When difference becomes disparity: Health status and health service utilization on the basis of race and ethnicity among U.S. adults with disabilities

In Healthy People 2010 and the 2005 Surgeon General's Call to Improve the Health and Wellness of People with Disabilities, national health policy goals were set to reduce health disparities not only among racial and ethnic population groups, but among people with disabilities. Today we have an extensive literature on racial and ethnic disparities in health and access to health services, a smaller number of studies concerning disparities based on disability, and very little at the intersection of these population groups. In order to address this gap, we investigated health status and service utilization differences on the basis of race and Hispanic ethnicity among several groups of persons with disabilities (distinguished on the basis of presence or absence of ADL/IADL limitations) and a contrast group of adults without disabilities. Examining pooled annual data from the 2002-2004 Medical Expenditure Panel Survey, we found racial and ethnic differences in several key measures of health status and service use not only for the non-disabled, but among adults with disabilities. For example, among those with disabilities not affecting ADLs/IADLs, 46.7% of non-Hispanic whites rated their overall health as fair or poor, compared to 60.4% of non-Hispanic blacks and 61.2% of Hispanics. Despite their worse self-rated health relative to whites, non-Hispanic blacks and Hispanics in this disability group each had significantly lower ambulatory visit rates than did non-Hispanic whites. Multivariate models controlling for predisposing, enabling and need-related factors reduced, but did not eliminate these significant differences based on race / ethnicity among people with disabilities.