Minority Groups Face Higher Rates of Disability & Incontinence With Less Access to Medicaid

Health disparities refer to the differences in health outcomes, care, and conditions that vary between groups of people in the U.S. These disparities can be measured by factors, such as:

• Incidence rates.
• Mortality rates.
• Life expectancy.
• Health status.
• Health insurance coverage.
• Quality of care.
• Affordability of and access to care.
• Disease prevalence.
• Presence of disabilities.

Such disparities are widespread across diverse groups, including those defined by gender, age, socioeconomic status, sexual orientation, ethnicity, and geographic location.

Minority groups have historically faced the greatest health inequities among populations affected by health disparities. Populations facing racial health disparities include but are not limited to: African Americans, Latinos, Asian, Native Hawaiian or Pacific Islanders, Hispanics, American Indians or American Natives.

Minority groups facing racial health disparities may experience:

• Higher rates of chronic diseases, such as diabetes, hypertension, arthritis, etc.
• Higher premature death rates.
• Higher rates of disabilities, such as autism, Down syndrome (DS), cerebral palsy (CP), etc.
• Higher rates of incontinence.
• Less access to Medicaid or other insurance resources.
• Low income.
• Less access or affordability to health care.

Studies have shown that Minority populations have a higher prevalence of disabilities. Disabilities include autism, DS, CP, spina bifida, muscular dystrophy, and more. According to the Centers for Disease Control and Prevention (CDC):

According to the National Disability Institute, “14% of working-age African Americans have a disability compared to 11% of Non-Hispanic Whites, and 8% of Latinos.” African Americans are also more likely than non-Hispanic Whites to have disabilities in each age group. Another study showed that non-Hispanic African Americans have the highest prevalence of severe disability among all racial groups.

In a study of non-Hispanic White, Chinese, non-Hispanic Black, and Hispanic men, it was shown that non-Hispanic Black men reported the highest rates of urge incontinence (13%), with 11% of Hispanic men experiencing urge incontinence. Non-Hispanic Black men also showed the highest prevalence of any urinary incontinence compared to White men.

According to the CDC, Black children were more likely to have a disability (2.82%) than Hispanic (1.77%), White children (1.76%), and Asian children (0.72%).

The prevalence of disabilities among Minority groups has contributed to a number of factors, such as lack of access to quality health care, housing barriers, socioeconomic barriers, educational barriers, and victimization rates.

Many individuals of all ages with special needs may experience incontinence (loss of bladder and / or bowel control) at some point. However, since certain Minority groups have higher rates of disabilities and less access to affordable health care, incontinence may be more prevalent and untreated among these populations.

According to a study from the National Library of Medicine that compared the rates of incontinence among over 2,000 middle-aged and older Hispanic, White, Black, and Asian-American women, Hispanic women were found to have the highest prevalence (36%) of weekly incontinence. The same study identified that Black women have higher rates of urge incontinence.

While more data is needed as Minority groups are underrepresented in incontinence studies, its shown that “urinary incontinence disproportionately affects women of color.”

Unfortunately, due to socioeconomic factors, lack of healthcare access, and cultural stigmas that influence how often incontinence is reported among children in Minority groups, there isn’t comprehensive data that focuses on the prevalence of incontinence in children in Minority groups.

Over the course of history, there have been multiple challenges that affect Minority groups, including economic barriers, cultural stigma, and lack of health care access and affordability.

While Minority groups are more likely to live in poverty or be uninsured, the presence of a disability increases an individual’s likelihood of falling into poverty.

Nearly 25% of American Indians and Alaska Natives, almost 20% of African Americans, and 17% of Hispanics live in poverty compared to just 8.2% of Whites. Supporting this, US Census Bureau data shows that 36% of African Americans with disabilities live in poverty– the highest rate among any racial group.

Those with disabilities in Minority populations are also less likely to delay or deny care compared to those without disabilities. It’s also been shown that around 30% of non-Hispanic Black and Hispanic adults with disabilities denied health care because of the cost of care.

Cultural taboos surrounding incontinence and disabilities and the lack of conversation within certain Minority communities may contribute to getting proper and needed medical care. Language barriers may also prevent access to information about incontinence, disabilities, and other health care resources.  

Health care is 1 of the largest barriers individuals in Minority groups may face, especially if individuals in these populations are managing incontinence.

According to the National Library of Medicine, Blacks and Hispanics are less likely to receive insurance from their employers and are more likely to have public health insurance coverage, such as Medicaid or Medicare. It’s also been shown that American Indian and Alaska Natives and Hispanic individuals are twice as likely to be uninsured compared to Whites.

The location of health care resources also acts as a barrier for Minority groups, as there is a lack of health care providers in more rural areas and lower income areas. Location also plays a role in accessing Medicaid and Medicare resources.

Racial barriers including the mistreatment of minority groups in the past for healthcare purposes (Anarcha, Betsy, and Lucy; Tuskegee Syphilis Study, forced sterilization, Henrietta Lacks and the HeLa Cells, and the Eugenics Movement to name a few) also contributes to generational trauma and the mistrust of the medical community.

Policies like Medicaid expansion under the Affordable Care Act (ACA) have minimized the health coverage gap Minority groups face. These policies have also improved health outcomes for those in Minority groups. To date, 40 states, including Washington D.C., have expanded Medicaid, making healthcare more affordable and accessible for individuals with disabilities and incontinence.

The continuation of Medicaid expansion is critical for improving healthcare for Minority groups and especially those with disabilities and incontinence.

We need to encourage healthcare systems, policymakers, and healthcare providers in communities— specifically underserved communities— to prioritize access to incontinence care and resources for those with disabilities.

To help break down the barriers Minority groups face in, healthcare providers can do many things.

Cultural awareness trainings enhance awareness of cultural differences, health beliefs / disbeliefs, and practices among various minority groups. This enhances communication, builds trust, and ensures that care is respectful of the patient's cultural background.

Healthcare providers should routinely screen for factors such as housing instability, food insecurity, transportation challenges, and financial hardships that may impact health and wellbeing. Ways to combat these concerns include being an advocate for your patient and partnering with local community organizations that serve minority groups to provide resources and support services.

Mobile clinics and outreach programs are a great way for healthcare providers to get involved.  Extended hours and flexible scheduling can make it easier for non-traditional work hours, work that does not provide PTO/sick leave, or caregiving responsibilities to access care.  Connecting patients with medication assistance programs help patients that would not otherwise be able to afford their medications access to reduced-cost or free prescriptions that are medically necessary for their healthcare needs.

Healthcare providers can work with policy makers directly to promote expanded coverage and advocate for reduced out-of-pocket costs, copays, and deductibles. 

Providing telemedicine services improve access to care for individuals who face geographic, transportation, or time-related barriers.  This also means that as healthcare providers, to ensure that telemedicine access is possible, advocating for affordable internet and digital devices is essential for more patients to utilize telehealth services effectively.

Recruit and retain minority healthcare professionals as well as provide mentorship and training programs that support minority students and professionals entering the healthcare fields.

References

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‌CDC. (2019, October 25). Infographic: Adults with Disabilities: Ethnicity and Race. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/disabilityandhealth/materials/infographic-disabilities-ethnicity-race.html

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‌National Minority Health Month: The Double Burden for Minorities with Disabilities - NACCHO. (n.d.). www.naccho.org. https://www.naccho.org/blog/articles/national-minority-health-month-the-double-burden-for-minorities-with-disabilities

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Disclaimer

Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.