Note: This content is an annual update published on March 15, 2023 to incorporate newly available data.
Racial and ethnic disparities in health and health care remain a persistent challenge in the United States. The COVID-19 pandemic’s uneven impact for people of color drew increased attention to inequities in health and health care, but they have been documented for decades and reflect longstanding structural and systemic inequities rooted in racism and discrimination. While inequities in access to and use of health care contribute to disparities in health, inequities across broader social and economic factors that drive health, often referred to as social determinants of health, also play a major role. Using data to identify disparities and the factors that drive them is important for developing interventions and directing resources to address them as well as for assessing progress toward achieving greater equity over time.
This analysis examines how people of color fared compared to White people across a broad range of measures of health, health care, and social determinants of health. Where possible, we present data for six groups: White, Asian, Hispanic, Black, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI). People of Hispanic origin may be of any race, but we classify them as Hispanic for this analysis. We limit other groups to people who identify as non-Hispanic. Unless otherwise noted, differences described in the text are statistically significant at the p<0.05 level. We use the most recent data available from several federal survey and administrative datasets (see Methodology). When the same or similar measures are available in multiple datasets, we use the data that allows us to disaggregate for the largest number of racial/ethnic groups.
Overall, this analysis found that Black, Hispanic, and AIAN people fared worse than White people across the majority of examined measures of health and health care and social determinants of health. Black people fared better than White people for some cancer screening and incidence measures, although they have higher rates of cancer mortality Despite worse measures of health coverage and access and social determinants of health, Hispanic people fared better than White people for some health measures, including life expectancy, some chronic diseases, and most measures of cancer incidence and mortality. These findings may, in part, have reflected variation in outcomes among subgroups of Hispanic people, with better outcomes for some groups, particularly recent immigrants to the U.S. Examples of some key findings include:
- Nonelderly AIAN (21%) and Hispanic (19%) people were more than twice as likely as their White counterparts (7%) to be uninsured as of 2021
- Among adults with any mental illness, Black (39%), Hispanic (36%), and Asian (25%) adults were less likely than White (52%) adults to receive mental health services as of 2021.
- Roughly, six in ten Hispanic (62%), Black (58%), and AIAN (59%) adults went without a flu vaccine in the 2021-2022 season, compared to less than half of White adults (46%).
- At birth, AIAN and Black people had a shorter life expectancy (65.2 and 70.8 years, respectively) compared to White people (76.4) as of 2021, and AIAN, Hispanic, and Black people experienced larger declines in life expectancy than White people between 2019 and 2021.
- Black infants were more than two times as likely to die as White infants (10.4 vs. 4.4 per 1,000), and AIAN infants were nearly twice as likely to die as White infants (7.7 vs. 4.4 per 1,000) as of 2021. Black and AIAN women also had the highest rates of pregnancy-related mortality.
- Black (13%) and Hispanic (11%) children were over twice as likely to be food insecure than White children (4%) as of 2021.
Asian people in the aggregate fared the same or better compared to White people for most examined measures. They fared worse for some measures, including receipt of some routine care and screening services and some social determinants of health, including home ownership, crowded housing, and childhood experiences with racism. They also had higher shares of people who were noncitizens and did not speak English well, which could have contributed to barriers accessing health coverage and care. Moreover, the aggregate data may have masked underlying disparities among subgroups of the Asian population. Asian people also have experienced increased discrimination and hate crimes amid the pandemic, which research suggests have negatively impacted their mental health.
Data gaps largely prevented the ability to identify and understand health disparities for NHOPI people. For nearly half of the examined measures, data were insufficient or not disaggregated for NHOPI people. Where data are available, NHOPI people fared worse than White people for at least half of measures. No difference was identified for the remaining measures where data were available, but this was largely due to the smaller sample size for NHOPI people in many datasets, which limited the power to detect statistically significant differences.
Overall, these data showed that people of color fared worse compared to White people across a broad range of measures related to health and health care, particularly Black, Hispanic, and AIAN people. However, patterns varied across measures and groups and there were likely variations in measures within the broad racial and ethnic classifications used for this analysis. Many of these disparities placed people of color at increased risk for negative health and economic impacts from the COVID-19 pandemic. Moreover, the pandemic exacerbated many of these disparities and may contribute to widening disparities in the future.
These data highlighted the importance of continuing efforts to address disparities in health and health care and show that it will be key for such efforts to address factors both within and beyond the health care system. While these data have provided insight into the status of disparities, ongoing data gaps and limitations hamper the ability to get a complete picture, particularly for smaller population groups and among subgroups of the broader racial and ethnic categories. As the share of people who identify as multiracial grows, it also will be important to develop improved methods for understanding their experiences. Going forward, reassessment of how data are collected and reported by race/ethnicity will be important for providing more nuanced understanding of disparities and, in turn, improved efforts to address them.
Background: Racial Diversity within the U.S. Today
As of 2021, 42% of the total population in the United States were people of color (Figure 2). This group included 19% who were Hispanic, 12% who were Black, 6% who were Asian, 1% who were American Indian or Alaska Native (AIAN), less than 1% who were Native Hawaiian or Other Pacific Islander (NHOPI), and 5% who identified as another racial category, including individuals who identified as more than one race. The remaining 58% of the population were White. The share of the population who identified as people of color has been growing over time, with the largest growth occurring among those who identify as Hispanic or Asian. The racial diversity of the population is expected to continue to increase, with people of color projected to account for over half of the population by 2050. Proposed changes to how data on race/ethnicity are collected and reported may also influence measures of the diversity of the population, as recent refinements in these questions and how they were coded have led to a growing share of people identifying as some other race or multiracial.
Certain areas of the country, particularly the South, were more racially diverse than others (Figure 3). Overall, the share of the population who were people of color ranged from below 10% in Maine, Vermont, and West Virginia to over half of the population in California, District of Columbia, Hawaii, Maryland, Nevada, New Mexico, and Texas. Most people of color lived in the South and West. More than half (59%) of the Black population resides in the South, and nearly eight in ten Hispanic people lived in the West (39%) or South (38%). Over three quarters of the NHOPI population (76%), almost half (48%) of the AIAN population, and 44% of the Asian population lived in the Western region of the country.
People of color were younger compared to White people. Hispanic people were the youngest population, with 32% ages 18 and younger, and 56% below age 35 (Figure 4). Roughly half of Black (48%), AIAN (50%), and NHOPI (51%) people were below age 35, compared to 43% of Asian people and 38% of White people.
Health Coverage and Access to and Use of Care
Overall, Black, Hispanic, and AIAN people fared worse compared to White people across most examined measures of health coverage and access to and use of care (Figure 5). Experiences for Asian people were mostly similar to or better than White people across these examined measures. Lack of data for over a third of the examined measures limited the ability to understand experiences of NHOPI people. Several measures for AIAN people also lacked sufficient data for a reliable estimate.
Despite small gains in health coverage across racial and ethnic groups between 2019 and 2021 reflecting policies adopted during the pandemic to stabilize coverage, nonelderly AIAN, Hispanic, NHOPI, and Black people remained more likely to be uninsured compared to their White counterparts. After the Affordable Care Act (ACA) Medicaid and Marketplace coverage expansion took effect in 2014, all racial and ethnic groups experienced large increases in coverage. Beginning in 2017, coverage gains began reversing and the number of uninsured people increased for three consecutive years. However, between 2019 and 2021, there were small gains in coverage across most racial and ethnic groups. Despite these recent gains, disparities in health coverage persisted as of 2021. Nonelderly AIAN and Hispanic people had the highest uninsured rates at 21% and 19%, respectively (Figure 6). Uninsured rates for nonelderly NHOPI and Black (both 11%) people also were higher than the rate for their White counterparts (7%). Nonelderly White and Asian people had the lowest uninsured rates at 7% and 6%, respectively.
Nonelderly adults of color were more likely than nonelderly White adults to report not having a usual doctor or provider and going without care. Roughly one third of Hispanic (34%) adults, one quarter of AIAN (24%) adults, and nearly two in ten NHOPI, Asian, and Black adults (21%, 19%, and 18%, respectively) reported not having a personal health care provider compared to White adults (16%) (Figure 7). In addition, Hispanic (18%), AIAN (15%), NHOPI (14%), and Black (14%) adults were more likely than White adults (9%) to report not seeing a doctor in the past 12 months because of cost, while Asian adults (7%) were less likely than White adults to say they went without a doctor visit due to cost. Asian (33%) and Hispanic (36%) adults were more likely than White adults (30%) to say they went without a routine checkup in the past year, while Black (21%) adults were less likely to report going without a checkup. All adults of color were more likely than White adults to report going without a visit to a dentist or dental clinic in the past year as of 2020.
In contrast to the patterns among adults, experiences were more mixed regarding access to and use of care for children. Across racial and ethnic groups for which data were available, nearly one in ten Hispanic (9%) children and 7% of Black children lacked a usual source of care when sick compared to 4% of White children as of 2021 (Figure 8). Hispanic (12%) and Asian (11%) children were more likely than White (8%) children to report going without a health care visit in the past year. Similar shares of Black (7%) children reported going without a health care visit as White children. Disaggregated data for AIAN and NHOPI children were not available for these measures.
Among adults with any mental illness, Black, Hispanic, and Asian adults were less likely than White adults to receive mental health services as of 2021. Roughly half of White (52%) adults with any mental illness reported receiving mental health services in the past year. (Figure 9). In contrast, about four in ten (39%) Black adults, just over a third of Hispanic (36%) adults, and only about a quarter of Asian (25%) adults with any mental illness reported receiving mental health care in the past year.
Experiences across racial/ethnic groups were mixed regarding receipt of recommended cancer screenings (Figure 10). Among those recommended for screening by the U.S. Preventive Services Task Force (USPSTF) as of 2020, Black people were less likely than White people to go without a recent mammogram or pap smear (15% vs. 22% and 17% vs. 22%, respectively). In contrast, AIAN and Asian people were more likely than White people to go without a mammogram (31% and 28%, respectively vs. 22%); Hispanic people also were more likely than White people to go without a pap smear (24% vs. 22%). For colorectal cancer screening, Hispanic, Asian, and AIAN people were more likely than White people to not be up to date on their screening, while there were no significant differences for Black and NHOPI people compared to White people. (Since, 2020, colorectal cancer screening recommendations have been expanded to begin at age 45.) Increases in cancer screenings, particularly for breast, colorectal, and prostate cancers, was one of the drivers of the decline in cancer mortality over the past few decades.
Hispanic and Black adults and children were more likely than their White counterparts to go without some immunizations (Figure 11). Roughly, six in ten Hispanic (62%), Black (58%), and AIAN (59%) adults went without a flu vaccine in the 2021-2022 season, compared to less than half of White adults (46%). Among children, nearly half (48%) of Black children went without a flu vaccine compared to 43% of White children, while Asian children were less likely than White children to go without the flu vaccine (28% vs. 43%). In 2019-2021, Black, AIAN, (both 37%) and Hispanic (31%) children were more likely than White (27%) children to have not received all recommended childhood immunizations; data were not available to assess childhood immunizations among AIAN and NHOPI children.
Similar racial disparities were observed in the initial rollout of the COVID-19 vaccinations, although they have narrowed over time and reversed for Hispanic people. As of January 11, 2023, overall, 81% of people had received at least one COVID-19 vaccination dose, and race/ethnicity was known for 76% of people who had received at least one dose. Based on those with known race/ethnicity, about half (51%) of Black people had received at least one dose compared with 57% of White people, two-thirds (67%) of Hispanic people, and over seven in ten NHOPI (71%), Asian (73%), and AIAN (78%) people (Figure 12). Uptake of the updated bivalent booster has been low across groups, with Black and Hispanic people about half as likely as White people to have received this booster so far. Overall, 10% of people over age five have received the updated bivalent booster vaccine dose as of January 11, 2023, with race/ethnicity data available for 90% of recipients. Based on those with known race/ethnicity, 20% of eligible Asian people and 16% of eligible White people had received a bivalent booster dose, roughly twice the shares of eligible Black (8%) and Hispanic people (8%) (Figure 12). The bivalent booster dose rate was 11% for eligible NHOPI people and 14% for eligible AIAN people.
Black people fared worse than White people across the across the majority of 30 examined measures of health, and AIAN people fared worse on half of the health measures for which they had data available (Figure 13). In contrast, Asian people fared better than White people for most examined health measures. Measures for Hispanic people were more mixed relative to White people. Data limitations for NHOPI people existed for half of the examined measures, limiting the ability to understand their experiences.
At birth, AIAN and Black people had a shorter life expectancy compared to White people, and AIAN, Hispanic, and Black people experienced larger declines in life expectancy than White people between 2019 and 2021. Life expectancy at birth represents the average number of years a group of infants would live if they were to experience throughout life the age-specific death rates prevailing during a specified period. Provisional data from 2021 show that overall life expectancy across all racial/ethnic groups was 76.1 years (Figure 14). Life expectancy for Black people was only 70.8 years compared to 76.4 years for White people and 77.7 years for Hispanic people. It was highest for Asian people at 83.5 years and lowest for AIAN people who had a life expectancy of 65.2 years. Life expectancies were even lower for Black and AIAN males, at 66.7 and 61.5 years, respectively. Data were not available for NHOPI people. Overall life expectancy declined by 2.7 years between 2019 and 2021, with AIAN people experiencing the largest life expectancy decline of 6.6 years, followed by Hispanic and Black people (4.2 and 4.0 years, respectively), and a smaller decline of 2.4 years for White people. Asian people had the smallest decline in life expectancy of 2.1 years between 2019 and 2021. These declines largely reflect an increase in excess deaths due to COVID-19, which disproportionately impacted Black, Hispanic, and AIAN people.
Self-Reported Health Status
Black, Hispanic, and AIAN adults were more likely to report fair or poor health status than their White counterparts, while Asian and NHOPI adults were less likely to indicate fair or poor health. One quarter of AIAN adults (25%) and roughly two in ten Black (20%) and Hispanic (21%) adults reported fair or poor health status compared to 14% of White adults as of 2021 (Figure 15). In contrast, 9% of Asian adults and 12% of NHOPI adults reported fair or poor health status.
AIAN adults were more likely to report having 14 or more unhealthy days within the past 30 days than White adults, while Asian adults were less likely to report this experience than their White counterparts (Figure 16). AIAN adults had the highest rates of 14 or more physically (17%) and mentally (21%) unhealthy days in the past 30 days, compared to White adults (11% and 15%, respectively). In contrast, Asian adults had the lowest rates of 14 or more physically (5%) and mentally (11%) unhealthy days.
Birth Risks and Outcomes
Black, AIAN, and NHOPI women had higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women (Figure 17). Notably, NHOPI women were four times more likely than White women to begin receiving prenatal care in the third trimester or to receive no prenatal care at all (20% vs. 4%). AIAN (12%) Black (9%), and Hispanic (8%) women also were more likely to have a birth with late or no prenatal care compared to White women (4%). Additionally, Asian, NHOPI, AIAN, Hispanic, and Black women were all more likely to have low birthweight births than White women. The overturning of Roe v. Wade could widen the already large disparities in maternal and infant health as people may face greater challenges accessing abortions. Data on abortion provision by race and ethnicity were limited as not all states report to the CDC’s federal surveillance system. Based on available data, in 2020, the abortion rate was higher for Black women compared with rates for Hispanic and White women; data for other groups were not available.
Teen birth rates have declined over time, but the birth rates among Black, Hispanic, AIAN, and NHOPI teens were over two times higher than the rate among White teens (Figure 18). In contrast, the birth rate for Asian teens was over four times lower than the rate for White teens.
Infants born to women of color were at higher risk for mortality compared to those born to White women. Overall infant mortality rates have declined, with the 2020 infant mortality rate representing the lowest rate recorded. Despite this overall improvement, disparities have persisted. Black infants were more than two times as likely to die as White infants (10.4 per 1,000 compared to 4.4 per 1,000) (Figure 19). AIAN and NHOPI infants both experienced mortality rates that were nearly twice as high as the mortality rate for White infants (7.7, and 7.2 vs. 4.4 per 1,000, respectively). Asian infants had the lowest mortality rate at 3.1 per 1,000 live births.
Black (41.4 per 100,000) and AIAN (26.5 per 100,000) women had the highest rates of pregnancy-related mortality (that is deaths within one year of pregnancy) between 2016-2018, while Hispanic women (11.2 per 100,000) had the lowest rate (Figure 20). More recent data for maternal mortality, which measures deaths that occur during pregnancy or within 42 days of pregnancy, shows that Black women had the highest maternal mortality rate across racial and ethnic groups in 2021 (68.9 per 100,000) and the largest increase when compared to pre-pandemic levels in 2019 (Figure 21). The maternal mortality rate for Hispanic women was less than the rate for White women prior to the pandemic (12.6 per 100,000 vs. 17.9 per 100,000 in 2019) but increased significantly during the pandemic and was higher than the maternal mortality rate for White women in 2021 (27.5 vs. 26.1 per 100,000). Due to insufficient available data, significance testing between groups was not possible for pregnancy-related mortality, and this measure was not included in the summary counts of disparities in health status, outcomes, and behaviors.
HIV and AIDS Diagnosis and Deaths
Black, Hispanic, NHOPI and AIAN people were more likely to be diagnosed with HIV or AIDS than White people. In 2020, the HIV diagnosis rate for Black people was roughly seven times higher than the rate for White people, and the rate for Hispanic people was about four times higher than the rate for White people (Figure 22). AIAN and NHOPI people also had higher HIV diagnosis rates compared to White people. Similar patterns were observed in AIDS diagnoses, with Black people having a roughly nine times higher rate of AIDS diagnoses compared to White people, while Hispanic, AIAN and NHOPI people also had higher rates of AIDS diagnoses. Most groups have seen decreases in HIV and AIDS diagnosis rates since 2013, although the HIV diagnosis rate has increased for AIAN and NHOPI people.
Among people ages 13 and older living with diagnosed HIV infection, Black (61%) and AIAN (63%) people had the lowest viral suppression rate, while White people (71%) had the highest rate during 2019. Viral suppression rates for NHOPI and Hispanic people were both 65% and seven in ten Asian people (70%) were virally suppressed (Figure 23). Viral suppression was one of the six indicators of the Ending the HIV Epidemic in the U.S. initiative and referred to the percentage of people with diagnosed HIV with less than 200 copies of HIV per milliliter of blood. Viral suppression promotes optimal health outcomes for people with HIV and also offers a preventive benefit as when someone is virally suppressed, they cannot sexually transmit HIV. Due to insufficient available data, significance testing between groups was not possible, and this measure was not included in the summary counts of disparities in health status, outcomes, and behaviors.
Chronic Disease and Cancer
Prevalence of chronic disease varied across racial and ethnic groups and by type of disease. As of 2021, diabetes rates for Black (16%), Hispanic (12%), and AIAN (15%) adults were all higher than the rate for White adults (11%). Black (6%), NHOPI (4%), Hispanic (3%) and Asian (3%) adults were less likely to have had a heart attack or heart disease than White adults (7%). Black and AIAN adults had higher rates of asthma compared to their White counterparts (12% and 13% vs. 10%), while Hispanic, NHOPI and Asian adults had lower asthma rates than White adults (8%, 6% and 6% vs. 10%). Among children, Black children were nearly twice as likely to have asthma compared to White children (17% vs 9%), while differences were not significant for other racial/ethnic groups; disaggregated data were not available for AIAN and NHOPI children (Figure 24).
AIAN, NHOPI, and Black people were more than twice as likely as White people to die from diabetes, and Black people were more likely than White people to die from heart disease (Figure 25). In 2021, the age-adjusted mortality rates for diabetes for AIAN, NHOPI, and Black people were twice as high as the rate for White people (51.0, 54.4, and 46.3 per 100,000 people vs. 22.4 per 100,000 people). Hispanic people also had a higher diabetes death rate compared to White people (29.4 vs. 22.4 per 100,000 people). In contrast, Asian people were less likely than White people to die from diabetes. Black people also had higher age-adjusted heart disease death rates than White people (226.2 vs. 179.8 per 100,000), while AIAN, Hispanic and Asian people had lower death rates.
People of color generally had lower rates of new cancer cases compared to White people, but Black people had higher cancer incidence rates for some cancer types (Figure 26). As of 2019, Black people had similar or lower rates of cancer incidence compared to White people for cancer overall and most of the leading types of cancer examined. However, they had higher rates of new colon and rectum and prostate cancer. AIAN people had a similar rate of colon and rectum cancer to White people. Other groups had lower cancer incidence rates than White people across all examined cancer types.
Although Black people did not have higher cancer incidence rates than White people overall and across most types of cancer that were examined, they were more likely to die from cancer. Black people had a higher cancer death rate than White people for cancer overall and for most of the leading cancer types examined as of 2019 (Figure 27). In contrast, Hispanic, Asian and Pacific Islander, and AIAN people had lower cancer mortality rates across most cancer types compared to White people. The higher mortality rate among Black people despite similar or lower rates of incidence compared to White people could reflect a combination of factors, including more limited access to care, later stage of diagnosis, more comorbidities, and lower receipt of guideline-concordant care, which are driven by broader social and economic inequities.
COVID-19 Cases, Hospitalizations, and Deaths
Age-adjusted data from the Centers for Disease Control and Prevention (CDC) show that, overall, people of color were at higher risk for COVID-19 infection, hospitalization, and death compared to their White counterparts. As of December 2022, AIAN and Hispanic people were one and a half times as likely as White people to be infected with COVID-19, and Hispanic, Black and AIAN people were roughly two times as likely as White people to be hospitalized for COVID-19 (Figure 28). Moreover, AIAN people were roughly two times as likely as White people to die from COVID-19, and Hispanic and Black people were more than 1.5 times as likely to die from COVID-19.
Smoking, AND Obesity
Smoking and obesity rates varied across racial/ethnic groups. As of 2021, AIAN (27%) and Black adults (16%) were more likely to smoke than White adults (14%), while Asian (6%) and Hispanic adults (11%) had lower smoking rates. Black (43%), NHOPI (43%), AIAN (39%), and Hispanic (37%) adults all had higher obesity rates than White adults (32%), while Asian adults had a lower obesity rate at 12% (Figure 29).
Mental heaLTH and substance use disorders
Overall rates of mental illness and substance use disorder were lower for people of color compared to White people but could be underdiagnosed among people of color. In 2020, people of color were generally less likely to report experiencing any mental illness or substance use disorders compared to their White peers. Just over a quarter of Black (28%) and Hispanic (27%) nonelderly adults reported having a mental illness or substance use disorder in 2020, compared to 36% of White nonelderly adults (Figure 30). Among adolescents, symptoms of anxiety and/or depression were higher among White (19%) and Hispanic (15%) adolescents and lower among Black adolescents (11%) in 2020. Research suggests that a lack of culturally sensitive screening tools that detect mental illness, coupled with structural barriers could contribute to underdiagnosis of mental illness among people of color.
AIAN and White people had the highest rates of deaths by suicide as of 2020. People of color have had larger increases in suicide death rates than their White counterparts. As of 2020, AIAN and White people had the highest rates of deaths by suicide compared to all other racial and ethnic groups (23.9 and 16.8 per 100,000, respectively). However, AIAN and Black people experienced the largest absolute increases in suicide death rates (7.0 and 2.3 percentage points, respectively) from 2010 to 2020 (Figure 31). Suicide-related death rates among adolescents roughly doubled for Asian, Black, and Hispanic adolescents during the same period (Figure 31). However, similar to the overall population data, AIAN adolescents accounted for the highest rates of deaths by suicide, over three times higher than White adolescents (22.7 vs. 7.3 per 100,000). In contrast, Black, Hispanic, and Asian adolescents had lower rates of suicide deaths compared to their White peers.
As of 2020, AIAN people had the highest rates of drug overdose deaths (41.9 per 100,000 in 2020) compared with all other racial and ethnic groups. Drug overdose death rates among Black people exceeded rates for White people as of 2020 (35.4 versus 32.8 per 100,000), reflecting larger increases among Black people in recent years (Figure 32). Data on drug overdose deaths among adolescents showed that while White adolescents account for the largest share of drug overdose deaths, Black and Hispanic adolescents accounted for a growing share of these deaths over time.
Social Determinants of Health
Social determinants of health are the conditions in which people are born, grow, live, work, and age. They include factors like socioeconomic status, education, immigration status, language, neighborhood and physical environment, employment, and social support networks, as well as access to health care. There has been extensive research and recognition that improving health and achieving health equity will require approaches that address social, economic, and environmental factors that influence health. The COVID-19 pandemic exacerbated existing inequities across many of these factors. For example, Black and Hispanic adults have had more difficulty paying household expenses, experienced higher rates of food insufficiency, and have been more likely to live in a household that experienced a loss of employment than White adults during the pandemic. Between 2019 and 2021, there were improvements in many of the examined social and economic factors, reflecting some economic recovery since the height of the COVID-19 pandemic.
Overall, Black, Hispanic, AIAN, and NHOPI people fared worse compared to White people across most examined measures of social determinants of health for which data were available (Figure 33). Experiences for Asian people were more mixed relative to White people across these examined measures. Reliable or disaggregated data for AIAN and NHOPI people were missing for several measures.
Work Status, Family Income, and Education
Across racial and ethnic groups, most nonelderly people lived in a family with a full-time worker, but Black, Hispanic, AIAN, and NHOPI nonelderly people were more likely than White people to be in a family with income below poverty (Figure 34). Across racial and ethnic groups most people lived in a family with a full-time worker, but Black, Hispanic, NHOPI and AIAN people were less likely than White people to have a full-time worker in the family as of 2021. Despite most people living in a family with a full-time worker, Black, Hispanic, AIAN, and NHOPI nonelderly people were more likely than their White counterparts to have family income below the federal poverty level ($21,811 for a family of three as of 2021).
Black, Hispanic, AIAN, and NHOPI people had lower levels of educational attainment compared to their White counterparts. Among people ages 25 and older, over two thirds of White people had completed some post-secondary education, compared to less than half (45%) of Hispanic people, just over half (52%) of AIAN people, 53% of NHOPI people, and 58% of Black people as of 2021 (Figure 35). Asian people were more likely than White people to have completed at least some post-secondary education, with 74% completing at least some college.
Assets and Debt
Black and Hispanic families had less wealth than White families. Wealth can be defined using net worth, a measure of the difference between a family’s assets and liabilities. The median net worth for White households in 2019 was $189,100 compared to just $24,100 for Black households and $36,050 for Hispanic households (Figure 36). Disaggregated data for other groups were not available.
People of color were less likely to own a home than White people (Figure 37). The homeownership rate among White people was 77% in 2021, compared to 69% for Asian people, 63% for AIAN people, 55% for Hispanic people, and 48% for both Black and NHOPI people.
Food Security, Housing, and Internet Access
Black and Hispanic nonelderly adults and children were more likely to experience food insecurity compared to their White counterparts. Among nonelderly adults, 12% of Black adults and 8% of Hispanic adults had low or very low food security compared to 4% of White adults as of 2021 (Figure 38). Disaggregated data for AIAN and NHOPI adults were not available. Among children, Black (13%) and Hispanic (11%) children were over twice as likely to be food insecure than White children (4%). Disaggregated data for AIAN and NHOPI children were not available.
People of color were more likely to live in crowded housing than their White counterparts (Figure 39). As of 2021, 3% of White people reported living in a crowded housing arrangement, that is having more than one person per room, as defined by the American Community Survey. In contrast, almost one third (28%) of NHOPI people, roughly one in five Hispanic (18%) people, 15% of AIAN people, and about one in ten Asian (12%) and Black (8%) people reported living in crowded housing.
AIAN, and Black people were less likely to have internet access than White people (Figure 40). Black (7%), and AIAN (15%) people were more likely than White people (5%) to report no internet access as of 2021. In contrast, Asian people were less likely to report no internet access than White people (2% vs. 5%).
People of color were more likely to live in a household without access to a vehicle than White people (Figure 41). Black and Asian people were the most likely to live in a household without a vehicle available (12% and 9%, respectively) followed by AIAN (8%), Hispanic (7%) and NHOPI (6%) people. White people were the least likely to report not having access to a vehicle in the household (4%).
Citizenship and Language
Among the nonelderly population, Black, Hispanic, Asian, and NHOPI people included higher shares of noncitizens compared to White people. Asian and Hispanic people had the highest shares of noncitizens at 26% and 19%, respectively, as of 2021 (Figure 42). Asian people are projected to become the largest immigrant group in the United States by 2055, surpassing Hispanic people. Immigrants were more likely to be uninsured than citizens and face increased barriers to accessing health care.
Hispanic and Asian people were more likely to speak English less than very well compared to White people. Almost one in three Asian people (31%) and Hispanic people (28%) reported speaking English less than very well compared to 2% of White people as of 2021 (Figure 43). Moreover, 16% of Asian people and 13% of Hispanic people reported that no one in the household ages 14 and older speaks English well compared to 1% of White people. There were also small but statistically significant differences for Black, AIAN, and NHOPI people compared to White people for this measure.
Racism and Adverse Childhood Experiences (ACEs)
Parents of Black, Hispanic, and Asian children were more likely to report their children were treated or judged unfairly because of their race/ethnicity than parents of White children. Over one in ten (14%) parents of Black children, and 6% of parents of Hispanic and Asian children reported that their children were treated or judged unfairly because of their race/ethnicity compared to 1% White children in 2020-2021 (Figure 44). Disaggregated data were not available for parents of AIAN and NHOPI children. Federal health surveys do not include national measures of experiences with racism among adults. However, a recent KFF survey found that Black and Hispanic adults were more likely than White adults to experience race-based discrimination while shopping working, getting health care, or interacting with the police.
Some adults and children of color were more likely to report adverse childhood experiences (ACEs) than their White counterparts (Figure 45). ACEs are potentially traumatic events that occur in childhood, such as experiencing violence, abuse, or neglect; witnessing violence; or growing up in a household with substance use problems or mental health problems. ACEs are linked to chronic health problems, mental illness, and substance use problems in adulthood. Research shows that the more ACEs a person experiences, the higher at risk they are for negative health and well-being and generally accepted thresholds for identifying adults and children at risk based on ACEs have been established in literature. The BRFSS survey measures eleven types of ACEs among adults. As of 2021, AIAN (31%), Black (22%) and Hispanic (22%) adults were more likely than White (19%) adults to have experienced four or more ACEs, while Asian adults were less likely than their White counterparts to report four or more ACEs (11% vs. 19%). Among children, the National Survey of Children’s Health measures nine types of ACEs. In 2020-2021, Black and Hispanic children were more likely than White children to report experiencing two or more ACEs (24% and 19% vs. 15%). Asian children were less likely than White children to report experiencing two or more ACEs (6% vs. 16%). Disaggregated data were not available for AIAN or NHOPI children.