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

doi:10.1370/afm.2849

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Figure 1.
Unadjusted use of preventive services among privately insured White, Black, and Hispanic adults with cerebral palsy or spina bifida.
PT = physical therapy; OT = occupational therapy.
Note: data source is the 2007-2017 Clinformatics Data Mart (OptumInsight).

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Table 1.

Characteristics of White, Black, and Hispanic Adults With Cerebral Palsy/Spina Bifida

Characteristic	Total	White	Black	Hispanic
Sample size, No. (%)	11,635 (100.0)^{^a}	8,935 (76.8)	1,457 (12.5)	1,243 (10.7)
Full enrollment length, y
Mean (SD)	7.8 (3.3)	7.8 (3.3)	7.4 (3.1)	8.2 (3.6)
Median (Q1-Q3)	7.0 (5.0-9.8)	7.0 (5.0-9.8)	6.9 (5.0-9.0)	7.3 (5.3-10.5)
Age, y
Mean (SD)	45.5 (17.6)	45.6 (17.7)	46.3 (16.9)	44.1 (17.0)^{^b}
Sex, No. (%)
Female	6,537 (56.2)	4,964 (55.6)	881 (60.5)	692 (55.7)
Male	5,098 (43.8)	3,971 (44.4)	576 (39.5)	551 (44.3)
Elixhauser comorbidity score
Mean (SD)	2.0 (2.3)	2.0 (2.2)	2.5 (2.6)^{^b}	1.8 (2.2)^{^b}
Education, No. (%)
< 12th Grade	74 (0.6)^{^c}	17 (0.2)^{^c}	6 (0.4)^{^b,^c}	51 (4.1)^{^b}
High school or some college	9,870 (84.8)	7,420 (83.0)	1,383 (94.9)^{^b}	1,067 (85.8)^{^b}
Bachelor degree or higher	1,666 (14.3)	1,477 (16.5)	65 (4.5)^{^b}	124 (10.0)^{^b}
Unknown	25 (0.2)^{^c}	21 (0.2)^{^c}	3 (0.2)^{^c}	1 (0.1)^{^c}
Household income, $, No. (%)
<40,000	2,722 (23.4)	1,774 (19.9)	594 (40.8)^{^b}	354 (28.5)^{^b}
40,000-99,000	4,199 (36.1)	3,232 (36.2)	478 (32.8)^{^b}	489 (39.3)^{^b}
≥100,000	3,061 (26.3)	2,711 (30.3)	148 (10.2)^{^b}	202 (16.3)^{^b}
Unknown	1,653 (14.2)	1,218 (13.6)	237 (16.3)^{^b}	198 (15.9)^{^b}

CP = cerebral palsy; Q1-Q3 = Quartile 1 and Quartile 3; SP = spinal bifida.
Note: data source is the 2007-2017 Clinformatics Data Mart (OptumInsight). Data are unadjusted and unmatched.
↵a Number with each condition: CP n = 7,198; SB n = 4,437.
↵b Significant (P value <0.05).
↵c Less than 1%.

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Table 2.

Prevalence of Psychological, Cardiometabolic, and Musculoskeletal Conditions Among White, Black, and Hispanic Adults With Cerebral Palsy/Spina Bifida

Conditions	White No. (%)	Black No. (%)	Hispanic No. (%)
Psychological
Adjustment disorder	238 (2.66)	40 (2.75)	19 (1.53)^{^a}
Alcohol-related disorders	91 (1.02)	20 (1.37)	10 (0.80)
Anxiety disorders	930 (10.41)	148 (10.16)	104 (8.37)^{^a}
Central pain	444 (4.97)	84 (5.77)	49 (3.94)
Delirium	116 (1.30)	18 (1.24)	11 (0.88)
Impulse control disorder	36 (0.40)	4 (0.27)	4 (0.32)
Insomnia	321 (3.59)	49 (3.36)	51 (4.10)
Mood disorders	1,329 (14.87)	193 (13.25)	121 (9.73)^{^a}
Post-traumatic stress disorder	51 (0.57)	7 (0.48)	7 (0.56)
Personality disorders	31 (0.35)	8 (0.55)	2 (0.16)
Substance-related disorders	144 (1.61)	21 (1.44)	16 (1.29)
Cardiometabolic
Diabetes type II	863 (9.66)	241 (16.54)^{^a}	161 (12.95)^{^a}
Cardiac dysrhythmias	826 (9.24)	143 (9.81)	110 (8.85)
Chronic kidney disease	202 (2.26)	68 (4.67)^{^a}	36 (2.90)
Heart failure	221 (2.47)	81 (5.56)^{^a}	28 (2.25)
Hypercholesterolemia	912 (10.21)	179 (12.29)^{^a}	114 (9.17)
Hypertension	2,515 (28.15)	581 (39.88)^{^a}	277 (22.28)^{^a}
Liver disease; nonalcoholic	94 (1.05)	11 (0.75)	24 (1.93)^{^a}
Peripheral and visceral atherosclerosis	399 (4.47)	99 (6.79)^{^a}	39 (3.14)^{^a}
Musculoskeletal
Muscle atrophy	66 (0.74)	10 (0.69)	5 (0.40)
Myalgia	537 (6.01)	80 (5.49)	59 (4.75)
Osteoarthritis	991 (11.09)	195 (13.38)^{^a}	106 (8.53)^{^a}
Osteoporosis	421 (4.71)	59 (4.05)	47 (3.78)
Other connective tissue disorder	2,963 (33.16)	501 (34.39)	308 (24.78)^{^a}
Pathological fracture	71 (0.79)	4 (0.27)^{^a}	6 (0.48)
Rheumatoid arthritis	163 (1.82)	32 (2.20)	29 (2.33)

Note: data source is the 2007-2017 Clinformatics Data Mart (Optumlnsight).
↵a Significant (P value <0.05).

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Table 3.

Adjusted Predicted Racial/Ethnic Disparities in Use of Preventative Services Among White, Black, and Hispanic Adults With Cerebral Palsy/Spina Bifida

Outcome Variables	White, %	Hispanic, %	Hispanic, OR (95% CI)	White, %	Black, %	Black, OR (95% CI)
Any office visit	85	87	1.14 (0.57-2.29)	85	85	1.05 0.49-2.26)
Any PT/OT services	19	22	1.18 (0.93-1.51)	21	18	0.80 (0.58-1.10)
Annual wellness visit	30	23	0.71 (0.53-0.96)^{^a}	30	18	0.50 (0.24-1.00)^{^a}
Bone density examination	2	2	1.42 (0.92-2.21)	2	1	0.54 (0.31-0.95)^{^a}
Cholesterol examination	32	34	1.06 (0.51-2.21)	37	28	0.66 (0.33-1.33)
Diabetes examination	14	20	1.47 (1.13-1.93)	16	17	1.05 (0.72-1.53)

PT = physical therapy; OR = odds ratio; OT = occupational therapy.
Note: data source is the 2007-2017 Clinformatics Data Mart (OptumInsight). All corresponding regression results are presented in Supplemental Tables 5-17.
↵a Significant (P value <0.05).

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SUPPLEMENTAL DATA IN PDF BELOW

Supplemental Figure 1. Schematic Flow Diagram of Sample Population
Supplemental Figure 2. Unadjusted Use of Preventive Services Among White, Black, Hispanic, and Asian Adults
Supplemental Table 1. Diagnostic Codes for Cerebral Palsy and Spina Bifida
Supplemental Table 2. Medical Codes for Preventative Services
Supplemental Table 3. Diagnostic Codes for Comorbid Conditions
Supplemental Table 4. Descriptive Characteristics of White, Black, Hispanic, and Asian Adults (18-64) with CP/SB
Supplemental Table 5. Prevalence of Psychological, Cardiometabolic, and Musculoskeletal Conditions Among White, Black, Hispanic, and Asian Adults (18-64) With CP/SB
Supplemental Table 6. Post Matched Characteristics of White and Hispanic People With CP/SB
Supplemental Table 7. Post Matched Characteristics of White and Black People With CP/SB
Supplemental Table 8. Regression Results for Any Office Visit Between Hispanic and White
Supplemental Table 9. Regression Results for Any Office Visits Between Black and White
Supplemental Table 10. Regression Results for Wellness Visits Between Hispanic and White
Supplemental Table 11. Regression Results for Wellness Visits Between Black and White
Supplemental Table 12. Regression Results for Cholesterol Screening Between Hispanic and White
Supplemental Table 13. Regression Results for Cholesterol Screening Between Black and White
Supplemental Table 14. Regression Results for Diabetes Screening Between Black and White
Supplemental Table 16. Regression Results for PT/OT Between Hispanic and White
Supplemental Table 17. Regression Results for PT/OT Between Black and White
Supplemental Table 18. Regression Results for Bone Density Screening Between Hispanic and White
Supplemental Table 19. Regression Results for Bone Density Screening Between Black and White

Mahmoudi_Supp.pdf
VISUAL ABSTRACT IN PNG FILE BELOW

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