Health Disparities in the U.S. - Part 2

What factors contribute to chronic health disparities in the United States? This is the second post in a series exploring that question through discussion of a specific factor. Post 1 addressed the influence of health insurance structure, coverage disparities and associated impact on health status/outcomes (post 1 link here).

This post focuses on a closely related factor – socioeconomic status. Income level is one of the strongest predictors of access to necessary medical care, chronic disease risk/management, risk of premature death and life expectancy.

The poor have less options for basic care

Over 74 million low-income adults and children are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The cost of their medical and dental care is covered through reimbursement payments to each healthcare provider. A major issue disincentivizing many providers from accepting Medicaid patients is a reimbursement rate (amount of payment received for service) that is much less on average than private insurance and only 72% of Medicare. Medical providers are far less likely to accept Medicaid patients (71%) than Medicare (85.3%) and privately insured (90%). Access to dental care is even more restricted as not all state Medicaid programs provide dental benefits and only 38 percent of dental practices accept Medicaid. Scheduling and attending appointments are more burdensome for Medicaid enrollees, who wait 24 days to schedule an appointment and are 20% more likely than privately insured patients to wait more than 20 minutes at the appointment.

High prescription drug costs

Prescription drugs cost 80-150% more in the United States than in other industrialized countries. In a poll conducted by the Kaiser Family Foundation, nearly 25% of respondents reported difficulties affording their prescriptions including a significant percentage of those with incomes less than $40,000 (35%). The Harvard School of Public Health similarly reported that one out of every four patients unable to fill a prescription for themselves or a family member due to cost. This could have severe health consequences for those with chronic diseases requiring daily medication management such as diabetes. The cost of insulin in the U.S. has risen by more than 1000% since 1999 and diabetics who are unable to afford their regular scheduled dose risk blindness, stroke, kidney failure, limp amputation and even death.

Life expectancy, chronic disease and mortality risk

Poor individuals in the United States are more likely to be impacted by serious chronic illnesses including heart disease, diabetes and several types of cancer. For example, a study conducted by the National Cancer Institute (NCI) found those with family incomes less than $12,500 were 1.7 times more likely to develop lung cancer than those with incomes $50,000 or higher. This could be attributable to significantly higher smoking prevalence among below the poverty line (41.1% (men)/32.5% (women)) compared with those at or above (18.3%).

Unsurprisingly, given the disparities in healthcare access, prescription drug costs, disease risk, and other factors highlighted above, life expectancy also varies widely by socioeconomic status in the United States. Top income earners live over 12 years longer on average than the very poor, and have gained six years of longevity since 2000 as compared to no change for those at the lowest income levels. Overall U.S. life expectancy decreased for the first time since the World War I/Spanish Flu era of 1915-1918 between 2015 and 2018. This four-year decline was driven primarily by the opioid epidemic which claimed over 200,000 lives and disproportionately impacted low-income communities.

Inequitable impact of COVID-19

The COVID-19 pandemic has infected over 8 million and killed more than 220,000 U.S. residents. It has also underscored the risk to groups already experiencing chronic inequities. Black, Latinx and American Indian/Alaska Native populations have higher rates of poverty, are more likely to uninsured with less access to healthcare services and are far more likely to be infected, require hospitalization and die from COVID-19 than whites.