How much is the economic burden of health inequities for disadvantaged racial and ethnic and education populations?
In 2018, the economic burden of health inequities for racial and ethnic minority populations (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander populations) was $421 billion or $451 billion and the economic burden of health inequities for adults without a 4-year college degree was $940 billion or $978 billion, according to 2 data sources, respectively.
The economic burden of health inequities is unacceptably high and warrants investments in policies and interventions to promote health equity for racial and ethnic minorities and adults with less than a 4-year college degree.
Health inequities exist for racial and ethnic minorities and persons with lower educational attainment due to differential exposure to economic, social, structural, and environmental health risks and limited access to health care.
To estimate the economic burden of health inequities for racial and ethnic minority populations (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander) and adults 25 years and older with less than a 4-year college degree in the US. Outcomes include the sum of excess medical care expenditures, lost labor market productivity, and the value of excess premature death (younger than 78 years) by race and ethnicity and the highest level of educational attainment compared with health equity goals.
Analysis of 2016-2019 data from the Medical Expenditure Panel Survey (MEPS) and state-level Behavioral Risk Factor Surveillance System (BRFSS) and 2016-2018 mortality data from the National Vital Statistics System and 2018 IPUMS American Community Survey. There were 87 855 survey respondents to MEPS, 1 792 023 survey respondents to the BRFSS, and 8 416 203 death records from the National Vital Statistics System.
In 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs.
Conclusions and Relevance
The economic burden of racial and ethnic and educational health inequities is unacceptably high. Federal, state, and local policy makers should continue to invest resources to develop research, policies, and practices to eliminate health inequities in the US.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Darrell J. Gaskin, PhD, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 644 N Broadway, Ste 441, Baltimore, MD 21205 (firstname.lastname@example.org).
Accepted for Publication: March 27, 2023.
Correction: This article was corrected on May 16, 2023, to correct rounding and data errors in the text and tables.
Conflict of Interest Disclosures: Drs LaVeist, Richard, Anderson, and Gaskin reported receiving consulting fees from Blue Cross Blue Shield Foundation of Massachusetts. Dr Gaskin reported being a member of the Maryland Health Equity Policy Committee. No other disclosures were reported.
Funding/Support: This research was funded by contract #75N94021C00002 from the NIH/NIMHD.
Role of the Funder/Sponsor: The NIH/NIMHD had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The director and 3 NIMHD staff members are authors and the manuscript received clearance for the NIH.
Additional Contributions: We are grateful for the insightful comments and guidance of the technical expert panel, who were compensated for their time, assembled by NIMHD: Elizabeth Arias, PhD (National Center for Health Statistics); José J. Escarce, MD, PhD (David Geffen School of Medicine, UCLA); Ninez Ponce, PhD, MPP (UCLA Fielding School of Public Health); Jonathan Skinner, PhD (Dartmouth); Barbara Wolfe, PhD (University of Wisconsin-Madison); and Steven Woolf, MD, MPH (Virginia Commonwealth University).
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