title: Disparities in access to health care among adults with physical disabilities: analysis of a representative national sample for a ten-year period.
abstract: BACKGROUND
  People with physical disabilities are the largest underserved subpopulation in the U.S. However, disparities in access to health care and how these have changed over time have not been fully explored.
  
  
  OBJECTIVE
  To examine national trends in disparities in access to health care and to identify the impact of physical disability and the personal factors that are associated with unmet health care needs, defined as self-reported ability to get medical care, dental care or prescription medications, among working age adults within the United States.
  
  
  METHODS
  Logistic regression analysis of a nationally representative sample of adults ages 25-64 (n = 163,220) with and without physical disabilities, using pooled data from the 2002-2011 Medical Expenditure Panel Survey.
  
  
  RESULTS
  Individuals with physical disabilities have 75% (p < 0.0001), 57% (p < 0.0001), and 85% (p < 0.000) higher odds of having unmet medical, dental, and prescription medication needs, respectively. Sociodemographic and health factors were related to unmet needs in all three measures of access to care. In particular, being female, living at or near the poverty level, and lacking health insurance increased the odds of unmet health care needs. Predicted probabilities of unmet health care needs from 2002 to 2011 show persistent gaps between individuals with and without physical disabilities, with a growing gap in unmet dental care (p = 0.004).
  
  
  CONCLUSIONS
  Having physical disabilities increase the odds of unmet health care needs. This study has important policy and community program implications. The Affordable Care Act could significantly reduce unmet health care needs, especially among individuals with physical disabilities.
authors.affiliation: Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: mahmoudi@med.umich.ed.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Meade
mesh_terms: D000328:Adult; D003729:Dental Care; D006233:Persons with Disabilities; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000639:trends; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011203:Poverty; D055553:Prescription Drugs; D012737:Sex Factors; D014481:United States
chemical_list: D055553:Prescription Drugs
keywords: Access; Disability; Disparity; Health care