Do racial and ethnic disparities in health care use vary with health?
OBJECTIVE
To determine the relationship between health status and the magnitude of black-white and Hispanic-white disparities in the likelihood of having any office-based or hospital outpatient department visits, as well as number of visits.


DATA SOURCE
2010-2014 Medical Expenditure Panel Survey.


STUDY DESIGN
The probability of having a visit is modeled using a Probit model, and the number of visits using a negative binomial model. We use a nonlinear rank-and-replace method to adjust minority health status to be comparable to that of whites, and predict utilization at different levels of health by fixing an indicator of health status. We compare estimated differences in predicted utilization across racial/ethnic groups for each level of health status to map out the relationship between the racial/ethnic disparity and health status, also stratifying by health insurance coverage.


EXTRACTION METHODS
We subset to nonelderly adults.


PRINCIPAL FINDINGS
We find that Hispanic-white differences in the probability of having an office-based or hospital outpatient department were widest among adults in excellent health (27 percentage points, 95% CI: [23, 31]) and narrowest when reporting poor or fair health (15 p.p. [13, 17]). Black-white and Hispanic-white differences in the number of visits were wider for adults who report poor or fair health (5.3 visits [4.0, 6.6] and 5.7 [4.3, 7.0], respectively) compared to excellent health (1.7 [1.2, 2.1] and 1.5 [1.1, 2.0], respectively) among adults who are full-year privately insured.


CONCLUSIONS
The magnitudes of racial/ethnic disparities vary with level of health.
['Biener|Adam I|AI|0000-0001-5510-7284', 'Zuvekas|Samuel H|SH|']
D000328:Adult D001741:African Americans D005260:Female D006297:Health Services Accessibility D054625:Healthcare Disparities D006630:Hispanic or Latino D006801:Humans D019458:Insurance Coverage D008297:Male D017057:Medically Uninsured D009819:Office Visits D014481:United States D044465:Whites
racial and ethnic disparities health care utilization perceived health