Disparities in Healthcare

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The Role of Primary Care in Reducing Disparities 

A 2022 review published in The American Journal of Medicine (Mikhael, Bhutani, and Cole) highlights that the majority of patients diagnosed with multiple myeloma initially present to their primary care provider (PCP) — and that on average, patients visit their PCP three times before a hematology referral is made. The diagnostic interval (time from first presentation to diagnosis) averages roughly 100 days, and is twice as long when a patient first presents to a PCP versus a hematologist. Critically, a real-world analysis found that 62% of patients who experienced a diagnostic delay were African American.

Part of the challenge is that multiple myeloma symptoms — bone pain, fatigue, anemia, renal insufficiency — overlap with more common conditions like diabetes, arthritis, and chronic kidney disease, all of which are more prevalent in Black patients. This overlap can cause providers to attribute myeloma symptoms to comorbidities, prolonging the path to diagnosis. Black/African American patients also present with a greater number of pre-existing comorbidities at diagnosis, further compounding this risk.

The review recommends that when multiple myeloma is suspected, PCPs initiate a testing protocol that includes serum protein electrophoresis (SPEP), serum free light chain assay (sFLC), and serum immunofixation electrophoresis (sIFE). Together, SPEP and sFLC achieve 100% diagnostic sensitivity for multiple myeloma. Black/African American patients are less likely than White patients to receive this full diagnostic workup — a gap that contributes directly to the higher rates of delayed diagnosis in this population. Heightened awareness and consistent application of these diagnostic steps in high-risk populations is a concrete, actionable way to begin closing the disparity gap.⁵ 

Disparities in Medicare  

Characteristics, Experiences and Outcomes of the Medicare Population by Race and Ethnicity 

A February 2021 Kaiser Family Foundation (KFF) study on “Racial and Ethnic Health Inequities and Medicare” drew “primary and secondary data analyses by KFF and other sources to examine the characteristics, experiences, and outcomes of the Medicare population by race and ethnicity.”  

Data from “a variety of sources to describe demographics, health status and disease prevalence, health coverage, access to care and service utilization and health outcomes, including the most current data available pertaining to disparities related to COVID-19 within the Medicare population” were collected for this purpose. The study also documents “disparities in income and wealth among people on Medicare.” 

Key Takeaways 

• Since the enactment of Medicare among all older adults, life expectancy at age 65 has improved. However, it is lower for Black adults than White or Hispanic adults (18.0, 19.4, and 21.4 years, respectively) and higher for Hispanic adults than Black or White adults. 
• Compared to White Medicare beneficiaries, Black and Hispanic beneficiaries have “fewer years of formal education and lower median per capita income, savings, and home equity” overall. 
• “Among Medicare beneficiaries, people of color are more likely to report being in relatively poor health, have higher prevalence rates of some chronic conditions, such as hypertension and diabetes than White beneficiaries; they are also less likely to have one or more doctor visit, but have higher rates of hospital admissions and emergency department visits than White beneficiaries.” 
• “While the vast majority of Medicare beneficiaries across all racial and ethnic groups have some source of supplemental coverage to help fill in Medicare’s benefit gaps and cost-sharing requirements, the share of beneficiaries with different types of coverage varies by race and ethnicity. A smaller share of Black and Hispanic Medicare beneficiaries than White beneficiaries have private supplemental coverage through Medigap or retiree health plans, while a larger share have wrap-around coverage under Medicaid; a larger share of Black and Hispanic than White beneficiaries are enrolled in Medicare Advantage plans.” 
• “While relatively few Medicare beneficiaries overall report problems with access to care, a larger share of Black and Hispanic beneficiaries report trouble getting needed care than White beneficiaries.” 
• “The COVID-19 pandemic has further highlighted stark racial/ethnic health inequities among Medicare beneficiaries, with Black, Hispanic, and American Indian/Alaska Natives accounting for disproportionate rates of COVID-19 cases and hospitalizations. Among adults ages 65 and older, people of color bear disproportionate rates of COVID-19 deaths relative to older White adults.” 

Disparities in Medicare Advantage Enrollees by Race and Ethnicity

A December 2023 KFF Report on “Disparities in Health Measures by Race and Ethnicity Among Beneficiaries in Medicare Advantage: A Review of the Literature” revealed that: 

• Over 50 percent of all Medicare beneficiaries are enrolled in Medicare Advantage plans, “with higher enrollment rates among Black, Hispanic, and Asian and Pacific Islander beneficiaries” compared to White beneficiaries. 
• As of 2021, enrollment in Medicare Advantage by racial groups are as follows: Blacks (59 percent); Hispanics (67 percent); Asian and Pacific Islanders (55 percent); and Whites (43 percent). 
• The KFF review “examines differences in measures of quality of care and beneficiary experience between people of color in Medicare Advantage plans and White Medicare Advantage enrollees or the total Medicare Advantage population.” 
• Findings from 20 identified published studies (published during a 5-year period, between January 2018 and April 2023) were synthesized in the analysis. 
• The 20 studies “collectively report on 46 different measures of quality of care and beneficiary experience, but not all studies examined all groups or included all measures.” 
• 17 of the 20 studies are controlled “for differences in enrollee health status and other demographic characteristics in some fashion.” 
• “While the scope of this review is limited to Medicare Advantage enrollees, the racial and ethnic disparities in quality of care and beneficiary described in this report mirror disparities in health and health care in traditional Medicare, the overall Medicare population, and more broadly, the U.S adult population.” 

BIPOC and Access to Healthcare  

A 2023 study by Kaiser Family Foundation on Key Data on Health and Health Care by Race and Ethnicity discuss how “racial and ethnic disparities in health and healthcare remain a persistent challenge in the United States."

The COVID-19 pandemic has made inequities in health and healthcare for people of color more pronounced. However, “they have been documented for decades and reflect longstanding structural and systemic inequities rooted in racism and discrimination."

Social determinants of health also play a major role when it comes to inequities “across broader social and economic factors that drive health.” 

The analysis examines how people of color across “a broad range of measures of health, healthcare, and social determinants of health compared to whites. Data is presented for six groups, where necessary: White, Asian, Hispanic, African American, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI).  

Support Our Cause

Join our campaign against healthcare disparities for people living with multiple myeloma. Connect with our team to learn how you can contribute to the IMF's goals of making healthcare accessible.

With support from:

AbbVie, Amgen, Bristol Myers Squibb, Genentech , GSK, Johnson & Johnson, Karyopharm Therapeutics, Kite, and Sanofi