured)
• American Indian and Alaska Native residents: Georgia (43.7% uninsured)
• Asian residents: Mississippi (16.4% uninsured)
• Hispanic residents: Tennessee (29.9% uninsured)

This data lends itself to a strong connection between more traditionally Republican states having a larger percentage of uninsured residents than their Democratic neighbors. There are undoubtedly many factors at play here, some of which may be:

• Opposition to the Affordable Care Act (ACA): Some Republican states resist Obamacare, including Medicaid expansion, leading to more uninsured residents.
• Geographic variation: Rural areas, common in Republican states, can face limited healthcare access.
• Lack of trust in the government: Research has shown that Republicans are less likely to feel they can trust the federal government, resulting in a rejection of a governmental role in their healthcare.4

Regardless of political affiliation, income inequality can play a role in the rate of uninsured Americans throughout the country. Not everyone has access to healthcare through their job, and even when it is available, premiums are often still too expensive for families to afford.

The National Health Quality and Disparities Report (NHQDR) provides data identifying healthcare gaps across geographic regions of our country. The benchmarks examined in the report give a closer look at quality disparities among vulnerable populations.

When assessing the care of home health providers, White adults (85.3%) were the most likely to feel that their provider “always explained things in a way that was easy to understand,” compared to 75.3% of Asian adults. In addition, 86.1% of White adults and 85.8% of Black adults reported that home healthcare providers “always listened carefully to them” in the previous two months of their care, while just 77.8% of Asian residents felt they had the same experience.

Data from standard health benchmarks also gives insight into potential racial disparities. Interestingly, Asian, Black, and Native Hawaiian/Pacific Islander populations have undergone more frequent blood cholesterol measurements within the past five years than any other racial group. However, less than 10% of Black and Native Hawaiian/Pacific Islander patients who were treated for chronic kidney failure received a kidney transplant within three years of renal failure — this stands in contrast to 16% of White patients with kidney disease.

For women and people assigned female at birth, getting regular mammograms is essential for breast cancer prevention and early detection. While a large percentage of Black (81.7%) and White (75.7%) women aged 50-74 reported receiving a mammogram in the last two years, only 59% of American Indian/Alaska Natives received this critical screening.

Finally, the NHQDR revealed that Black children have the lowest vaccination rate among all races. This issue is multifaceted, stemming from not only a potential lack of healthcare access but also from a trend of vaccine hesitancy among Black American mothers, which often stems from healthcare interactions impacted by racism.5 Black patients are also the least likely to get the help or advice they need the same day they contact their home health provider.

While advancements in public health have led to a continually increasing life expectancy for Americans, data shows there are still some significant differences between racial and ethnic groups in the U.S. when it comes to aging.6 Asian men and women live far longer than any other population, with an average life expectancy of 84.5 years. American Indian and Alaska Natives (67.9 years) and Black individuals (72.8 years), however, have the lowest life expectancy among the U.S. population.

Women have historically lived longer than men across all races and continue to do so, although the U.S. Census Bureau predicts that the age gap may narrow over the next 30 years.6 So, why do women tend to live longer than men? This could be due to several reasons:

• Healthcare utilization: Women tend to seek healthcare services more often than men, leading to earlier detection and treatment.7
• Lifestyle choices: Men are more prone to risky behaviors like smoking and excessive alcohol consumption.8
• Occupational hazards: Men are overrepresented in hazardous occupations like firefighting and military service.9
• Health risks: While heart disease affects all sexes, men are typically affected at an earlier age.10

Examining specific health conditions reveals racial disparities among the U.S. population. Black individuals aged 13 and above are disproportionately affected by HIV, with a rate of 41.8 new cases per 100,000 people. Sadly, this rate of infection is nearly three times higher than that of any other racial group.

Black Americans also experience the highest rates of drug overdose (from opioids), heart failure, and colorectal cancer compared to other races and ethnicities. The greatest of these is hospital admission for heart failure — with 836 Black individuals out of every 100,000 experiencing an admission to the hospital for this condition. This is in stark contrast to just 305 admissions per 100,000 White people and 178 per 100,000 Asian Americans.

The reasons for disparities such as these run deep. In addition to the usual heart disease risk factors, like obesity and diabetes, researchers have noted that racial discrimination, food insecurity, and struggles with income feed the stress that can significantly contribute to the risk of hypertension and heart disease in Black Americans.11

We performed a comprehensive data analysis examining healthcare disparities, including life expectancy, insurance rates, and quality of care, in order to identify the states and racial groups facing the most significant healthcare challenges. Our investigation drew upon surveys and data from the Centers for Disease Control and Prevention (CDC), the U.S. Census American Community Survey, and the National Healthcare Quality and Disparities Report to yield our findings.

Innerbody Research is committed to providing objective, science-based suggestions and research to help our readers make more informed decisions regarding health and wellness. We dedicated our resources to craft this report illuminating the prevailing social injustices within the U.S. healthcare system and igniting discussions on avenues for improvement based on our findings. We aim to reach as many people as possible by making this information widely available. As such, please feel free to share our content for educational, editorial, or discussion purposes. We only ask that you link back to this page and credit the author as Innerbody.com.