Racial/Ethnic Disparities in Health Literacy, Perception of Health Status, and Access to Healthcare Among Heart Transplant Patients of the National Institutes of Health All of Us Research Program

Background: Racial and ethnic disparities in healthcare remain a major challenge. We aim to better characterize and understand the ethnic/racial disparities in health literacy, self-perceived health status, and barriers to healthcare access among heart transplant patients. Methods: This study utilized data from the National Institutes of Health (NIH) All of Us Research Program. Surveys were used to collect sociodemographic data, baseline health status, self-perception of health status, health literacy, and access to healthcare among heart transplant patients. Participants were categorized by race into Black/African-American (BAA), Non-White Hispanic (NWH), and White Caucasian (WC). All data extraction was conducted through the All of Us Researcher Workbench, and statistical analyses were performed using R Studio. Results: Among the 565 patients with heart transplantation, there are 131 BAA, 107 NWH, and 327 WC. Socio-economic status varied among our patients with WC reporting higher education and higher annual income and more likely to own a home compared with BAA and NWH (p < 0.05). Furthermore, BAA and NWH reported worse general health status, quality of life, ability to carry out daily physical activity, and usual social role compared to WC (p < 0.05). Compared to WC, NWH reported higher fatigue and pain score, whereas BAA reported higher emotional problems, less social satisfaction, increased difficulty with physical activity, and higher pain score (p < 0.05). A higher proportion of NWH and BAA compared with WC had barriers to healthcare access in the past 12 months (p < 0.05). When asked about difficulty understanding medical information and the need for health material assistance, the WC cohort had higher proportion responding “Never” compared with BAA and NWH (p < 0.05). Similarly, the WC cohort had higher proportion reporting “Extremely” when inquired about medical form confidence compared with BAA and NWH (p < 0.05). Conclusion: BAA and NWH had poorer socioeconomic status, perceived their health as worse, reported lower quality of life, and demonstrated lower health literacy compared to WC.