Major health disparities exist among enrollees of employer-sponsored insurance for chronic conditions, maternal health, behavioral health, substance use and healthcare access, a new Morgan Health report found.
Morgan Health is a business unit of JPMorgan Chase. It commissioned NORC at the University of Chicago, an independent social research organization, to produce the report. It analyzed three nationally representative public surveys: the 2019 National Health Interview Survey (12,372 respondents), the 2017-March 2020 National Health and Nutrition Survey (3,103 respondents) and the 2019 National Survey of Drug Use and Health (14,580 respondents). It also examined birth certificates recorded in the 2020 natality vital statistics registry.
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Despite having employer-sponsored coverage, many enrollees still have unmet social needs that worsen health outcome disparities, the report found. In total, 7.7% of enrollees were food insecure, in which the household lacks access to adequate food due to cost or other reasons. After controlling for age and sex among different races, disparities 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 on the severe health disparities that exist across the country’s workforce,” Dan Mendelson, Morgan Health CEO, said in a news release. “The business community has a responsibility to understand and recognize 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.”
Chronic disease
Enrollees with chronic diseases vary by race, the report found. Black enrollees had the highest percentage of people with high blood pressure at 60.4%, compared to 40.7% of Asian enrollees, 44.2% of Hispanic enrollees and 46% of White enrollees.
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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.
Enrollees with diabetes also varied by race, with 13.4% of Black enrollees, 13.3% of Hispanic enrollees, 14.1% of Asian enrollees and 8.8% of White enrollees diagnosed with the condition. Asian, Hispanic and Black enrollees were undiagnosed for diabetes at a rate 3 percentage points higher than White enrollees.
For all enrollees, 42.8% were classified as obese, but like other chronic conditions, the findings varied by race. Black and Hispanic enrollees had the highest percentage of obesity, at 56.2% and 46.4% respectively, compared to 43% of White enrollees and 16.2% of Asian enrollees.
Cesarean section delivery
Cesarean section deliveries can reduce maternal morbidity and mortality in high-risk deliveries. But they can increase the risk of infection and blood clots and create postpartum complications — including death — in low-risk deliveries.
For low-risk deliveries, 20.1% of Black enrollees had a C-section, compared to 17.7% of Asian enrollees, 17% of Hispanic enrollees and 13.6% of White enrollees.
Adjusting for age and sex, Black, Asian and Hispanic enrollees were more likely to have a C-section in the case of a low-risk delivery by 6.5, 3.9 and 3.4 percentage points more than White enrollees, respectively.
Behavioral health and substance use
The report found that White enrollees were more likely to suffer from behavioral health and substance use issues than Black, Hispanic and Asian enrollees. About 10% of White enrollees experience serious psychological distress, compared to 8.4% of Black enrollees, 9.1% of Hispanic enrollees and 6.1% of Asian enrollees. White enrollees were also more likely to experience anxiety and depression.
When it came to visiting mental health providers, White enrollees were 4.8 percentage points more likely than Black enrollees to do so, and 5 percentage points more likely than Hispanic and Asian enrollees, after adjusting for age and sex.
There was a higher disparity in mental health when it came to lesbian, gay or bisexual enrollees, who experience psychological distress at 12.1 percentage points higher, anxiety 16.6 percentage points higher and depression at 18.4 percentage points higher than straight enrollees, after adjusting for age and sex.
For substance use, Hispanic enrollees were found to have the highest heavy alcohol use, while White enrollees had the highest drug use. Lesbian, gay and bisexual enrollees also had significantly higher alcohol and drug use than straight enrollees.
Accessing care
Even with employer-sponsored insurance, enrollees of racial/ethnic minority backgrounds and lower income have more difficulty accessing care, the report found.
Households with less than $50,000 of annual income were about six times more likely to skip medical care and prescriptions because of cost than households with more than $150,000 in annual income. Households earning less than $50,000 a year were also seven times more likely to have difficulty paying bills than those making $150,000 a year or more.
Additionally, while almost 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 higher than White enrollees to have visited an ED. Asian enrollees were 4.3 percentage points less likely to visit an ED than White enrollees.
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