Pounds of cure: Access to preventive care for working-age adults

Access to preventive health services is essential for maintaining public health. This is especially true for people with disabilities, many of who also have multiple chronic health conditions. In 2014, more than 20 million Americans reported having a disability, ranging from vision and hearing impairments to various physical limitations. To date, research on access to preventive services by people with disabilities has focused mostly on older adults on Medicare, but little has been done to study how working-age adults, many of whom rely on employer-sponsored health insurance, access preventive care.

Preeti Zanwar, PhD, MPH, instructional assistant professor in the Texas A&M School of Public Health, Gilbert Gimm, PhD, associate professor from George Mason University, and Elizabeth Wood, MHPA, a doctoral candidate from Washington State University, completed a research study on how working-age adults access preventive health services and how disabilities affect health care. Their study, published in the Archives of Physical Medicine and Rehabilitation, used nationally representative survey data on 75,145 non-institutionalized, working-age Americans from 18-64 years old between 2003 and 2012 to see whether disabilities affected access to three preventive services: blood pressure checks, flu vaccinations and dental visits.

Working-age adults were divided into three groups: those with physical limitations, those with nonphysical limitations and those without limitations.

“To control for confounding effects, we took individual demographic factors like age, sex, race and ethnicity, income and education into account,” Zanwar said. “We also considered whether subjects had chronic health conditions like high blood pressure or diabetes, type of health insurance coverage, and whether they had a regular health care provider.”

The research team’s analysis found that working-age adults with disabilities were more likely to receive blood pressure screenings and flu shots than those without disabilities. However, there was no significant difference in flu shot rates for people with nonphysical limitations and those with no limitations. On the other hand, people with both physical and nonphysical limitations were less likely to receive regular dental care. Women were more likely to receive blood pressure checks and flu shots as were subjects with health insurance.

“Having a regular physician also affects access to services, with adults reporting a regular source of care being three times more likely to receive blood pressure checks and twice as likely to receive flu shots and dental care,” Zanwar said.

This study adds to the existing research on disparities in access to preventive care, but the findings do not show a causal role for any of the factors studied. Further research will be needed to show how chronic health conditions affect physical limitations and access to care by gender. However, the findings do have implications for health care providers and policymakers. The first of these is the need to better understand how socioeconomic factors affect access to care and how best to overcome such obstacles. Second is the need to maintain health insurance coverage for people across the board. Related to this is the need to help adults maintain continuity of care by making sure health insurance plans have adequate provider networks and to make preventive care more accessible for people with disabilities.

“These findings help to shed light on how physical and nonphysical limitations, among other factors, affect access to preventive care,” Zanwar said. “With better knowledge, providers and policymakers will be better able to make it easier for all working-age adults to get the care they need to live healthier lives.”