Online Program

Insurance status and disparities in health access and health status of men aged 18 to 64 in Massachusetts: An examination of data from a local-level behavioral risk factor surveillance survey (BRFSS)

Monday, November 4, 2013 : 2:30 p.m. - 2:50 p.m.

Lisa Arsenault, PhD, Institute for Community Health, Institute for Community Health, Cambridge, MA
Shalini Tendulkar, ScD, ScM, Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Stacey King, MS, Cambridge Public Health Department, Cambridge, MA
Albert Pless Jr., MS, Cambridge Public Health Department, Cambridge, MA
Derek Arledge, Cambridge Public Health Department, Cambridge, MA
Lise Fried, DSc, MS, Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Background: Men of color and low SES experience disparities in both healthcare access and health status. Massachusetts, since its 2006 healthcare insurance reform, has achieved the lowest rate of uninsured in the US; yet state level BRFSS data suggest that despite universal coverage gains, disparities remained consistent between 2006 and 2008. This analysis uses local-level BRFSS data collected in 2008 to examine the role insurance status may play in racial/economic disparities among men (age 18-64). Methods: The 2008 5-Cities in Massachusetts BRFSS was conducted in 5 communities neighboring Boston, MA. The survey was a stratified, random sample of telephone-equipped households which included demographic, insurance coverage, healthcare access and health status questions. Analyses were weighted to account for the sampling scheme. Results: Uninsured rates were 9.5% for men of color compared to 5.1% for white, non-Hispanic men. After adjusting for age and income, men of color were more likely to report healthcare cost barriers (OR=1.26 95% CI: 1.19-1.32). However stratified analyses further suggested this racial disparity was fully attenuated among those with health insurance (OR=1.05; 95% CI: 0.96-1.09) and exaggerated among those without health insurance (OR=3.68; 95% CI 3.15-4.30). Similar findings were observed for other indicators of healthcare access and health status as well as in comparisons of men by income. Conclusions: Insurance coverage remains a key factor in healthcare access. Aggregate analyses of population-level data may obscure important effects of coverage among minority and disadvantaged groups. Examining disparities between groups that have similar insurance statuses may yield more informative results.

Learning Areas:

Public health or related public policy

Learning Objectives:
Explain the methodology utilized in population based surveillance studies. Identify benefits of increased health care access on the health of minority and disadvantaged populations of men.

Keyword(s): Access to Health Care, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been an epidemiologist at the Institute for Community Health (ICH) and lead analyst on the 5-City BRFSS study for the past 4 years. As we are part of a safety net hospital in MA, the majority of my work is related to community-based program evaluation, disparities research, and analysis of data related to healthcare access and utilization and outcomes of physical and mental health in vulnerable populations.
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.