Changes in US health care access in the 90s: race and income differences from the CARDIA Study. Coronary Artery Risk Development in Young Adults

UMMS Affiliation

Department of Quantitative Health Sciences

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Adolescent; Adult; African Americans; Cohort Studies; European Continental Ancestry Group; Female; Financing, Personal; Health Services Accessibility; data; Health Services Research; Humans; *Income; Insurance Coverage; Longitudinal Studies; Male; Prospective Studies; United States; Urban Population


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


OBJECTIVE: Health care financing is changing rapidly in the United States. We investigated whether and how health care access is changing concurrently with changes in financing, with special attention to a minority population.

METHODS: We examined a longitudinal biracial (half African-American, half White) urban cohort of 3,565 individuals, aged 25-37 years old, in 1992-93 and again in 1995-96. We measured access by self-reported (1) health insurance status, (2) regular source of medical care, and (3) lack of care due to financial problems.

RESULTS: In 1992-93, 30.3% of the cohort experienced at least one access barrier, with a decline to 26.8% in 1995-96 (P<.005). However, access improved more for Whites than for African Americans; and access improved for higher, but not for lower, income groups (7% improvement for high income, vs 2% deterioration for lower income, P<.01). In addition, there was an 11% to 19% absolute increase in individuals making co-payments for health care utilization across all race/sex groups, with African Americans having markedly higher proportions of cost-sharing. African-American, low income, and unemployed individuals reported more acute care, but fewer outpatient visits. Income and employment explained racial differences.

CONCLUSION: While access has improved or stabilized for higher income groups, there is a widening gap according to income, accompanied by an acute care pattern for low income groups that may be both inadequate and cost inefficient.


Ethn Dis. 2000 Autumn;10(3):418-31.

Journal/Book/Conference Title

Ethnicity and disease

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