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Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017 [JAMA]

Results of this analysis suggest that there has been a clear lack of progress on health equity during the past 25 years in the United States. Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health. 

N=5.4 million
  Average age = 44.5  76% non-Latinx  8.7% black  7.7% Latinx

The final sample included: 
5 456 006 respondents for self-reported health and
5 349 527 respondents for healthy days.

Health Equity Metric declined over time
Health justice declined over time
Healthy days declined over time
Health justice declined over time
Income disparities worsened 

The results of this study show a worrisome lack of progress on health equity during the past 25 years in the United States. Although there are some differences across conceptualizations of health equity, and small differences across the 2 concepts of overall health, the overall pattern is one of stagnation mixed with unambiguous decline. Much previous work has focused on mortality.

The results here, although focusing on general health rather than mortality, are consistent with this previous work. One study found a narrowing in national black-white disparities in all-cause mortality from 1990 to 2005.4 From 2001 to 2014, income disparities in life expectancy increased, and an analysis of disparities in life expectancies across counties found that they have been increasing since 1980 and were correlated with county level racial/ethnic proportions and income.

Such results are in line with the results for increasing income disparities in general health as reported herein.

Also similar is an analysis of education-related disparities in mortality across states, which found wide differences across states, coupled with an overall pattern of minimal progress.

Looking at trends in several concepts of health equity using broad concepts of health reveals an overall pattern that provides important context to studies focusing on particular diseases and conditions.

To cite a handful of the literature, studies have found little change in black-white differences in obesity since 1980 and in preventable hospitalizations (2001-2009); modest declines in tuberculosis from 1993 to 201034; and a mixed pattern of both increases and decreases in racial/ethnic disparities in diabetes from 2006 to 2010.

Please see attached for the full article.

JAMA Trends in Health Equity in US

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