For racially diverse patients with disabilities, increased barriers to health care

"This special issue of Medical Care is focused on the intersection of disability, race, and ethnicity and the particular health care barriers faced by people at this intersection," accord to an introductory article by the supplement guest editors, led by Willi Horner-Johnson, PhD, of Oregon Health & Science University, Portland. The goal is to set a new research agenda for research into health care disparities affecting adults with disabilities who are also members of underserved racial and ethnic groups.

Analyzing Disparities by Both Disability and Race/Ethnicity

Despite an extensive body of research on health care disparities, researchers have only begun to explore issues of diversity among people with disabilities, or how disability may affect inequities related to race and ethnicity. "This supplement is among the first efforts in the peer-reviewed literature to bridge the gap between these two fields of research," the guest editors write.

The special issue includes nine papers, contributed by leading experts, presenting original research and new insights on disparities at the intersection of disability and race/ethnicity. An opening commentary calls for collaborative approaches to merging these historically separate "tracks" of health disparities research. Original research papers present evidence of racial and ethnic disparities within various groups of people with disabilities. One paper provides a snapshot of "difference, disparity, and disability" at the national level.

Other studies report on racial differences in the use of assistive technology by veterans with severe disabilities; and in health care services for young people with muscular dystrophy, even with similar health care benefits. Another paper reports relatively low racial/ethnic disparities in accessing preventive care among adults with intellectual and developmental disabilities.

"Braid the Strands" to Achieve Health Equity

Another set of papers looks at unique issues at the intersection of disability, race, and ethnicity. Analysis of nationally representative data confirms separate disparities by disability and race/ethnicity, but finds limited evidence of "interaction or additive effects" between the two. Other papers address the "critical gap" in research on racial/ethnic differences in barriers to health care among people with disabilities and the challenges facing immigrant families of individuals with developmental disabilities.

The special issue concludes with a commentary from Dr Camara Phyllis Jones of Morehouse School of Medicine, Atlanta. Dr Jones discusses the "parallels and intersections" between disability and race/ethnicity -- including the need to "braid the strands" to achieve health equity. She writes, "Achieving health equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need."

The editors and contributors to the special issue hope their efforts will provide a starting point for building a more robust set of research data on the health care issues facing the growing number of Americans who have disabilities and belong to underserved racial or ethnic groups. "As healthcare transformation proceeds, efforts to reduce inequity in health care will gain increasing prominence," Dr Horner-Johnson and colleagues conclude. "Our hope is that these efforts will take into account the full range of patient diversity and needs, including those at the intersection of disability, race, and ethnicity."

The journal's special issue can be found at: http://journals.lww.com/lww-medicalcare/toc/2014/10001