Local Income Inequality, Individual Socioeconomic Status, and Unmet Healthcare Needs in Ohio, USA.

Dmitry Tumin,Emily A Shrider,Michael Nau,Michelle Menegay,Rachel Tumin

doi:10.1089/heq.2017.0058

Abstract

Purpose: Income inequality has been implicated as a potential risk to population health due to lower provision of healthcare services in deeply unequal countries or communities. We tested whether county economic inequality was associated with individual self-report of unmet healthcare needs using a state health survey data set.Methods: Adults residents of Ohio responding to the 2015 Ohio Medicaid Assessment Survey were included in the analysis. Ohio's 88 counties were classified into quartiles according to the Gini coefficient of income inequality. The primary outcome was a composite of self-reported unmet dental care, vision care, mental healthcare, prescription medication, or other healthcare needs within the past year. Unmet healthcare needs were compared according to county inequality quartile using weighted logistic regression.Results: The analytic sample included 37,140 adults. The weighted proportion of adults with unmet healthcare needs was 28%. In multivariable logistic regression, residents of counties in the highest (odds ratio [OR]=1.13, 95% confidence interval [CI]: 1.01–1.26; p=0.030) and second-highest (OR=1.16, 95% CI: 1.04–1.30; p=0.010) quartiles of income inequality experienced more unmet healthcare needs than residents of the most equal counties.Conclusion: Higher county-level income inequality was associated with individual unmet healthcare needs in a large state survey. This finding represents novel evidence for an individual-level association that may explain aggregate-level associations between community economic inequality and population health outcomes.

Highlights

Unequal access to healthcare is an important mechanism mediating socioeconomic disparities in health status
Data for the study were obtained from the 2015 Ohio Medicaid Assessment Survey (OMAS), a cellphone and landline telephone survey of noninstitutionalized adults living in Ohio.[28]
Using a state health survey uniquely designed for inference at the county level, the present study demonstrates that unmet healthcare needs are more common among residents of counties with higher levels of economic inequality than among residents of economically equal counties

Summary

Introduction

Unequal access to healthcare is an important mechanism mediating socioeconomic disparities in health status. Health advantages accrue to people with higher income, greater educational attainment, and full-time employment due to, in part, better health insurance coverage and greater access to primary and specialty medical care.[1,2,3,4] Even among adults with private insurance coverage, many have high deductibles and out-ofpocket costs, leading families to forgo needed medical care because of cost.[5] This may initiate a vicious spiral wherein poor health itself increases the risk of unmet healthcare needs,[6] defined as the difference between health services necessary to deal with a particular health problem and the actual services a person receives.[7] Estimates of the prevalence of unmet healthcare needs vary according to the study population and the specific operationalization of this concept. Before the enactment of the Patient Protection and Affordable Care Act in 2010, 10% of American adults self-reported unmet healthcare needs,[8] whereas *23% had no usual source of medical care

Methods

Results

Discussion

Conclusion