title: Disparities in access to health care among middle-aged and older adults with disabilities.
abstract: Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n=13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.
authors.affiliation: a Department of Public Policy, Doctoral Program in Gerontology , University of Maryland, Baltimore County , Baltimore , Maryland , USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Miller
authors.forename: Adele
authors.initials: A
authors.lastname: Kirk
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaiser
authors.forename: Lukas
authors.initials: L
authors.lastname: Glos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: disability; disparities; race and ethnicity; socioeconomic status