While the overall use of preventive services regardless of ethnicity is low, privately-insured minority adult patients with cerebral palsy or spina bifida are less likely to receive certain preventive services compared with privately-insured adult patients who are White, according to study findings published in the Annals of Family Medicine.
The onset of disabilities such as cerebral palsy and spina bifida generally occurs in young children. Adult patients with cerebral palsy or spina bifida are at higher risk for chronic diseases, hence they have a greater need for preventive treatment compared with the general population. For this study, researchers at the University of Michigan sought to analyze the disparities in use of preventive services, comparing adult patients who are White vs Black and adult patients who are White vs Hispanic diagnosed with either cerebral palsy or spina bifida.
The researchers identified 11,635 adults with either cerebral palsy or spina bifida, obtaining information from 2007 to 2017 through a private insurance database. Among these adults, there were 8935 adult patients who were White, 1457 who were Black, and 1243 who were Hispanic. Utilization of preventive services were assessed, including medical office visits, physical or occupational therapy, diabetes screening, bone density screening, cholesterol screening, and wellness visits.
The researchers discovered a low overall rate of usage of recommended preventive services among adults with cerebral palsy and spina bifida regardless of ethnicity.
Compared with adult patients with are White, adults who are Hispanic with cerebral palsy or spina bifida attended wellness visits less frequently (odds ratio [OR], 0.71; 95% CI, 0.53-0.96), but were more likely to receive diabetes screenings (OR, 1.47; 95% CI, 1.13-1.93).
Similarly, adults who are Black with cerebral palsy or spina bifida attended wellness visits and received bone density screenings less frequently than adults who are White (OR, 0.50; 95% CI, 0.24-1.00; OR, 0.54; 95% CI, 0.31-0.95, respectively).
“Interventions to address physical accessibility, adoption of telehealth, and increased clinician education may mitigate these disparities…” the researchers suggested. “It is imperative that health care systems target interventions to clinical settings that serve minority patients, where they could have the greatest impact,” they concluded.
One limitation included lack of representation of the overall population of patients with cerebral palsy and spina bifida, which was limited only to privately-insured adults. Other study limitations included selection bias, lack of accurate ethnoracial representation of the US population since it assessed only privately-insured adults, and not publicly insured patients. Additionally, use of claims data failed to capture personal, cultural, or lifestyle preferences of each person in the cohort as well as environmental barriers preventing access to these preventive services.
Groskaufmanis L, Lin P, Kamdar N, et al. Racial and ethnic inequities in use of preventive services among privately insured adults with a pediatric-onset disability. Ann Fam Med. 2022;20(5):430-437. doi:10.1370/afm.2849