{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:34:52Z","timestamp":1787499292313,"version":"build-2736575974"},"posted":{"date-parts":[[2020,11,4]]},"group-title":"Health Systems and Quality Improvement","reference-count":46,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2020,11,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine trends in rates and racial\/ethnic disparities of key access to care measures among adults in the US in the last two decades.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data from the National Health Interview Survey, 1999\u20132018.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Individuals &gt;18 years old.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Exposure<\/jats:title>\n                  <jats:p>Race and ethnicity: non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main outcome and measures<\/jats:title>\n                  <jats:p>Rates of lack of insurance coverage, lack of a usual source of care, and foregone\/delayed medical care due to cost. We also estimated the gap between non-Hispanic White and the other subgroups for these outcomes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 596,355 adults, of which 69.7% identified as White, 11.8% as Black, 4.7% as Asian, and 13.8% as Hispanic. The proportion uninsured and the rates of lacking a usual source of care remained stable across all 4 race\/ethnicity subgroups up to 2009, while rates of foregone\/delayed medical care due to cost increased. Between 2010 and 2015, the percentage of uninsured diminished for all, with the steepest reduction among Hispanics (\u22122.1% per year). In the same period, rates of no usual source of care declined only among Hispanics (\u22121.2% per year) while rates of foregone\/delayed medical care due to cost decreased for all. No substantial changes were observed from 2016\u20132018 in any outcome across subgroups. Compared with 1999, in 2018 the rates of foregone\/delayed medical care due to cost were higher for all (+3.1% among Whites, +3.1% among Blacks, +0.5% among Asians, and +2.2% among Hispanics) without significant change in gaps; rates of no usual source of care were not significantly different among Whites or Blacks but were lower among Hispanics (\u22124.9%) and Asians (\u22126.4%).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>Insurance coverage increased for all, but millions of individuals remained uninsured or underinsured with increasing rates of unmet medical needs due to cost. Those identifying as non-Hispanic Black and Hispanic continue to experience more barriers to health care services compared with non-Hispanic White individuals.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>KEY POINTS<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>In the last 2 decades, what has been achieved in reducing barriers to access to care and race\/ethnicity-associated disparities?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Using National Health Interview Survey data from 1999\u20132018, we found that insurance coverage increased across all 4 major race\/ethnicity groups. However, rates of unmet medical needs due to cost increased without reducing the respective racial\/ethnic disparities, and little-to-no change occurred in rates of individuals who have no usual source of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning<\/jats:title>\n                    <jats:p>Despite increased coverage, millions of Americans continued to experience barriers to access to care, which were disproportionately more prevalent among those identifying as Black or Hispanic.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.1101\/2020.10.30.20223420","type":"posted-content","created":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T10:15:50Z","timestamp":1604484950000},"source":"Crossref","is-referenced-by-count":51,"title":["Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999\u20132018"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-9437","authenticated-orcid":false,"given":"C\u00e9sar","family":"Caraballo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9922-7808","authenticated-orcid":false,"given":"Dorothy","family":"Massey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5617-489X","authenticated-orcid":false,"given":"Shiwani","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarnath R.","family":"Annapureddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brita","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carley","family":"Riley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7932-382X","authenticated-orcid":false,"given":"Karthik","family":"Murugiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9136-5093","authenticated-orcid":false,"given":"Javier","family":"Valero-Elizondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oyere","family":"Onuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Nunez-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard P.","family":"Forman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khurram","family":"Nasir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeph","family":"Herrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-127X","authenticated-orcid":false,"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2020110615400775000_2020.10.30.20223420v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000467"},{"issue":"3","key":"2020110615400775000_2020.10.30.20223420v1.2","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1353\/hpu.2013.0131","article-title":"Effect of race and health insurance on health disparities: results from the National Health Interview Survey 2010","volume":"24","year":"2013","journal-title":"J Health Care Poor Underserved"},{"key":"2020110615400775000_2020.10.30.20223420v1.3","doi-asserted-by":"publisher","DOI":"10.1177\/107755800773743583"},{"issue":"3","key":"2020110615400775000_2020.10.30.20223420v1.4","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1111\/1475-6773.12705","article-title":"Racial\/ethnic and gender disparities in health care use and access","volume":"53","year":"2018","journal-title":"Health Serv Res"},{"key":"2020110615400775000_2020.10.30.20223420v1.5","unstructured":"2018 National Healthcare Quality and Disparities Report. 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