May 1, 2019
Study finds link in Minnesota between health care, poverty, race and premature death
New research from the Minnesota Department of Health (MDH) finds that during a five-year period one in five deaths of Minnesotans younger than 75 were potentially avoidable with effective and timely health care treatment.
The study, Disparities in Premature Death Amenable to Health Care, 2011 to 2015 (PDF), analyzed deaths in Minnesota between 2011 and 2015. Researchers looked for “health care amenable” or premature deaths related to diseases such as stroke, heart disease, treatable cancers and others that might have been prevented through timely and effective health care treatment. The analysis found that for those five years, 14,027 out of 76,907 deaths for Minnesota residents under age 75 were potentially avoidable with health care treatment. These premature deaths led to an estimated productivity loss for the state of $1.3 billion.
“Too many people under 75 had their lives cut short because of lack of access to effective and timely health care treatments,” said Minnesota Department of Health Commissioner Jan Malcolm. “In Minnesota we can do better. Among other things, this study points out the urgent need to improve health care coverage and access and to ensure our health care system better meets the needs of all patients, which is a priority in Governor Walz’s One Minnesota budget plan.”
The MDH study was not designed to determine the reasons why premature deaths occurred in Minnesota. However, other research has found that some factors that can contribute to a lack of access of care include the complexity of the system, lack of insurance coverage, the system’s failure to meet patient needs, systemic barriers related to structural racism or historical trauma, or the cost of care. This is particularly true for Minnesotans living in high-poverty census tracts and census tracts where half or more of the residents are people of color or American Indians. At the same time, the study did not have clinical information prior to the death record to examine specific barriers to accessing health care.
Minnesota had the lowest health-care-amenable death rates in the U.S. during this time, according to the Commonwealth Fund’s State Health System Ranking. However, the rate of potentially preventable deaths was more than twice as high for Minnesotans living in high poverty and racially diverse areas compared to majority white census tracts or higher income census tracts. For the Minnesotans in this study who died before age 75, those living in higher income majority white census tracts lived an average of 57 years, while those living in low-income majority white census tracts lived 54 years. Among those in the study who were living in lower-income census tracts where the majority of people were people of color or American Indians and who died before age 75, the average was 50 years.
Communities and families are harmed in a number of ways when members die young. In addition to the personal loss experienced by friends and families, there are consequences such as the loss of emotional support, family integrity, and personal or community history. Premature death also leads to income loss due to fewer years worked, and can lead to financial struggles for families who lose a primary wage earner. The higher rate of premature death in areas of high poverty led to an added $114 million per year in productivity loss than if these areas had the same statewide rate during 2011 to 2015. A disproportional amount of this additional productivity loss, $73 million, was concentrated in areas that also had high diversity.
“One of our findings was that among deaths amenable to health care, chronic heart disease was the leading cause of death in high-poverty areas, followed closely by treatable cancer and stroke,” said MDH Research Scientist Nathan Hierlmaier. In addition, health care amenable mortality rates for surgical conditions, heart disease, maternal and infant conditions, and respiratory disease in these high-poverty areas were nearly double the statewide average.
This research is consistent with other studies that found links between shorter life spans and factors such as health care access, poverty, race and ethnicity. One local study found Minnesota census tracts have life expectancies that vary by up to 27 years. National research showed low-income Americans died much sooner than more affluent neighbors, and there are racial disparities in mortality due to chronic heart disease, cancer, diabetes, and infant mortality.
Governor Walz’s One Minnesota Budget is focused on making sure all Minnesotans have timely access to health care. This could contribute to reducing these deaths; it provides every Minnesotan with additional health care options, encourages stability in the individual health insurance market, and makes health care more affordable in Minnesota. In addition, Governor Walz is calling for the extension of the Health Care Access Fund, which provides essential health care coverage through the MinnesotaCare and Medical Assistance (MA) programs and supports public health activities. MDH operates more than 16 grants and programs funded by the Health Care Access Fund that improve the health of the population and enhance the efficiency and stability of the health care system.