219324 When difference becomes disparity: Health status and health service utilization on the basis of race and ethnicity among U.S. adults with disabilities

Wednesday, November 10, 2010 : 10:30 AM - 10:48 AM

Stephen Gulley, PhD, MSW , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
Elizabeth K. Rasch, PT, PhD , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
Leighton Chan, MD, MPH , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
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.

Learning Areas:
Advocacy for health and health education
Diversity and culture
Provision of health care to the public

Learning Objectives:
Learning objectives: At the conclusion of the session, the participant will be able to: 1) Define the term disparity as it differentially relates to racial and ethnic groups and people with disabilities; 2) Explain both the strengths and limitations of using survey data to measure potential health disparities among people with disabilities; 3) Describe potential disparities in health status and health service use on the basis of race/ethnicity among U.S. community dwelling persons with disabilities aged 18 and up; 4) Tell colleagues about the importance of clear definitions, careful measurements and consistent methods when analyzing and reporting health disparities for people with and without disabilities.

Keywords: Health Disparities, Disability Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I have worked extensively with survey data on people with disabilities and quantitative research methods; I have published my work in peer-reviewed journals and have presented at national conferences before, including APHA; I teach in the area of health policy and disability at Brandeis University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.