title: Disparities in health care utilization by race among teenagers and young adults with muscular dystrophy.
abstract: BACKGROUND
  For people with muscular dystrophy (MD) health care access is crucial and utilization is expected to be high. A multidisciplinary approach is needed for optimal management of symptoms of this rare condition. Regular primary care, specialty care, therapy, and medicine use can improve quality of care and reduce need for emergency treatment and hospitalization. We analyzed health insurance and administrative data to test for racial disparities in regular care use among teenagers and young adults with MD.
  
  
  METHODS
  We used South Carolina Medicaid and other administrative data for individuals aged 15-24 years to determine annual health care utilization patterns for individuals with MD by race. We studied adolescents and young adults with MD because this age group represents a time when the condition is typically intensifying and the transition from pediatric to adult care is expected. We used Generalized Estimating Equation models to analyze longitudinal utilization data conditional on other factors that may lead to utilization differences.
  
  
  RESULTS
  Race is correlated with health care utilization among adolescents and young adults with MD. Blacks have lower overall utilization, and less primary care, therapy, and specialist care use but higher incidence of hospitalization and emergency treatment use compared with whites and also to other races. The most striking disparity was the use of outpatient services. Blacks utilized these services 50% less compared with whites and 70% less compared with others. Even in regression analysis, where we take into account individual unobserved factors and allow clustering at the individual level, these differences remained and were in most cases statistically significant.
  
  
  CONCLUSIONS
  Our results indicate that there are differences in health care utilization by race even when individuals have access to the same health care benefits. This means simply offering coverage to individuals with MD may not be sufficient in eliminating health disparities. Future studies will be needed to examine other possible sources of these racial disparities, such as resource awareness, health knowledge, or access barriers such as transportation.
authors.affiliation: *Department of Economics, Moore School of Business †Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina ‡Department of Family and Preventive Medicine, University of South Carolina School of Medicine §Division of Research and Statistics, South Carolina Budget and Control Board, Columbia, SC ∥Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA.
authors.forename: Orgul D
authors.initials: OD
authors.lastname: Ozturk
authors.forename: Suzanne
authors.initials: S
authors.lastname: McDermott
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Mann
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.forename: Julie A
authors.initials: JA
authors.lastname: Royer
authors.forename: Lijing
authors.initials: L
authors.lastname: Ouyang
mesh_terms: D000293:Adolescent; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009136:Muscular Dystrophies / Q000208:ethnology*; D013022:South Carolina; D060305:Transition to Adult Care; D014481:United States; D055815:Young Adult