Difference, disparity, and disability: a comparison of health, insurance coverage, and health service use on the basis of race/ethnicity among US adults with disabilities, 2006-2008

Abstract

Background: In the United States, research on health disparities has begun to include people with disabilities as a minority population. However, there is a gap in our knowledge of whether, and to what extent, racial and ethnic disparities may affect the health or health care access of people with disabilities.

Objectives: We examined potential disparities in overall health, insurance coverage status, and health service use between non-Hispanic whites, non-Hispanic blacks, and Hispanics, among a nationally representative US sample of adults with and without disabilities (N=63,257), using both bivariate and multivariate methods. We tested 2 definitions of disparity.

Results: Under the more conservative definition, we confirmed the presence of both racial and ethnic disparities in overall health, total annual health care visits, and the percentage reporting no doctor visit during the year among people with less severe disabilities; Hispanics also evidenced a disparity in rates uninsured relative to non-Hispanic whites in this group. Racial/ethnic disparities were less common among persons with more severe disabilities that affected activities of daily living or instrumental activities.

Conclusions: We conclude that the reduction of disparities between the populations of people with and without disabilities will require specific attention to racial and ethnic disparities in health, insurance coverage, and service use.

Figure 1. Differences in fair or poor overall health on the basis of race/ethnicity among persons with and without disability limitations: Covariate adjusted, predicted marginal percentages, MEPS 2006-2008 (pooled data)

Estimates based on logistic regression models controlling for age, sex, and beliefs about the importance of medical care and insurance. * differs significantly (p<.05) from the estimate for non-hispanic whites with the same disability status.

Figure 2. Any period without insurance coverage during the year on the basis of race/ethnicity among persons with and without disability limitations: Covariate adjusted, predicted marginal percentages, MEPS 2006-2008 (pooled data)

Estimates based on logistic regression models controlling for age, sex, overall health and beliefs about the importance of medical care and insurance. * differs significantly (p<.05) from the estimate for non-Hispanic whites with the same disability status.

Figure 3. Differences in annual healthcare utilization during the year on the basis of race/ethnicity among persons with and without disability limitations: Covariate adjusted, predicted marginal percentages, MEPS 2006-2008 (pooled data)

Estimates of total ambulatory health care visits based on loglink models controlling for age, sex, overall health and beliefs about the importance of medical care and insurance. * differs significantly (p<.05) from the estimate for non-Hispanic whites with the same disability status.