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

Key PointsQuestionHow have racial and ethnic differences in self-reported health status, access, and affordability among US adults changed between 1999 and 2018? FindingsIn this serial cross-sectional study that included 596355 adults, there were marked racial and ethnic differences in measures of health status, access, and affordability, with evidence of improvement in some subgroups but persistence overall. In 2018, Black individuals with low income had the highest estimated prevalence of poor or fair health (24.9%), while White individuals with middle or high income had the lowest (6.3%). MeaningBetween 1999 and 2018, some estimated racial and ethnic differences in measures of self-reported health status and health care access improved, but many differences persisted. ImportanceThe 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. ObjectiveTo 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 ParticipantsSerial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596355 adults. ExposuresSelf-reported race, ethnicity, and income level. Main Outcomes and MeasuresRates and racial and ethnic differences in self-reported health status and health care access and affordability. ResultsThe study included 596355 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 RelevanceIn 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. This cross-sectional survey study examines 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among US adults.