Diverging Racial and Ethnic Disparities in Access to Physician Care Comparing 2000 and 2007
ABSTRACT To examine recent changes in racial and ethnic disparities in access to physician services in the United States, and investigate the economic factors driving the changes observed.
Using nationally representative data on adults aged 25-64 from the 2000 and 2007 Medical Expenditure Panel Survey, we examine changes in two measures of access: whether the individual reported having a usual source of care, and whether he/she had any doctor visits during the past year. In each year, we calculate disparities in access between African Americans and Whites, and between Hispanics and Whites, applying the Institute of Medicine's definition of a disparity. Nonlinear regression decomposition techniques are then used to quantify how changes in personal characteristics, comparing 2000 and 2007, helped shape the changes observed.
Large disparities in access to physician care were evident for both minority groups in 2000 and 2007. Disparities in no doctor visits during the past year diminished for African Americans, but disparities in both measures worsened sharply for Hispanics.
Disparities in access to physician care are improving for African Americans in one dimension, but eroding for Hispanics in multiple dimensions. The most important contributing factors to the growing disparities between Hispanics and Whites are health insurance, education, and income differences.
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ABSTRACT: OBJECTIVE: We conducted a descriptive study of the correlates of refusal and acceptance of human papillomavirus (HPV) vaccination by rural parents of preadolescent and adolescent children. We hypothesized that the correlates of parents who allow their children aged 9 to 13 years to get the HPV vaccine and those of parents who do not allow vaccination would differ significantly. METHODS: This cross-sectional study was implemented during the school years 2009-2011 in the elementary and middle schools of three rural counties in Georgia. Parents were recruited at school functions to complete an anonymous validated survey. RESULTS: Parents who chose to vaccinate their children or intended to vaccinate were twice as likely to be from a race other than African American and 2.7 times more likely to have a religion other than Baptist. Using stepwise logistic regression and after adjustment for race and religion, we found that parents who had vaccinated or intended to vaccinate had significantly higher scores on perceived barriers (1.02 times more likely to vaccinate) and lower scores on perceived benefits (1.01 times more likely to vaccinate) (model p < .001). CONCLUSIONS: The results suggest that healthcare providers in rural areas can increase HPV vaccine uptake and reduce HPV-related cancers by using a multifaceted approach to educating their patients within the context of the patients' cultural values, geographic location, and economic situation. Such an approach could dispel misinformation and increase vaccine uptake.Journal of Adolescent Health 11/2012; 52(5). DOI:10.1016/j.jadohealth.2012.08.011 · 2.75 Impact Factor
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ABSTRACT: Objectives.To compare racial/ethnic disparities in access to physician services among older adults in 2000 and 2007 and to identify potential factors driving the changes observed.Method.Using 2000 and 2007 Medical Expenditure Panel Survey data, we examine 2 measures of access for adults aged 65 and older: whether the individual reports of having a usual source of care (USC) and whether he/she made any physician visits during the past year. We model the determinants of access using logistic regressions and then calculate disparities in access between older African Americans and older Whites and between older Hispanics and older Whites applying a disparity definition suggested by the Institute of Medicine. RESULTS: In both 2000 and 2007, significant racial/ethnic disparities were evident in having no USC and in having no physician visits. Over the period, the disparity in having no physician visits diminished by 6.16% (p = .003) for African Americans, but it worsened by 5.28% (p = .021) for Hispanics. These changes were associated with a positive shift in the distribution of education among older African Americans and an erosion in Medicare among Hispanic seniors. CONCLUSION: Among older adults, disparities in access to physician services have diminished for African Americans but have grown worse for Hispanics.The Journals of Gerontology Series B Psychological Sciences and Social Sciences 12/2012; DOI:10.1093/geronb/gbs105 · 2.85 Impact Factor
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ABSTRACT: BACKGROUND: Diabetes has long been a leading cause of death in the United States, and worldwide. Diabetes-related preventive services are recommended to delay or to avoid diabetes complications. Racial disparity in the receipt of diabetes preventive care is well documented; however, little is known about the contributors to this disparity. OBJECTIVE: This study aims to explore potential mediators linking race/ethnic disparities to reduced receipt of preventive care, and to better understand the dynamics underlying the relationships between race/ethnic characteristics and preventive care. Implications for pharmacist roles are explored. METHODS: This study used 2008 Medical Expenditure Panel Survey (MEPS) data. The outcome of diabetes preventive care was assessed by participants' self-reports in MEPS. Household income and health insurance coverage were identified as potential mediators based on Andersen's Health Care Utilization Behavior model. Logistic regression was used to examine the direct effects of study independent variables on diabetes preventive care. Path analysis was conducted to identify racial disparities' direct and indirect effects on diabetes preventive care via potential mediators. All estimates were weighted to the U.S. non-institutionalized population. RESULTS: Racial differences occurred with respect to receiving A1C tests, diabetic foot exams, and eye exams. After controlling for patient age, gender, living area, income, and health insurance status, racial differences persisted in diabetes preventive care. Hispanics were the least likely to receive all three elements of diabetes preventive care. In addition, patients were less likely to receive diabetes preventive care who were younger, lived in rural areas, had lower family income and were uninsured. A lower rate of diabetes preventive care in minority patients was partially explained by their higher rate of being uninsured or having low family income. CONCLUSION: The results suggest that minority, rural, low-income, uninsured, and young diabetes patients are at a higher risk of not receiving diabetes preventive care. This study is unique in its use of path analysis to assess racial disparities in diabetes preventive care and to do so drawing on Andersen's Health Care Utilization Behavior model. In response to the disparity findings which were reinforced in this study, pharmacists have a need and an opportunity to help identify and address important gaps in diabetes preventive care through diabetes patient assessment, education, referral, and monitoring.Research in Social and Administrative Pharmacy 12/2012; 9(6). DOI:10.1016/j.sapharm.2012.11.005 · 2.35 Impact Factor