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)

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.