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Research ArticleOriginal Research

Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability

Lauren Groskaufmanis, Paul Lin, Neil Kamdar, Anam Khan, Mark D. Peterson, Michelle Meade and Elham Mahmoudi
The Annals of Family Medicine September 2022, 20 (5) 430-437; DOI: https://doi.org/10.1370/afm.2849
Lauren Groskaufmanis
1Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
MD
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Paul Lin
2Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
MS
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Neil Kamdar
2Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
3Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
4Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
5Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
6Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
7Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
MA
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Anam Khan
8School of Public Health, University of Michigan, Ann Arbor, Michigan
MS
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Mark D. Peterson
2Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
3Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
PhD, MS
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Michelle Meade
2Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
3Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
PhD
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Elham Mahmoudi
1Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
2Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
PhD
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  • For correspondence: Mahmoudi@med.umich.edu
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Abstract

PURPOSE Cerebral palsy (CP) and spina bifida (SB) are pediatric-onset disabilities. Adults living with CP/SB are in a greater need of preventive care than the general population due to their increased risk for chronic diseases. Our objective was to compare White/Black and White/Hispanic inequities in the use of preventive services.

METHODS Using 2007-2017 private claims data, we identified a total of 11,635 adults with CP/BS. Of these, 8,935 were White, 1,457 Black, and 1,243 Hispanic. We matched health-related variables (age, sex, comorbid conditions) between White adults and those in each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and US Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical/occupational therapy; (3) wellness visit; (4) bone density screening; (5) cholesterol screening; and (6) diabetes screening.

RESULTS The rate of recommended services for all subpopulations of adults with CP/SB was low. Compared with White adults, Hispanic adults had lower odds of wellness visits (odds ratio [OR] = 0.71, 95% CI, 0.53-0.96) but higher odds of diabetes screening (OR = 1.48, 95% CI, 1.13-1.93). Compared with White adults, Black adults had lower odds of wellness visits (OR = 0.50, 95% CI, 0.24-1.00) and bone density screening (OR = 0.54, 95% CI, 0.31-0.95).

CONCLUSIONS Preventive service use among adults with CP/SB was low. Large White-minority disparities in wellness visits were observed. Interventions to address physical accessibility, adoption of telehealth, and increased clinician education may mitigate these disparities, particularly if initiatives target minority populations.

Key words:
  • cerebral palsy
  • disability
  • health care disparity
  • preventive
  • spina bifida
  • Received for publication July 22, 2021.
  • Revision received April 27, 2022.
  • Accepted for publication May 4, 2022.
  • © 2022 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 20 (5)
The Annals of Family Medicine: 20 (5)
Vol. 20, Issue 5
September/October 2022
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Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability
Lauren Groskaufmanis, Paul Lin, Neil Kamdar, Anam Khan, Mark D. Peterson, Michelle Meade, Elham Mahmoudi
The Annals of Family Medicine Sep 2022, 20 (5) 430-437; DOI: 10.1370/afm.2849

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Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability
Lauren Groskaufmanis, Paul Lin, Neil Kamdar, Anam Khan, Mark D. Peterson, Michelle Meade, Elham Mahmoudi
The Annals of Family Medicine Sep 2022, 20 (5) 430-437; DOI: 10.1370/afm.2849
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Keywords

  • cerebral palsy
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  • health care disparity
  • preventive
  • spina bifida

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