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Regional Variation Noted in Prevalence of Delayed Care

Populations in counties with high prevalence likely to be Hispanic, have low income, chronic disease

THURSDAY, March 28 (HealthDay News) -- There is considerable county-wide variation in the prevalence of delayed care, with high prevalence linked to a weaker health care infrastructure, according to a letter published in the March 28 issue of the New England Journal of Medicine.

Noting that the Affordable Care Act is expected to reduce the number of adults who delay seeking medical care due to cost, Cheryl R. Clark, M.D., Sc.D., from Brigham and Women's Hospital in Boston, and colleagues examined the existing variation in and correlates of delayed care. County-level geographic variation in the prevalence of delayed care was assessed among 289,333 adults, aged 18 to 64 years, in the 2010 Behavioral Risk Factor Surveillance System.

The researchers found that the prevalence of delayed care varied from 6.5 percent in Norfolk, Mass., to 40.6 percent in Hidalgo, Texas. The prevalence of delayed care was higher with more restrictive Medicare eligibility criteria. A lower prevalence of delayed care correlated with a higher concentration of primary care doctors. Based on data from six counties, in counties with the highest prevalence of delayed care, populations were more likely to be Hispanic, have low incomes, and have a high prevalence of chronic disease. State Medicaid expansion was relatively late in these areas.

"Our results suggest stark geographic differences in the prevalence of care delayed because of cost," the authors write. "States and counties with a high prevalence of delayed care had a weaker health care infrastructure than states with a lower prevalence of delayed care."

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