Cited by 394Health disparities and outcomesHealthcare Policy and ManagementPublic Health and Social Inequalities

The DOI matches its Crossref record; 77 of the 83 references it cites were found in a registry or an index; none of the 23 sources its claims cite is checked for support yet.

Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999–2018

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Published version of a preprint

Abstract

IMPORTANCE: The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE: To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES: Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES: Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS: The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE: In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.

Overview

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Crossref · 10.1001/jama.2021.9907

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  • The paper relies on this without support.

    Prior research had not examined national long-term trends from the individual's perspective.

    “Prior studies have not evaluated national, long-term trends from the individual's perspective.”
  • The paper relies on this without support.

    Eliminating racial and ethnic differences in health status and health care access is a US goal.

    “The elimination of racial and ethnic differences in health status and health care access is a US goal”
  • The paper relies on this without support.

    The ACA became law in March 2010.

    “Of note, the Affordable Care Act was enacted in March 2010.”
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Metadata

Authors
Mahajan, S., Caraballo, C., Lu, Y., Valero-Elizondo, J., Massey, D., Annapureddy, A. R., Roy, B., Riley, C., Murugiah, K., Onuma, O., Nunez-Smith, M., Forman, H. P., Nasir, K., Herrin, J., & Krumholz, H. M.
Affiliations
  • Yale New Haven Hospital (US)
  • Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
  • Yale University (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • Houston Methodist (US)
Corresponding author
Krumholz, Harlan M.
Venue
JAMA
Published
2021-08-17
Volume
326
Issue
7
Pages
637
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W3195936663
Cited by
368
References
83
Citations by year
2026: 73 · 2025: 90 · 2024: 83 · 2023: 69 · 2022: 41 · 2021: 11
FWCI
28.31
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
Funders
  • State of Connecticut Department of Public Health
  • Yale University
  • Shenzhen Center for Health Information
  • National Institutes of Health (UL1TR001863)
  • U.S. Food and Drug Administration
  • National Heart, Lung, and Blood Institute (K12HL138037)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
racial and ethnic disparities, health status, health care access, health care affordability, health care costs, low income, Black people, Asian adults, White adults, health trends

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