The Checkup Gap: Why Millions of Americans in Marginalized Communities Are Missing Their Annual Doctor Visit
Summary
Chronic disease is the nation's biggest health problem. Roughly 6 in 10 U.S. adults live with a chronic condition, and chronic disease drives 7 in 10 deaths nationwide — most of it preventable or manageable with early detection.
Access to that early detection is not equal. Hispanic adults are the most likely to lack a personal doctor (36%, vs. 16% of White adults) and the most likely to skip a routine checkup (30%, vs. 26% of White adults). AIAN and NHPI adults report similar gaps.
The result shows up in disease rates. Black, American Indian/Alaska Native (AIAN), and Hispanic adults have meaningfully higher rates of diabetes and obesity than White adults, and Black adults die of cancer and pregnancy-related causes at markedly higher rates — despite similar or lower disease incidence in some cases.
Cost and lack of a regular provider are the two biggest drivers of missed care, not lack of concern for one's health.
Closing the gap requires better data, not just more messaging — culturally grounded research design, community-based sampling, and trusted local partnerships are what actually reach the populations that national surveys undercount. This is the work Lumovance does every day for government, education, and public-sector research partners.
Why the Annual Checkup Still Matters
It's easy to skip the doctor when you feel fine. But that's exactly the problem preventive care is built to solve. Conditions like high blood pressure, high cholesterol, and elevated blood sugar typically produce no symptoms in their early stages — by the time a person feels something is wrong, the disease may already be advanced.
Chronic conditions — heart disease, cancer, stroke, diabetes, and chronic kidney disease — are the leading drivers of death, disability, and health spending in the United States. Roughly six in ten American adults live with at least one chronic condition, and about four in ten live with two or more. An annual visit is the single most reliable opportunity to catch high blood pressure, prediabetes, or an early-stage cancer while it's still manageable — and it's also when a provider can update vaccinations, review medications, and build the ongoing relationship that makes future care easier to access.
The problem is that access to this basic checkpoint is not distributed evenly across the country.
The National Picture
As of 2023, roughly 43% of the U.S. population identifies as a person of color, including 20% Hispanic, 12% Black, 6% Asian, and smaller shares of American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) adults. Across nearly every major measure of health coverage, access to care, and chronic disease outcomes, Hispanic, Black, and AIAN people fare worse than White people — while Asian adults, in the aggregate, fare similarly to or better than White adults on many (though not all) measures.
These aren't small differences. Among people under 65, AIAN (19%) and Hispanic (18%) adults are more than twice as likely as White adults (7%) to be uninsured. Uninsured rates for NHPI (13%) and Black (10%) adults are also higher than for White adults.
The Checkup Gap, Community by Community
Two things determine whether someone gets an annual checkup: whether they have a regular doctor to go to, and whether they can afford the visit. Both break down along racial and ethnic lines.
Roughly one in three Hispanic adults (36%) — and about one in four AIAN adults (25%) — report not having a personal healthcare provider at all, compared to 16% of White adults. Hispanic adults are also the most likely to say they went without a routine checkup in the past year (30%, vs. 26% of White adults) and the most likely to skip care because of cost (23%, vs. 12% of White adults). Interestingly, Black adults are about as likely as White adults to have a personal provider (15% vs. 16% report not having one) and are actually less likely than White adults to report skipping a routine checkup — a reminder that these disparities don't move in one direction and vary by community and by measure.
Data table (accessibility):
Group | No personal doctor | Skipped care due to cost |
White | 16% | 12% |
Black | 15% | 16% |
Asian | 19% | 8% |
AIAN | 25% | 18% |
NHPI | 22% | 19% |
Hispanic | 36% | 23% |
Source: KFF, "Key Data on Health and Health Care by Race and Ethnicity" (December 2025), analysis of the 2024 National Health Interview Survey.
When Care Is Delayed, Disease Takes Hold
The consequences of these access gaps show up clearly in chronic disease rates. Diabetes affects 17% of Black adults, 16% of AIAN adults, and 13% of Hispanic adults, compared to 12% of White adults. Obesity — a major risk factor for diabetes, heart disease, and some cancers — affects 42% of Black adults, 41% of AIAN adults, and 36% of Hispanic adults, compared to 32% of White adults and just 13% of Asian adults.
Data table (accessibility):
Group | Diabetes prevalence | Obesity prevalence |
White | 12% | 32% |
Black | 17% | 42% |
Asian | n/a (not disaggregated) | 13% |
AIAN | 16% | 41% |
Hispanic | 13% | 36% |
Source: KFF, "Key Data on Health and Health Care by Race and Ethnicity" (December 2025), analysis of the 2024 Behavioral Risk Factor Surveillance System.
The pattern repeats across nearly every major disease category:
Diabetes deaths: Black, AIAN, and NHPI adults die of diabetes at roughly twice the rate of White adults; Hispanic adults also have a higher diabetes death rate.
Cancer: Black people don't have higher overall cancer incidence than White people — but they have a higher overall cancer death rate, likely reflecting later-stage diagnosis, more limited access to care, and lower receipt of guideline-recommended treatment.
Maternal health: Black women are more than three times as likely as White women to die of a pregnancy-related cause.
Cardiovascular disease: Black and Hispanic adults with hypertension have consistently lower rates of blood pressure control than White adults, even after adjusting for income.
Screenings: Hispanic, AIAN, and Asian adults are more likely than White adults to be behind on colorectal cancer screening and Pap smears; AIAN and Hispanic adults are also more likely to be overdue for a mammogram.
None of this reflects a lack of concern for one's own health. It reflects unequal access to the systems — insurance, transportation, paid time off, a nearby clinic, a provider who speaks your language or looks like you — that make consistent preventive care possible.
What We're Hearing on the Ground
Alongside the national data, we've begun collecting first-person responses directly from community members about their own checkup habits — part of an early-stage community listening effort. This is a very small, non-representative pilot so far (a handful of respondents), and we're not treating it as statistically meaningful on its own. But it's already echoing the national pattern: respondents who identified as Black, Hispanic, and multiracial reported last seeing a doctor anywhere from six months to more than five years ago — the same wide spread the national data predicts. As this outreach scales to a representative sample, it will let us pair national statistics with the specific, local reasons people in a given community are or aren't getting seen. No names, contact information, or other identifying details are collected or shared in this reporting.
Closing the Gap: How Research Can Move the Needle
Disparities like these are, at their core, a data and access problem — and that's the problem Lumovance is built to help solve. As a research consulting firm focused on hard-to-reach populations, we work with government agencies, state and city partners (including here in New York City), and educational and private-sector research institutions to answer the question national surveys often can't: who, specifically, in this community isn't getting care, and why?
That means:
Designing culturally grounded research instruments that ask the right questions, in the right languages, in formats communities actually respond to — rather than importing a generic national survey and hoping it translates.
Building trust-based sampling strategies that reach people missed by phone- and web-based surveys, including through community health workers, trusted local organizations, and in-language outreach.
Disaggregating data by race, ethnicity, language, and neighborhood so that "Asian" or "Hispanic" as a single category doesn't hide very different experiences among, say, Filipino vs. Vietnamese respondents, or Puerto Rican vs. Cuban respondents — a distinction national datasets frequently collapse.
Turning findings into program design — giving government, education, and public health partners the evidence base to target outreach, funding, and clinic placement where the checkup gap is actually widest.
Better outreach campaigns can't fix a gap that's driven by cost, access, and trust. Better data can point resources at the actual barriers — and that's where the return on closing this gap starts.
The Bottom Line
An annual checkup is one of the least expensive, most effective tools in American healthcare — and it's currently reaching some communities far less than others. Hispanic, AIAN, and NHPI adults face the steepest access barriers; Black and AIAN adults carry a disproportionate share of the resulting chronic disease burden. Closing that gap starts with understanding, community by community, exactly where and why people are falling through.
References
KFF, "Key Data on Health and Health Care by Race and Ethnicity" — Nambi Ndugga, Latoya Hill, Alisha Rao, Akash Pillai, and Samantha Artiga. Published December 16, 2025. https://www.kff.org/racial-equity-and-health-policy/key-data-on-health-and-health-care-by-race-and-ethnicity/
Centers for Disease Control and Prevention, "Advancing Chronic Disease Practice Through the CDC Data Modernization Initiative," Preventing Chronic Disease, 2023. https://www.cdc.gov/pcd/issues/2023/23_0120.htm
CDC/NCHS, "Access to Health Care Among U.S. Adults," National Health Statistics Reports No. 207, August 2024. https://www.cdc.gov/nchs/data/nhsr/nhsr207.pdf
KFF, "Racial and Ethnic Health Inequities and Medicare," August 2025. https://www.kff.org/medicare/racial-and-ethnic-health-inequities-and-medicare/
CDC, "Excess Burden of Poverty and Hypertension, by Race and Ethnicity, on the Prevalence of Cardiovascular Disease," Preventing Chronic Disease, 2023. https://www.cdc.gov/pcd/issues/2023/23_0065.htm
Alba C, et al., "Changes in Health Care Access and Preventive Health Screenings by Race and Ethnicity," JAMA Health Forum, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10837752/
Photo credits: CDC and National Cancer Institute, via Unsplash (free to use under the Unsplash License).
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