Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.
Research has consistently shown significant health disparities among racial and ethnic groups in the U.S.; not rooted in genetics but in historical and from ongoing systematic inequities. Structural racism that has been embedded in employment, education, healthcare, and housing has led to unequal health outcomes, such as higher rates of chronic illnesses among Black, and Indigenous populations. An implied bias in healthcare also contributes to inequality in diagnosis, treatment, and overall care. Furthermore, the historical injustices including "medical exploration" during slavery and segregation have sown further mistrust and inequity that persists today. Efforts to reduce these differences include culturally competent care, diverse healthcare work-forces, and systematic policy corrections specifically targeted at addressing these disparities.
Background
The U.S. Census definition of race is often applied in biomedical research in the United States. According to the Census Bureau in 2018, race refers to one's self-identification with a certain racial group. The Bureau also specifies that its use of "race" is as a social concept, not a biological or anthropological one. The Census Bureau recognizes five races: Black or African American, White (European American), Asian, Native Hawaiian or other Pacific Islander, and American Indian or Alaska Native. Despite the fact that the United States continues to become more diverse, these Census categories have not changed for almost 20 years. The Census Bureau also recognizes differences in ethnicity among the population, and it defines ethnicity as whether a person is of Hispanic origin or not. For this reason, ethnicity is broken out into two categories in its data, Hispanic or Latino and Not Hispanic or Latino. Hispanics may report as any race. These categories are used across most federal health surveys and statistical systems, which is why emerging patterns in mortality, chronic illnesses and diseases, and access to care in the U.S. are reported along the same racial and ethnic lines.
The 2010 U.S. census further specifies the number of Americans who identified with each racial and ethnic group; in 2010, 38.9 million identified as African American, 14.6 million as Asian American, 2.9 million as American Indian or Alaskan Native and 50.4 million as Hispanic or Latino. These numbers are used in national reports, such as CDC's Health, United States and AHRQ's National Healthcare Quality and Disparities Reports, to calculate rates and compare different results across multiple groups over time.
Measures of the relationship between race and medicine are imperfect and inconsistent. The 2000 U.S. Census definition is inconsistently applied across the range of studies that address race as a medical factor, making it more difficult to assess racial categorization in medicine. Additionally, the socially constructed nature of race makes it so that the different health outcomes experienced by different racial groups can be connected to social factors rather than inherent biological ones. A 2023 scoping review of the literature found that in studies conducted in multiracial or multiethnic populations, the inclusion of race or ethnicity variables lacked thoughtful conceptualization and informative analysis regarding race or ethnicity as indicators of exposure to racialized social disadvantage. This highlights the need for the more thoughtful and theoretically sound rationale for the inclusion of race or ethnicity variables in health research, aligning with the understanding of race as a social construct and acknowledging its role as a marker of exposure to racialized social disadvantage. Recent consensus reports have also alerted against using race as a fixed biological marker in clinical systems (e.g., kidney function "race corrections"), instead suggesting that researchers specify the true social or environmental exposure they want to measure. Public health agencies have stated that breaking down date by specific origin (e.g., separating Native Hawaiian from other Pacific Islanders, or Mexican origin from other Hispanic subgroups) can show hidden disparities that general Census categories tend to miss.
There are significant disparities in health outcomes between the five racial groups recognized by the U.S. Census. These health disparities are in part caused by different levels of income across the five groups recognized by the U.S. Census. Although the level of income plays a key role in health disparities outcomes, other factors tie into this as well, such as bias and racism which cause notable differences in access to healthcare and the quality of healthcare received by those of minority groups.
Non-white racial groups may experience bias and racism within the medical system, impacting these groups' access to and quality of care. Additionally, the racism experienced in daily life affects health outcomes. The stress associated with racism can negatively impact a person's physical and mental health and has been shown to contribute to health problems such as depression, anxiety, insomnia, heart disease, skin rashes, and gastrointestinal problems. Discriminatory stresses can also cause issues like blood pressure inconsistencies, and low-birth weight problems for women. This repetitive "weathering" effect, described in U.S. public health literature explains why some Black women experience markers of physiologic aging and higher risk of adverse birth outcomes at earlier ages when compared to White women in similar socioeconomic status. National Academic reviews and peer-reviewed studies have linked repeated exposure to discrimination with higher levels of allostatic load, emotional dysregulation which stems from hypothalamic-pituitary-adrenal axis, and finally with higher risk of cardiometabolic disease. As a scientifically studied topic in medicine, racism's Medical Subject Headings code for the United States National Library of Medicine's MEDLARS/MEDLINE, PubMed and PubMed Central bibliographic and open access medical journal databases is D063505.
Life expectancy
The twentieth century witnessed a great expansion of the upper bounds of the human life span. At the beginning of the century, average life expectancy in the United States was 47 years. By the century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although longevity in the U.S. population has increased substantially, race disparities in longevity have been persistent. African American life expectancy at birth is persistently five to seven years lower than European Americans. By 2018 that difference had shrunk to 3.6 years.
As of 2020, Hispanics had a life expectancy at birth of 78.8 years, followed by non-Hispanic Whites at 77.6 years and non-Hispanic blacks at 71.8 Years. In 2021, life expectancy for Native Americans was 65 years. For black Americans, 71; for white Americans, 76; for Hispanic Americans, 78; and 84 for Asian Americans.
A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. While 65-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), those differences were reduced when controlling for education. The same was not true for females: at 65 years old, black and white women had similar life expectancies to white women. And at ages 75 and 85, both black men and black women had significantly longer life expectancies than their white peers, with the black advantage being even greater when matching for education.
During the 20th century, the difference in life expectancy between black and white men in the United States did not decline.
Throughout the 20th century, life expense expectancy in the US rose. in 1900 the average life expectancy at birth was 47 years old. By the end of the century, it had increased to over 70 and many individuals consistently lived into their 80s. However while overall lifespan improved, the difference, differences in life expectancy between racial and ethnic groups have persisted at a plateau.
Historically, African-Americans have experience more life expectancy than white Americans. And the early 2000s the gap between black and white population was around 5 to 7 years but by 2018 the gap had narrowed to 3.6 years data from 2021 show the following life expectancy estimate: 65 years for Native Americans, 71 years for non-Hispanic black Americans, 76 years for non-Hispanic white Americans, 78 years for Hispanic Americans, and 84 years for Asian Americans.
This clear view of these disparities are shaped by various social structural factors, including differences in access to healthcare, exposure to chronic stressors, social economic status, and community level conditions, such as environmental quality and neighborhood safety. Structural racism has also been identified as a significant influence for the differences in life expectancy and overall health outcomes.
Research has shown that education is a very powerful predictor of life expectancy. And one study when adjusting for education, the life expectancy gap between black and white men narrowed significantly. At 65 the difference is in both total active life expectancy between black and white men were reduced one education levels were held constant. This trend was less consistent among women or life. Expectancy differences by race were smaller overall
Despite some progress, the reduction in the life expectancy gap has not been the same. For example, during the 20th century, the life expectancy difference between black and white men show little long-term decline. More recent events, such as COVID-19 has revealed more vulnerabilities among racial and ethnic minority groups, contributing to temporary declines in the life expectancy in some populations.
+Life expectancy by race in each state in 2018StateAll RacesWhiteHispanicBlackAsianAmerican Indian