The 2022 National Healthcare Quality and Disparities Report: We Still Have Much Work to Do

What does healthcare in the United States look like?

The answer, of course, is complicated. It depends on one's perspective. But regardless of how one attempts to address the question, a mixed picture emerges, signaling a great deal that still needs to be done to ensure that patients receive the healthcare they need and deserve.

Bringing this picture into focus is central to AHRQ's annual publication of the National Healthcare Quality and Disparities Report (NHQDR)—a Congressionally mandated summary of health and healthcare delivery status in the United States. The newly released 2022 NHQDR is the broadest, deepest, and most comprehensive yearly account of the state of American healthcare—and it crystalizes the achievements and challenges we face, especially among racial and ethnic minorities and underserved communities.

As in the past, the newest NHQDR highlights areas in which the healthcare delivery system has made important advances. Mortality from HIV/AIDS, for example, has declined steadily since early 2000. Significant improvements have occurred for people receiving care at home. And decades of basic and clinical research have yielded many effective ways to prevent or treat breast cancer. Between 2000 and 2020, the breast cancer death rate decreased by approximately 29 percent.

But the NHQDR also documents many troubling trends in healthcare quality and delivery. To begin with, life expectancy declined by 1.8 years in 2020 compared with 2019. The decline was more remarkable for Hispanic and non-Hispanic Black people than non-Hispanic White people. The sharp drop in life expectancy is partly due to the outsized impact of COVID-19, but COVID-19 does not explain why the life expectancy in the United States has fallen behind that of other countries.

In addition, the NHQDR underscores shortcomings in the healthcare delivery system's capacity to deliver safe, high-quality care. In January 2022, the number of healthcare workers employed in hospitals was 2 percent lower than in January 2020, before the COVID-19 pandemic. During the same time period, the decline was 12.1 percent among nursing home workers. Professions such as phlebotomists, medical assistants, and licensed vocational nurses account for many of the lost healthcare workers. However, these professions play a critical role in delivering healthcare services; losing them from the healthcare workforce may signal future difficulty in meeting demand for services.

What are we to make of this very mixed picture?

First, I encourage you to take a careful look at the data and information in the NHQDR, especially the report's new Portrait of American Healthcare. You may also want to review the report's deep dive into data on four special emphasis topics that are priorities for the Biden-Harris administration: maternal health, child and adolescent mental health, substance abuse disorders, and oral health. Excerpts from the compelling data in both sections are listed below.

As you’ll see, the NHQDR is not prescriptive. Nor does it assign blame. Its purpose is to document U.S. healthcare quality and disparities so that everyone—policymakers, health system leaders, researchers, clinicians, and patients—can have a deeper understanding of the challenges we face, as well as the opportunities for making lasting improvements in healthcare delivery.

AHRQ’s mission is to assist healthcare professionals and health system executives pursue excellence in healthcare for the American people by producing the evidence needed to improve care for all. I believe the 2022 NHQDR provides a valuable roadmap to achieving these goals.

Key Trends Noted in the NHQDR's Portrait of American Healthcare

• Before and during the COVID-19 pandemic, 135 rural hospitals closed between 2010 and 2020, threatening rural residents' access to services provided by those hospitals.
• The percentage of people with health insurance coverage has increased greatly in the past decade. However, those gains vary by race and ethnicity. Non-Hispanic American Indian or Alaska Native groups and Hispanic groups are significantly less likely to be insured.
• Disparities data show that in 2020, among adolescents ages 12–17 years, non-Hispanic White adolescents (7.4 deaths per 100,000 population) were more likely to die from suicide than Hispanic (5.0 deaths per 100,000 population) or non-Hispanic Black (4.6 deaths per 100,000 population) adolescents.
• The fourth-leading cause of death in the United States in 2020, after heart disease, cancer, and COVID-19, was unintentional injuries. Drug overdoses were the most common cause of unintentional injuries, accounting for more than 40 percent of unintentional injury deaths. As highlighted below, mortality rates for this condition continue to rise.
• Data increasingly showed that social, economic, environmental, and community conditions—together known as social determinants of health—may substantially influence the population's health more than care delivered by practitioners and healthcare systems. We know that healthcare organizations will increasingly need to address the social needs that patients bring to their healthcare encounters due to these social drivers of care. These societal conditions and challenges pose barriers to providing adequate care to all.

Highlights from the NHQDR's Four Special Emphasis Topics

• Maternal health: The United States has the highest maternal mortality rate of industrialized countries, and the 2022 NHQDR shows that this rate is increasing. The overall maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births, up from 20.1 deaths in 2019 and 17.4 deaths in 2018.
• Child and adolescent mental health: Nearly 20 percent of American children have a mental, emotional, developmental, or behavioral disorder. Rates of emergency visits with principal diagnoses related to mental health increased by 24.6 percent for children up to 17 years old between 2016 and 2018. The report also finds that suicidal behaviors among high school students increased more than 40 percent in the decade up to 2019. Despite these troubling trends, the NHQDR shows limited access to mental health services.
• Substance use disorders: The opioid epidemic has cost more than $400 billion yearly in lost productivity, healthcare expenses, criminal justice costs, and losses from motor vehicle crashes. Although the rise in opioid-related deaths had briefly flattened between 2017–2018, rates of overdose deaths involving any opioid have begun to rise again, increasing by 36.8 percent between 2019 and 2020. Our challenges with alcohol misuse also loom large; in 2020, the percentage of people aged 12 and over who needed treatment for alcohol misuse and who received such treatment at a specialty facility was less than 10 percent for people at all income levels.
• Oral health: Approximately one in seven people were unable to get or delayed getting needed dental care due to cost in 2019, a rate far higher than the percentage of people unable to get or get needed medical care due to cost. The data also indicate that access to oral healthcare and outcomes has improved for children, not adults. This may be explained by the fact that Medicaid and the Children's Health Insurance Program (CHIP) provides comprehensive dental coverage for children. In contrast, Medicaid, in the majority of States, does not provide this benefit for adults, nor does Medicare.

Dr. Valdez is Director of AHRQ.

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