Patients from historically disenfranchised racial and ethnic groups who also have disabilities face significant burdens accessing primary care services. As a result, they are at higher risk for multimorbidity and adverse health events.
While health insurance-covered preventive services provided through primary care improves health outcomes in the general population, it’s unclear if these same outcomes extend to privately insured people with disabilities who are also from marginalized populations.
A new study supported by researchers from the Department of Family Medicine found that even when Black and Hispanic patients with disabilities were privately insured, their utilization of preventive care services was significantly lower than people with no disabilities. Their study, “Racial and ethnic inequities in use of preventive services among privately insured adults with pediatric-onset disability,” was recently published in the Annals of Family Medicine.
Study results suggest that patients with disabilities who are also from marginalized backgrounds are receiving suboptimal preventative care from their health providers, even if they have health insurance.
The paper’s authors include Medical Resident Lauren Groskaufmanis and Associate Professor Elham Mahmoudi, both of Family Medicine; Paul Lin of the Institute for Healthcare Policy and Innovation (IHPI); Neil Kamdar of IHPI and Physical Medicine and Rehabilitation (PM&R); Anam Khan of the School of Public Health; Associate Professor Mark D. Peterson of IHPI and PM&R; and Professor Michelle Meade of PM&R and Family Medicine. This research was supported by a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR#90RTHF0001-01-00).
The researchers examined insurance claims data from 11,635 patients -- 8,935 white patients, 1,457 Black patients, and 1,243 Hispanic patients -- over a 10-year period to determine how often patients with cerebral palsy or spina bifida (the most common congenital conditions that cause permanent movement disorders) received important preventive care services such as annual wellness visits, bone density scans, cholesterol assessment, and diabetes screenings. They adjusted for age, sex, comorbities, income, education, visit type, completed routine screenings, and inclusion in specific U.S. Census divisions.
For most preventive services, privately insured patients with spina bifida or cerebral palsy, regardless of ethnicity, accessed preventive services at lower rates than people with no disabilities.
Of note, the researchers found that bone density screening rates were low across all patients with cerebral palsy or spina bifida, which is particularly concerning as patients with these conditions are at high risk for osteoporosis and fractures. Furthermore, Black and Hispanic patients with cerebral palsy or spina bifida were less likely to have an annual wellness visit compared to their white counterparts. Additionally, Black patients were less likely to be screened for bone density than white patients. The researchers did not find inequities in the use of other preventive services.
“Our study results suggest that barriers to care may include factors other than insurance coverage,” said Mahmoudi, “We strongly recommend increasing the physical accessibility of health care centers, increased adoption of telehealth services, and clinician education. These health care disparities are concerning and call for flexibility and creativity on the part of the U.S. healthcare system so that all people with disabilities, regardless of race or ethnicity, receive the care they need and deserve.”
Article citation: Groskaufmanis, L., Lin, P., Kamdar, N., Khan, A., Peterson, M. D., Meade, M., &; Mahmoudi, E. (2022). Racial and ethnic inequities in use of preventive services among privately insured adults with a pediatric-onset disability. The Annals of Family Medicine, 20(5), 430–437. https://doi.org/10.1370/afm.2849