Minnesota may consistently appear at or near the top of various national health performance scorecards, but not all people in the state are equally likely to see themselves reflected in those high rankings.
In fact, Minnesota has some of the largest racial, ethnic and geographic inequities in health status and incidence of chronic disease in the country, according to a report released Monday by MN Community Measurement, a nonprofit that works to improve health care in the state by collecting, assessing and publishing health data.
“Recent immigrants are the ones who seem to have the greatest disparity in their outcomes. But we also see some big gaps for African-American and Hispanic populations,” said Jim Chase, president of MN Community Measurement, in a interview with MinnPost.
Furthermore, disparities appear to vary by region within racial and ethnic groups, sometimes significantly. For example, the report found that the gap in health-care outcomes for Hispanics is different — much narrower — in the East Metro than in other parts of the state.
“We hope this report helps us work with groups to understand what’s driving that and what can be done to reduce those disparities,” said Chase.
Key findings
Using data collected from medical groups across the state, the new report focuses on health-care outcomes in five areas: diabetes care, vascular care, asthma care for adults, asthma care for children and colorectal cancer screening.
“We had to start with measures that we were already collecting from the medical groups,” said Chase. In future reports, his organization hopes to add measures for three other areas: maternity care, depression and preventive pediatric care (such as immunizing against childhood diseases).
The report found a number of disparities in health-care outcomes among Minnesota’s various racial and ethnic populations, including these key ones:
White and Asian patients generally had higher outcomes rates, while American Indian and black patients generally had lower rates, both statewide and across regions. For example, among the patients whose data were collected for the report, 44 percent of Asians and 41 percent of whites received optimal diabetes care, compared to 27 percent of blacks and 25 percent of American Indians.
Hispanics generally had lower outcomes rates than non-Hispanics, both across the five quality measures and in most geographic regions. Hispanics living in some regions of the state, however, had notably higher rates than non-Hispanics for two measures: optimal vascular care and asthma care for adults. For example, 61 percent of Hispanic adults in southeast Minnesota received optimal asthma care, compared with 46 percent of non-Hispanic adults.
Immigrants from African countries — particularly those from Somali — had some of the lowest health-care outcomes rates statewide. For example, only 22 percent of Somali immigrants had been screened for colorectal cancer compared to 70 percent of patients statewide. And only 21 percent of Somali patients received optimal diabetes care.
Asian immigrants tended to have higher outcome rates across multiple measures and geographic areas. In fact, Vietnamese immigrants had the highest statewide rate for optimal diabetes care of any racial or ethnic group. In the West Metro Region, 64 percent of Vietnamese immigrants were receiving such care.
There was one exception to these higher rates among Asian immigrants: those born in Laos. They generally had lower health-care outcomes than other Asian-born patients and other patients in general. For example, while 62 percent of Asian-born patients living in Minnesota had been screened for colorectal cancer, only 40 percent of patients born in Laos had been similarly screened. (That compared with 70 percent of whites statewide.)
The report wasn’t designed to identify the specific reasons for these disparities, but it does suggest that some of those racial and ethnic disparity gaps may be the result of a language barrier. “Variation in English proficiency can add to the challenges of health care access and the attainment of better health care outcomes,” the report notes.
But such health-care inequities also reflect, as a Minnesota Department of Health report noted last year, “social, economic and environmental disadvantages, such as structural racism and a widespread lack of economic and educational opportunities.”
Geographical barriers
The current report also found that health-care outcomes rates in Minnesota varied considerably by geographic area. For example, compared to other regions of the state, the East and West Metro regions generally reported better outcomes across multiple measures for most racial and ethnic groups. The southwest and northeast regions of the state, on the other hand, tended to have poorer outcomes.
The southwest region scored particularly low for colorectal cancer screening. That may be the result of people needing to travel further distances to get the screening, said Chase.
“In Greater Minnesota it can be more challenging to staff [medical clinics] with the same number of providers as you can in the Twin Cities,” he added.
‘A call to action’
In the report, Chase and his colleagues at MN Community Measurement write that they hope their findings will “serve as a call to action to our community to examine and use this data to build a foundation for understanding and reducing health inequity in our state and communities.”
As background information in the report points out, racial and ethnic minorities represent about a third of the U.S population today — a percentage that is projected to expand to more than half by 2043.
Minnesota’s foreign-born population is increasing even faster than in the rest of the country. It has tripled since 1990, while the national average has only doubled. The state’s immigration pattern also differs from the national one in that about one-third of Minnesota’s immigrants were born in Latin America, compared to more than half of immigrants nationally. About 20 percent of Minnesota’s immigrants were born in Africa, however, compared to only about 4 percent nationally.
In addition, Minnesota — particularly the Twin Cities — is home to a relatively large American Indian population.
'Important work to be done'
When it comes to narrowing health disparities in Minnesota, “there is important work to be done,” said Chase. Minnesota is unique, he added, in that so many groups around the state “are actually collecting this type of information and trying to use it for improvement.”
“Patients shouldn’t be surprised now if they are asked much more frequently what their race or ethnicity is,” he added. “What we’re hoping is that patients actually welcome that question because they realize that, ‘Oh, they’re not asking it to find ways to not get me care, but to find ways of giving me better care.’”
You can download read the full report on the MN Community Measurement’s website.