Gender And Racial Disparities In Access To Health Care: The Coronary Artery Risk In Young Adults (Cardia) Study

Background: Changes in the US economy have led to national declines in access to health care and a widening of disparities. We aimed to examine trends in access to health care from 1992-2010 among Black and White men and women. Methods: We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-center cohort of black and white men and women. Having poor access to care was defined as having 1 or more of the following barriers to care: no insurance, no usual source of care, and did not seek care due to cost. Participant’s health care access was determined in 1992, 1995, 2000, 2005, and 2010. We used GEE regression models with a linear spline to examine the association of gender, race and time with health care access adjusting for age, measures of socioeconomic status and comorbidity as time-dependent covariates. Results: This study included 3,521 participants: 883 White men, 668 Black men, 983 Black women and 987 White women. Mean age was 32 years in 1992. Poor access to health care declined from 1992-2000 but then began increasing from 2000 to 2010. The adjusted prevalence of poor access to care was 25% in 1992, 22% in 1995, 15% in 2000, 17% in 2005 and 19% in 2010 (p-value Discussion: Access to health care improved through 2000 but has declined in the past decade; these patterns mirror changes in the economy and the recession. Men were much more likely to experience barriers to care, although this gender gap appears to be decreasing. The observed ethnic disparity in health care access may reflect underlying differences in educational attainment and education-related employment opportunities that enhance access to health care.