Wide health disparities among enrollees in employer-sponsored chronic disease insurance, maternal health, behavioral health, substance use, and health care access, new Morgan Health report found.
Morgan Health is a business unit of JPMorgan Chase. He commissioned NORC at the University of Chicago, an independent social research organization, to prepare the report. It analyzed three nationally representative community surveys: the 2019 National Health Interview Survey (12,372 respondents), the 2017-March 2020 National Health and Nutrition Examination Survey (3,103 respondents), and the 2017 National Survey on Drug Use and Health 2019 (14,580 respondents). He also reviewed birth certificates recorded in the 2020 birth registry.
Despite having employer-sponsored coverage, many enrollees still have unmet social needs that exacerbate disparities in health outcomes, the report found. A total of 7.7% of enrollees were food insecure, where the household did not have access to adequate food due to cost or other reasons. After controlling for age and gender among different races, the differences become more apparent. Black and Hispanic enrollees were 9.8 and 6 percentage points, respectively, more likely to be food insecure than white enrollees.
“These findings are a wake-up call for business leaders about the serious health disparities that exist in the nation’s workforce,” said Dan Mendelson, CEO of Morgan Health, in news release. “The business community has a responsibility to understand and acknowledge these disparities and, more importantly, act to eliminate them. This will require active engagement with health plans and providers to close gaps and improve health outcomes.
Enrollees with chronic conditions differed by race, the report found. Black enrollees had the highest percentage of people with high blood pressure at 60.4 percent, compared with 40.7 percent of Asian enrollees, 44.2 percent of Hispanic enrollees and 46 percent of white enrollees.
When adjusted for age and sex, black enrollees were 16.7 percentage points more likely to have high blood pressure than white enrollees and 15.7 percentage points more likely to have uncontrolled high blood pressure, according to the report.
Enrollment with diabetes also varied by race, with 13.4% black, 13.3% Hispanic, 14.1% Asian, and 8.8% white. Asian, Hispanic, and black participants were not diagnosed with diabetes at rates 3 percentage points higher than white enrollees.
Of all enrollees, 42.8% were classified as obese, but like other chronic conditions, findings varied by race. Blacks and Hispanics had the highest rates of obesity, at 56.2% and 46.4%, compared to 43% of white enrollees and 16.2% of Asian enrollees.
Birth by caesarean section
Cesarean delivery can reduce maternal morbidity and mortality in high-risk births. But they can increase the risk of infection and blood clots and create postpartum complications — including death — in low-risk births.
For low-risk births, 20.1% of black enrollees had a cesarean delivery, compared with 17.7% of Asian enrollees, 17% of Hispanic enrollees, and 13.6% of white enrollees.
Adjusted for age and sex, black, Asian, and Hispanic enrollees were 6.5, 3.9, and 3.4 percentage points more likely than white enrollees to have a cesarean section for a low-risk birth, respectively.
Behavioral health and substance use
The report found that white enrollees were more likely to suffer from behavioral health and substance use problems than black, Hispanic and Asian enrollees. About 10 percent of white enrollees experience serious psychological distress, compared with 8.4 percent of black enrollees, 9.1 percent of Hispanic enrollees, and 6.1 percent of Asian enrollees. White enrollees were also more likely to experience anxiety and depression.
When it comes to visiting mental health providers, white enrollees are 4.8 percentage points more likely than blacks to do so and 5 percentage points more likely than Hispanic and Asian enrollees, after adjusting for age and sex.
There was a greater disparity in mental health when it came to enrolled lesbian, gay or bisexual women, who experienced psychological distress 12.1 percentage points higher, anxiety 16.6 percentage points higher and depression 18.4 percentage points higher than heterosexual enrollees, after adjusting for age and sex.
Regarding substance use, Hispanics were found to have the highest alcohol use, while white enrollees had the highest drug use. Lesbian, gay, and bisexual participants also had significantly higher alcohol and drug use than heterosexual participants.
Access to care
Even with employer-sponsored insurance, racial/ethnic minority and lower-income enrollees have a harder time accessing care, the report found.
Households with less than $50,000 in annual income are about six times more likely to miss medical care and prescriptions because of costs than households with more than $150,000 in annual income. Households earning less than $50,000 a year are also seven times more likely to have trouble paying bills than those earning $150,000 a year or more.
Additionally, while nearly all enrollees have a typical source of care, some use emergency departments more frequently. After adjusting for age and sex, black enrollees were 4.9 percentage points more likely than white enrollees to have visited an emergency room. Asian enrollees were 4.3 percentage points less likely to visit the ED than white enrollees.
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