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Assessing Racial Disparities in Healthcare Expenditures via Mediator Distribution Shifts
Xiaxian Ou1, Xinwei He1, David Benkeser1
1Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA.
Statistics in Medicine
|May 27, 2026
Summary
Racial disparities in healthcare spending persist, driven mainly by differences in socioeconomic status and health. Equalizing these factors reduces gaps, but residual disparities suggest unmeasured influences on healthcare expenditure.
Area of Science:
- Health Economics
- Health Services Research
- Epidemiology
Background:
- Racial disparities in healthcare expenditures are a significant concern.
- Understanding the drivers of these disparities is complex and requires nuanced analysis.
Purpose of the Study:
- To develop and apply a framework for decomposing racial disparities in healthcare expenditures.
- To quantify the impact of mediating variables (SES, insurance, health behaviors, health status) on these disparities.
Main Methods:
- Developed a novel framework to decompose disparities using shifts in mediator distributions.
- Employed influence-function techniques and flexible machine learning (super learners, two-part models) for valid inference.
- Utilized data from the Medical Expenditures Panel Survey (MEPS) from 2009-2016.
Main Results:
- Substantial racial disparities in healthcare expenditures were observed, with the largest gaps between non-Hispanic Whites and Hispanics.
- Socioeconomic status and health status were the primary contributors to expenditure disparities.
- Insurance access played a significant role, especially for Hispanic populations, while health behaviors had minimal impact.
Conclusions:
- Differences in socioeconomic status and health status explain a significant portion of racial healthcare expenditure disparities.
- Residual disparities persist, indicating the influence of unmeasured or structural factors.
- The proposed framework offers a robust method for analyzing and understanding drivers of health disparities.
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