title: Vulnerability and unmet health care needs. The influence of multiple risk factors.
abstract: BACKGROUND
  Previous studies have demonstrated a strong association between minority race, low socioeconomic status (SES), and lack of potential access to care (e.g., no insurance coverage and no regular source of care) and poor receipt of health care services. Most studies have examined the independent effects of these risk factors for poor access, but more practical models are needed to account for the clustering of multiple risks.
  
  
  OBJECTIVE
  To present a profile of risk factors for poor access based on income, insurance coverage, and having a regular source of care, and examine the association of the profiles with unmet health care needs due to cost. Relationships are examined by race/ethnicity.
  
  
  METHODS
  Analysis of 32,374 adults from the 2000 National Health Interview Survey.
  
  
  METHODS
  Reported unmet needs due to cost: missing/delaying needed medical care, and delaying obtaining prescriptions, mental health care, or dental care.
  
  
  RESULTS
  Controlling for personal demographic and community factors, individuals who were low income, uninsured, and had no regular source of care were more likely to miss or delay needed health care services due to cost. After controlling for these risk factors, whites were more likely than other racial/ethnic groups to report unmet needs. When presented as a risk profile, a clear gradient existed in the likelihood of having an unmet need according to the number of risk factors, regardless of racial/ethnic group.
  
  
  CONCLUSIONS
  Unmet health care needs due to cost increased with higher risk profiles for each racial and ethnic group. Without attention to these co-occurring risk factors for poor access, it is unlikely that substantial reductions in disparities will be made in assuring access to needed health care services among vulnerable populations.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA. lshi@jhsph.edu
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Stevens
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D017057:Medically Uninsured / Q000208:ethnology; D008875:Middle Aged; D011203:Poverty / Q000208:ethnology; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D035862:Vulnerable Populations / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data