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Forgoing Physician Visits Because of Cost: A Source of Health Disparities for Elderly People With Disabilities?

  • Jae Chul Lee
    Correspondence
    Reprint requests to Jae Chul Lee, PhD, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL 60611-3152
    Affiliations
    Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
    Search for articles by this author
  • Allen W. Heinemann
    Affiliations
    Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL

    Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
    Search for articles by this author

      Abstract

      Lee JC, Heinemann AW. Forgoing physician visits because of cost: a source of health disparities for elderly people with disabilities?

      Objective

      To examine disparities in having a usual source of care and forgoing physician visits because of cost between elderly people (age ≥65y) with and without disabilities after consecutively controlling for predisposing, enabling, and perceived and evaluated health need factors using the Andersen behavioral model, and to identify the determinants of such disparities.

      Design

      Cross-sectional analysis.

      Setting

      Community.

      Participants

      Nationally representative sample of community-dwelling adults age 65 years or greater in the United States from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) (N=93,933).

      Interventions

      Not applicable.

      Main Outcome Measures

      Responses to 2 BRFSS questions: (1) whether the respondent had a health care provider, and (2) whether the respondent had forgone seeing a physician because of cost in the past 12 months.

      Results

      After controlling for the aforementioned factors, elderly persons with disabilities were more likely than their counterparts without disabilities to have a usual source of care (adjusted odds ratio [AOR]=1.33; 95% confidence interval [CI], 1.08–1.64), and those with disabilities were more likely to forgo physician visits because of cost (AOR=1.64; 95% CI, 1.31–2.04). The unadjusted odds of forgoing physician visits (odds ratio [OR]=2.13; 95% CI, 1.87–2.43) did not decrease after controlling for predisposing factors (AOR=2.32; 95% CI, 1.96–2.75), whereas the odds were attenuated after controlling for enabling factors (AOR=2.18; 95% CI, 1.84–2.59), perceived health need (AOR=1.70; 95% CI, 1.37–2.12), and evaluated health need (AOR=1.64; 95% CI, 1.31–2.04).

      Conclusions

      Although elderly people with disabilities were more likely than their counterparts without disabilities to have a usual source of care, those with disabilities were more likely to forgo physician visits because of cost. Elderly persons with greater perceived health needs were most likely to experience the disparity.

      Key Words

      List of Abbreviations:

      AOR (adjusted odds ratio), BRFSS (Behavioral Risk Factor Surveillance System), CI (confidence interval), MI (multiple imputation), OR (odds ratio)
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