Disparities in health and healthcare are most likely to occur among women of racial and ethnic minority groups, socioeconomically disadvantaged populations and underserved rural populations. These disparities continue to affect healthcare despite increasing recognition among patients and providers.
Studies have shown while current health status, disease risk factors, access to healthcare, genetics, social, economic and environmental factors affect healthcare outcomes, these factors do not account for all gaps in healthcare outcomes and services.
Examples of racial and ethnic disparities in women's health
1. Maternal death: Maternal death in the U.S. is more common in non-Hispanic, Black women and has been rising. Data from the Centers for Disease Control show Black and American Indian/Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women.
2. Severe maternal morbidity (life-threatening event during pregnancy, delivery and postpartum):
A study between 2006-2015 showed the rate of severe maternal morbidity was up to 115 percent higher for Black compared to white women. A study including 11.3 million births between 2012-2014 in the U.S. showed non-Hispanic, Black women were 80 % more likely to be readmitted in the postpartum period.
3. Preterm birth: A study showed even after adjusting individual factors, non-Hispanic, Black women were at higher risk of having preterm birth compared to non-Hispanic, white women.
4. Complication of postpartum hemorrhage: A study of 360,000 women reported even after adjusting for comorbidity (associated illness), non-Hispanic, Black women who experienced postpartum hemorrhage had a higher risk of severe illness and death compared to non-Hispanic, white women.
5. Gestational diabetes: A study showed Hispanic women had the highest risk of gestational diabetes compared to other racial/ethnic groups.
6. Route of hysterectomy and outcome: A study showed, women undergoing hysterectomy for benign disease, Black women are more likely to have open surgery rather than minimally invasive surgery (e.g., laparoscopic) and higher risk of surgical complications even after adjusting other factors like size of the uterus, prior surgery, weight, etc.
7. Cervical cancer: Incidence of cervical cancer and mortality is higher in non-white women than white women.
8. Breast cancer: Although Black women have a lower incidence of breast cancer, their mortality is higher than white women in the U.S.
9. Ovarian cancer: Non-Hispanic, Black women have consistently worse survival outcomes from ovarian cancer compared to white women, despite very similar distributions of cancer stage.
10. Endometrial cancer: A study showed mortality risk is 55% higher from endometrial cancer among Black women compared to white women, as Black women are less likely to be diagnosed with early-stage disease. However, late-stage diagnosis appears to be the result of improper evaluation rather than biological cause—at least two studies have shown Black women are less likely to receive care consistent with current standards, resulting in late diagnosis.
11. Health screenings: A survey data showed American Indian/Alaska Native and Asian women were least likely to be up to date with recommended pap smear and mammogram screenings.
Understanding the problem
Patient factors: Many health disparities are directly related to inequities in income, housing, education and job opportunities. As an example, women who are perceived as non-adherent to recommended treatments may simply be hampered by social barriers such as lack of stable housing or lack of affordable food or transportation.
Although many disparities diminish after taking these factors into account, some remain because of factors at healthcare systems and practitioner levels.
Healthcare system factors: One significant factor is poor access to healthcare for citizens who are either uninsured or underinsured.
Practitioner level factors: Evidence suggests that factors such as stereotyping and implicit bias on the part of healthcare providers may contribute to racial and ethnic disparities in health. Historic or cultural legacy appears to have impaired the development of patient trust and can reduce adherence to clinician recommendations.
Proposed solution
To work toward a solution, we must take many factors into consideration, be persistent and target the root causes of suboptimal outcomes, while addressing social factors. We should:
- Extend or facilitate access to healthcare not only during pregnancy but before and after pregnancy. This has been shown to reduce adverse outcomes.
- Increase awareness about preventive health visits and encourage racial and ethnic minority women to respond.
- Research disease causation and treatment options that benefit minority women.
- Encourage diversity at all levels of the healthcare system.
- Train our staff on implicit bias. The Council on Patient Safety in women's health recommends its "Reduction of Peripartum Racial/Ethnic Disparities" bundle to every health system. Adherence to standard-of-care and evidence-based practices are also helpful.
Harsh Adhyaru, MD, is a board-certified obstetrician and gynecologist at UT Health East Texas Physicians in Jacksonville. Call 903-541-5396 to schedule an appointment. To find a women’s health provider in your area, call 903-596-DOCS (3627) or visit uthealtheasttexasdoctors.com/womens.