Income and race-ethnicity disparities for medical care utilization and expenditures in the United States, 2017-2019

BackgroundThe COVID-19 pandemic has focused attention on race and income disparities in SARS-CoV-2 mortality and morbidity. Much less attention has been paid to other socioeconomic factors including income. ObjectiveThe goal of this study was to compare disparities in medical care utilization and related expenditures associated with income to those associated with race and ethnicity in the US for those aged 0 to 64 for four categories of medical services: hospital, emergency room, ambulatory care, and prescription medications. MethodsWe used Medical Expenditure Panel Survey data for years 2017 through 2019. For each of the four medical services, there were three measures. First was the percentage of those aged 0-64 with or without utilization and expenditures. Due to statistical issues related to zero values for utilization and expenditures, the second and third measures were average utilization and expenditures only for those with both utilization and expenditures. Disparities by income and race-ethnicity were measured by calculating the percent difference between the group with the lowest utilization or expenditures and the group with the highest utilization or expenditures. ResultsFor 9 of the 12 separate differences the income differences exceed the corresponding race-ethnicity difference and the income differences are generally much greater in magnitude. Within the income comparisons, those on Medicaid had the greatest utilization in 7 of the 8 comparisons. The High Income group had greatest expenditures for 3 of the 4 medical services. Non-Hispanic Whites had the greatest utilization and expenditures for 9 of the 12 measures and Hispanics had the least utilization and expenditures for 9 of the 12 measures. ConclusionsThese results indicate that income inequalities are more strongly associated with medical care utilization and expenditures than race-ethnicity among those aged 0-64. Although more research should focus on income related health disparities in the United States, it is time to recognize that sound health policy must include reducing socioeconomic inequalities, especially those related to income.