wow-inequalities/02-data/intermediate/wos_sample/905847cba4f507236cff3df1817d50aa-okoro-catherine-a./info.yaml

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abstract: 'Problem/Condition: As a result of the 2010 Patient Protection and
Affordable Care Act, millions of U.S. adults attained health insurance
coverage. However, millions of adults remain uninsured or underinsured.
Compared with adults without barriers to health care, adults who lack
health insurance coverage, have coverage gaps, or skip or delay care
because of limited personal finances might face increased risk for poor
physical and mental health and premature mortality.
Period Covered: 2014.
Description of System: The Behavioral Risk Factor Surveillance System
(BRFSS) is an ongoing, state-based, landline- and cellular-telephone
survey of noninstitutionalized adults aged 18 years residing in the
United States. Data are collected from states, the District of Columbia,
and participating U.S. territories on health risk behaviors, chronic
health conditions, health care access, and use of clinical preventive
services (CPS). An optional Health Care Access module was included in
the 2014 BRFSS.
This report summarizes 2014 BRFSS data from all 50 states and the
District of Columbia on health care access and use of selected CPS
recommended by the U.S. Preventive Services Task Force or the Advisory
Committee on Immunization Practices among working-aged adults (aged
18-64 years), by state, state Medicaid expansion status, expanded
geographic region, and federal poverty level (FPL). This report also
provides analysis of primary type of health insurance coverage at the
time of interview, continuity of health insurance coverage during the
preceding 12 months, and other health care access measures (i.e., unmet
health care need because of cost, unmet prescription need because of
cost, medical debt {[}medical bills being paid off over time], number of
health care visits during the preceding year, and satisfaction with
received health care) from 43 states that included questions from the
optional BRFSS Health Care Access module.
Results: In 2014, health insurance coverage and other health care access
measures varied substantially by state, state Medicaid expansion status,
expanded geographic region (i.e., states categorized geographically into
nine regions), and FPL category. The following proportions refer to the
range of estimated prevalence for health insurance and other health care
access measures by examined geographical unit (unless otherwise
specified), as reported by respondents. Among adults with health
insurance coverage, the range was 70.8\%-94.5\% for states,
78.8\%-94.5\% for Medicaid expansion states, 70.8\%-89.1\% for
nonexpansion states, 73.3\%-91.0\% for expanded geographic regions, and
64.2\%-95.8\% for FPL categories. Among adults who had a usual source of
health care, the range was 57.2\%-86.6\% for states, 57.2\%-86.6\% for
Medicaid expansion states, 61.8\%-83.9\% for nonexpansion states,
64.4\%-83.6\% for expanded geographic regions, and 61.0\%-81.6\% for FPL
categories. Among adults who received a routine checkup, the range was
52.1\%-75.5\% for states, 56.0\%-75.5\% for Medicaid expansion states,
52.1\%-71.1\% for nonexpansion states, 56.8\%-70.2\% for expanded
geographic regions, and 59.9\%-69.2\% for FPL categories. Among adults
who had unmet health care need because of cost, the range was
8.0\%-23.1\% for states, 8.0\%-21.9\% for Medicaid expansion states,
11.9\%-23.1\% for nonexpansion states, 11.6\%-20.3\% for expanded
geographic regions, and 5.3\%-32.9\% for FPL categories. Estimated
prevalence of cancer screenings, influenza vaccination, and having ever
been tested for human immunodeficiency virus also varied by state, state
Medicaid expansion status, expanded geographic region, and FPL category.
The prevalence of insurance coverage varied by approximately 25
percentage points among racial/ethnic groups (range: 63.9\% among
Hispanics to 88.4\% among non-Hispanic Asians) and by approximately 32
percentage points by FPL category (range: 64.2\% among adults with
household income <100\% of FPL to 95.8\% among adults with household
income >400\% of FPL). The prevalence of unmet health care need because
of cost varied by nearly 14 percentage points among racial/ethnic groups
(range: 11.3\% among non-Hispanic Asians to 25.0\% among Hispanics), by
approximately 17 percentage points among adults with and without
disabilities (30.8\% versus 13.7\%), and by approximately 28 percentage
points by FPL category (range: 5.3\% among adults with household income
>400\% of FPL to 32.9\% among adults with household income <100\% of
FPL).
Among the 43 states that included questions from the optional module, a
majority of adults reported private health insurance coverage (63.4\%),
followed by public health plan coverage (19.4\%) and no primary source
of insurance (17.1\%). Financial barriers to health care (unmet health
care need because of cost, unmet prescribed medication need because of
cost, and medical bills being paid off over time {[}medical debt]) were
typically lower among adults in Medicaid expansion states than those in
nonexpansion states regardless of source of insurance. Approximately
75.6\% of adults reported being continuously insured during the
preceding 12 months, 12.9\% reported a gap in coverage, and 11.5\%
reported being uninsured during the preceding 12 months. The largest
proportion of adults reported >= 3 visits to a health care professional
during the preceding 12 months (47.3\%), followed by 1-2 visits
(37.1\%), and no health care visits (15.6\%). Adults in expansion and
nonexpansion states reported similar levels of satisfaction with
received health care by primary source of health insurance coverage and
by continuity of health insurance coverage during the preceding 12
months.
Interpretation: This report presents for the first time estimates of
population-based health care access and use of CPS among adults aged
18-64 years. The findings in this report indicate substantial variations
in health insurance coverage; other health care access measures; and use
of CPS by state, state Medicaid expansion status, expanded geographic
region, and FPL category. In 2014, health insurance coverage, having a
usual source of care, having a routine checkup, and not experiencing
unmet health care need because of cost were higher among adults living
below the poverty level (i.e., household income <100\% of FPL) in states
that expanded Medicaid than in states that did not. Similarly, estimates
of breast and cervical cancer screening and influenza vaccination were
higher among adults living below the poverty level in states that
expanded Medicaid than in states that did not. These disparities might
be due to larger differences to begin with, decreased disparities in
Medicaid expansion states versus nonexpansion states, or increased
disparities in nonexpansion states.
Public Health Action: BRFSS data from 2014 can be used as a baseline by
which to assess and monitor changes that might occur after 2014
resulting from programs and policies designed to increase access to
health care, reduce health disparities, and improve the health of the
adult population. Post-2014 changes in health care access, such as
source of health insurance coverage, attainment and continuity of
coverage, financial barriers, preventive care services, and health
outcomes, can be monitored using these baseline estimates.'
affiliation: 'Okoro, CA (Corresponding Author), CDC, Natl Ctr Chron Dis Prevent \&
Hlth Promot, Div Populat Hlth, Atlanta, GA 30333 USA.
Okoro, Catherine A.; Zhao, Guixiang; Town, Machell, CDC, Natl Ctr Chron Dis Prevent
\& Hlth Promot, Div Populat Hlth, Populat Hlth Surveillance Branch, Atlanta, GA
30333 USA.
Fox, Jared B., CDC, Policy Res Anal \& Dev Off, Atlanta, GA 30333 USA.
Eke, Paul I.; Greenland, Kurt J., CDC, Natl Ctr Chron Dis Prevent \& Hlth Promot,
Div Populat Hlth, Atlanta, GA 30333 USA.'
author: Okoro, Catherine A. and Zhao, Guixiang and Fox, Jared B. and Eke, Paul I.
and Greenland, Kurt J. and Town, Machell
author-email: cokoro@cdc.gov
author_list:
- family: Okoro
given: Catherine A.
- family: Zhao
given: Guixiang
- family: Fox
given: Jared B.
- family: Eke
given: Paul I.
- family: Greenland
given: Kurt J.
- family: Town
given: Machell
da: '2023-09-28'
files: []
issn: 1545-8636
journal: MMWR SURVEILLANCE SUMMARIES
keywords-plus: 'DEPENDENT COVERAGE EXPANSION; CLINICAL PREVENTIVE SERVICES;
YOUNG-ADULTS; INSURANCE-COVERAGE; OREGON EXPERIMENT; MENTAL-HEALTH; ACT;
MORTALITY; MEDICAID; REFORM'
language: English
month: FEB 24
number: '7'
number-of-cited-references: '54'
pages: 1-41
papis_id: 798068307209f61ea6eb981573276908
ref: Okoro2017surveillancehealth
times-cited: '69'
title: Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64
Years-Behavioral Risk Factor Surveillance System, United States, 2014
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000397075300001
usage-count-last-180-days: '2'
usage-count-since-2013: '21'
volume: '66'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2017'