Measuring the Association of Race, Neighborhood Segregation, and Healthcare Use Among People With Intellectual and Developmental Disabilities

Few studies examine the impacts of structural inequities on service access and use for people with intellectual and developmental disabilities (IDD). This secondary data analysis used data from the Medical Expenditure Panel Survey and the American Community Survey to examine the association of race, neighborhood segregation, and hospital and outpatient use among people with IDD. Our sample included children and adults with a diagnosis of IDD. Multilevel logistic regression models with random intercepts were used to assess the association between race, neighborhood segregation, and emergency room (ER), hospital, and any outpatient use. Our analyses adjusted for individual-level predisposing, enabling, and need characteristics. Ninety-four percent of the sample reported use of outpatient services, 15% had at least one ER visit, and 5% had at least one hospitalization. Living in a segregated neighborhood was associated with lower odds of any outpatient use (OR = 0.35, 95% CI: 0.15-0.85). We found no evidence of association between neighborhood segregation and hospital or ER use. Other (vs. White) race was associated with lower odds of any outpatient use (OR = 0.33, CI: 0.12-0.90) and higher odds of hospital use (OR = 8.00, CI: 2.26-28.35). Scholars need larger integrated datasets and more nuanced methods for longitudinal analyses to map associations better between race, neighborhood segregation, and their impact on service use.