The U.S. Department of Health and Human Services defines health disparities as differences in the occurrence, frequency, death, and burden of diseases and other unfavorable health conditions that exist among specific population groups, including racial and ethnic minority groups.

Disparities in racial and ethnic minorities

In March 2002, the Institute of Medicine issued a report finding “overwhelming evidence” that racial and ethnic minorities suffer disparities in health care. Factors contributing to differences in health care include poverty; lack of access to health care; lack of health insurance; language and literacy barriers; and poor expectations of the result of cancer treatment, the doctors, and/or the health-care system. Although there are many causes that limit access to care, racial and ethnic disparities in health care contribute significantly to this problem in the United States. Research shows that minorities are in poorer health, experience greater obstacles to receiving care, are more likely to be uninsured, and are at greater risk of receiving care of poor quality than other Americans.

The most recent National Healthcare Disparities Report by the U.S. Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) finds that limited progress is being made to eliminate health care disparities and that many significant gaps in quality and access have not been addressed.

Areas of disparity in cancer care

Issues related to disparity in cancer care can be broken down into several areas, including prevention, diagnosis, and treatment.

Prevention

People from minority populations participate much less often in cancer prevention programs than do white people. They also may be less likely to use genetic testing to identify whether they have an increased cancer risk.

• In the AHRQ report mentioned above, 23% of Hispanic women reported that they have never had a Pap test, compared with 17% of non-Hispanic white women.
  
  
• Minority women tend to be more reluctant to undergo testing for the breast cancer genes 1 and 2 (BRCA 1 and BRCA 2), even when they have a family history of breast or ovarian cancer, according to a 2005 report in the Journal of the American Medical Association.

Diagnosis

Diagnosis of cancer is often delayed in people from minority groups.

• The Medical Expenditure Panel Survey from the AHRQ found that nearly 30% of Hispanic people and 20% of African American people lack a usual source of health care, compared with less than 16% of white people.
  
  
• Uninsured, African American, Hispanic, and low-income patients are less likely than white, high-income, and insured patients to receive recommended care and are more likely to be admitted to the hospital for potentially preventable conditions, according to a 2006 report from The Commonwealth Fund.

Treatment

Differences in the result of cancer treatment are not only because of delays from lack of access to care and problems with prevention and diagnosis, but may also reflect the lower quality of medical services in some underprivileged areas, according to a 2005 article in the journal Medical Care. For example, physicians treating African American patients are less likely to be board certified, and these doctors have less access to specialists and other technology resources.

How health care disparities affect people of different races/ethnic groups

Overall, minority populations have a higher risk of developing cancer and a higher total death rate. According to data from the National Cancer Institute (NCI), African American people have the most numbers of new cases of cancer and the highest death rates from cancer, even though they make up a minority of the U.S. population.

The section below highlights examples of these health care disparities, using data from the NCI and the American Cancer Society’s publication, Cancer Facts and Figures. These data demonstrate the disparities in health care faced by racial and ethnic minority groups in the United States:

African Americans

• African American people are less likely than white people to survive five years after being diagnosed with most types of cancer, at any stage of diagnosis.
  
  
• African American women are diagnosed less often with breast cancer than white women, but are more likely to die of breast cancer than white women. The risk of the less treatable, more deadly type of breast cancer is twice as high in African American women.
  
  
• African American men have the highest risk of developing prostate cancer. They also tend to have cancers that are more aggressive and have more than twice the death rate when compared to other racial and ethnic groups.
  
  
• Despite its preventable nature, colorectal cancer continues to kill a disproportionate number of African American people each year. New diagnoses of colorectal cancer among African American men and women are about 17% higher than in white men and women.

Hispanic Americans

• Cancer is the second leading cause of death for Hispanic people in the United States, accounting for about 20% of all deaths.
  
  
• Hispanic people have lower numbers of new cancers for all cancers combined when compared with white people, but generally have higher rates of uterine, cervix, liver, gallbladder, and stomach cancers, which are associated with certain infections.
  
  
• Liver cancer rates are twice as high in Hispanic men and women compared with white men and women.
  
  
• Colorectal cancer is the second-most commonly diagnosed cancer in both Hispanic men and women.

Asian Americans

• Cancer affects Asian American people in very different ways, based on country of origin. According to a study of the five largest Asian American groups – Chinese, Filipino, Vietnamese, Korean, and Japanese – colorectal cancer rates are highest among Chinese Americans; prostate cancer is more common and more often deadly among Filipino men; and Vietnamese women have the highest number of new cancers and death rates from cervical cancer of all Asian American women.
  
  
• A significant number of Korean American women are not familiar with the Pap test, a decades-old standard for cervical cancer screening.

Native American/Alaska Natives

• For all cancers combined and various site-specific cancers, the five-year cancer survival rate (the percentage of patients who survive at least five years after the cancer is detected) for American Indian women is significantly lower than that for white women.
  
  
• Alaska Native women have the highest death rate of all ethnic groups for all cancers combined, and for colorectal and lung cancers specifically.

Contributing factors to health disparities among racial/ethnic minorities

People from minority groups are more likely than white people to lack health insurance. The following statistics come from a March 2008 Commonwealth Fund article and a 2006 U.S. Census Bureau report:

• In 2006, the uninsured rate for non-Hispanic white people remained unchanged at 11%.
  
  
• The uninsured rate for African American people increased in 2006 to 21% up from 19% in 2005.
  
  
• The uninsured rate for Asian people decreased to 16% in 2006, down from 17% in 2005.
  
  
• Among Hispanic people, the rate of the uninsured increased in 2006 to 34%, up from 32% in 2005.
  
  
• About one in three people who are from the American Indian/Alaska Native population do not have health insurance.

In addition, 16% of African American people and 13% of Hispanic people rely on hospitals or clinics for their usual source of care, compared with 8% of white Americans.

Last Updated: August 05, 2008