Understanding Health Disparities
The COVID-19 pandemic disproportionately impacted people of color and under-resourced communities, which saw higher rates of transmission, hospitalizations, and deaths. But COVID-19 is not unique in its impact on these communities, though it has brought a greater awareness of the ways certain populations interact with the healthcare system and that those encounters may not be equitable for all. A number of recent studies have sought to quantify the different ways people experience health care in America.
Children of color are more likely to be hospitalized with the flu
In August, the JAMA Network Open journal published a study from the Centers for Disease Control and Prevention (CDC) analyzing U.S. flu hospitalizations over the decade from 2009 to 2019. Among the study’s findings, children of color under the age of 5 were significantly more likely to be hospitalized and to die of the flu than non-Hispanic white children in the same age group. Most starkly, American Indian/Alaska Native children were three times as likely to be hospitalized. Black and Hispanic children under the age of 5 were roughly twice as likely as non-Hispanic white children to be hospitalized with the flu. Asian and Pacific Islander children were 26% more likely to be hospitalized than non-Hispanic white children the same age.
While rates of flu vaccination among children under 5 years of age vary somewhat between white children and children of color, the differences weren’t enough to explain the variations in hospitalization rates. Instead, researchers cited social determinants of health (SDOH), which the CDC defines as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life risks and outcomes.” SDOH can include adults working in jobs that do not provide sick leave or health insurance or living in an area without easy access to vaccines and preventive health care. The same factors that make certain children more likely to require hospitalization for the flu can impact their likelihood of developing asthma, diabetes, cancer, and other longer-term health issues.
Health equity perception gap between patients and doctors
In a survey of 2,200 patients, more than half of respondents from disadvantaged communities said the healthcare system was “rigged” against them, a slight increase over the previous year’s survey. But in a similar survey of healthcare providers, 90% said they treat their patients with respect and are sensitive to patients’ feelings. The difference is stark.
Among the patient group as a whole, approximately half said patients are treated fairly by the healthcare system. But when looking at “health disparity populations,” the numbers look very different. Just over a quarter of Black and Latinx respondents (27% each), one-third of LGBTQ+ respondents, and 23% of people with low socioeconomic status felt positive about how they are treated by the healthcare system. Additionally, roughly half of respondents in health disparity populations said their negative feelings had increased since the beginning of the COVID-19 pandemic when underserved populations experienced higher rates of transmission and death.
Following a COVID-19 diagnosis, Black patients are less likely to receive medical follow-ups
Looking specifically at COVID-19 outcomes after hospitalization, a University of Michigan study concluded that Black patients had the lowest rate of post-discharge physician follow-ups — just 60.2% — of all racial and ethnic groups. They also saw the longest delays in returning to work, averaging more than 35 days. Additionally, among patients who required hospital readmission in the two months following their initial discharge, more than half were patients of color — a rate disproportionate to their percentage of the general population.
The study also found that Black and Latinx patients were hospitalized at a rate three times higher than white patients. The study authors noted that these patient groups had a number of conditions — including obesity, diabetes, and kidney disease — that are associated with an increased risk of severe illness. Compounding these issues, these patient groups also represented a significant number of essential workers who were in constant contact with others throughout the pandemic, unable to work from home, and often without health insurance or paid sick time. The study concluded, “Health disparities, or preventable differences in health outcomes, are known to be driven by a variety of economic, environmental, and social factors, including institutional or structural racism and bias in health treatment” — in other words, social determinants of health.
Closing the trust gaps with patients
Whether you work in a large hospital or a private practice, there are things you can do to build trust with your patients. Relationships are built at the individual level and patients from marginalized communities may be hesitant to trust a new physician, assuming — based on previous negative experiences — the doctor isn’t going to listen to them and may even make assumptions about their intelligence or express skepticism about the severity of their pain or medical issue.
Be aware that some patients are not meeting you on equal footing and many have had poor experiences with the healthcare system.
Consider how your existing protocols can be enhanced to ensure consistency among patients and that all patients have an understanding of what to expect following a visit.
Seek out expert resources, research, and guidance from organizations like the American Medical Association.