title: Usual source of care and unmet health care needs: interaction of disability with race and ethnicity.
abstract: BACKGROUND
  Having a usual source of care (USC) and having unmet health care needs have been found to vary in relation to sociodemographic differences in the US population, including race, ethnicity, and disability status. People in underserved racial and ethnic groups who also have a disability may experience a complex mix of health care advantages and disparities. However, little is known about this intersection.
  
  
  OBJECTIVE
  To determine how disability status, combined with membership in an underserved racial or ethnic group, is associated with having a USC and unmet health care needs.
  
  
  METHODS
  We conducted multivariate regression analyses of 2002-2010 data from the Medical Expenditure Panel Survey, focused on working age adults (18-64 y).
  
  
  RESULTS
  Although most racial and ethnic groups were less likely to have a USC than non-Hispanic whites, people with disabilities were more likely to have a USC; Hispanics with basic activity limitations were the only disability group with elevated odds of lacking a USC. Conversely, disability was strongly associated with unmet health care needs, but we did not find inflated impacts of both having a disability and belonging to an underserved racial or ethnic group.
  
  
  CONCLUSIONS
  We found limited evidence of interaction or additive effects of disability and race/ethnicity but did confirm separate disparities for each. Ongoing research is needed to track both disability-related and racial/ethnic disparities, to determine whether increased insurance coverage, provider training, care coordination, and other efforts under the Affordable Care Act lead to reductions in disparities.
authors.affiliation: Institute on Development & Disability, Oregon Health & Science University, Portland, OR.
authors.forename: Willi
authors.initials: W
authors.lastname: Horner-Johnson
authors.forename: Konrad
authors.initials: K
authors.lastname: Dobbertin
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000208:ethnology*; D006233:Persons with Disabilities; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D014481:United States