METHODS: Three years of Behavioral Risk Factor Surveillance System (BRFSS) data, 2012 to 2014, were analyzed. We examined the disparities of health care access among AI/AN adults by demographic characteristics, ethnicity, geographic location, employment status, and high-risk chronic conditions, which included diabetes, cardiovascular disease, asthma, cancer, chronic obstructive pulmonary disease (COPD), and kidney disease. SAS 9.3 was used to perform the odds ratios and the logistic regression model.
RESULTS:
The three-year overall prevalence of not having any type of health care insurance among Florida AI/AN adults was 35%, which was significantly higher than the Florida overall prevalence of 20.8%. The trend of uninsured AI/AN adults in Florida increased by 29% from 2012 (29.9%) to 2014 (38.7%), while the overall Florida prevalence of uninsured adults decreased during the same time period. Nearly one in three AI/AN adults (30.4%) could not see a doctor in the past year because of cost, and 35% of AI/AN adults do not have a personal doctor. Compared to Florida overall, AI/AN adults have a significantly lower percentage of receiving mammograms (42.9% vs. 58.4%), PAP tests (36.4% vs. 51%), blood stool tests (8.2% vs. 13.8%), and sigmoidoscopy or colonoscopy tests (55.9% vs. 69.2%).
AI/AN adults were more likely to be uninsured if they were 18-44 years old (OR=9.0), had less than high school education (OR=4.6), or had a household income of less than $25,000 (OR=19.2). The prevalence of being uninsured was also high among AI/ANs who were of Hispanic ethnicity (42.3%), who were out of work (55.8%), and who had at least one high-risk chronic condition (37.3%).
CONCLUSIONS:
Significant racial disparities exist in health care access between Florida AI/AN adults and the overall Florida adult population. Further public health policies that target AI/ANs may be necessary to diminish these racial disparities. These findings provide important information to policy makers for evaluation of AI/AN insurance policies.