# Barriers to preventive care among US adults of multiple races eligible for type 2 diabetes screening: an observational study

## TL;DR

This study explores differences in access to diabetes screening among U.S. adults of mixed racial backgrounds, finding varied barriers to preventive care.

## Contribution

The study highlights the heterogeneity in preventive care barriers among multiple race subgroups, which are often grouped together.

## Key findings

- Adults of mixed American Indian/Alaska Native and White race had higher healthcare cost concerns than either group alone.
- Mixed Asian and Pacific Islander race subgroups had lower healthcare cost concerns compared to either group alone.
- Tailored interventions may be needed to address preventive care disparities among multiple race subgroups.

## Abstract

Little is known about disparities in access to preventive care among people of multiple races, who are often aggregated into a single category, despite comprising a heterogeneous population. We therefore described the prevalence of barriers to preventive care for type 2 diabetes among US adults, by disaggregated subgroups of multiple races.

In a pooled cross-sectional study of adults eligible for type 2 diabetes screening from the Behavioral Risk Factor Surveillance System (2013–2022), we evaluated the prevalence of: being uninsured, not having a primary care doctor, healthcare cost concerns in the past 12 months, and not having a physical exam in the past 12 months.

Among 3,301,491 adults eligible for type 2 diabetes screening, mean age was 52.2 years and 52.3% were women. The prevalence of barriers to preventive care showed substantial heterogeneity among all racial and ethnic groups. Prevalence among multiple race subgroups generally fell in between estimates of their corresponding single race groups. Adults reporting both American Indian/Alaska Native (AIAN) and White race had a higher prevalence of healthcare cost concerns than adults who reported either racial group alone (AIAN and White: 17.8%, 95% confidence interval: [17.0-18.7%]; AIAN: 15.7% [15.0-16.4%]; White: 9.8% [9.7–9.8%]). The opposite pattern was observed among adults who reported both Asian and Pacific Islander race (Asian and Pacific Islander: 6.0% [5.0-7.2%]; Asian: 7.7% [7.3–8.1%]; Pacific Islander: 12.5% [11.4–13.7%]). This latter pattern was also observed for being uninsured among adults who reported both Pacific Islander and White race (Pacific Islander and White: 6.6% [4.9–8.7%]; Pacific Islander: 13.2% [11.9–14.7%]; White: 8.1% [8.0-8.2%]), and those who reported both Asian and White race (Asian and White: 5.2% [4.2–6.5%]; Asian: 6.9% [6.5–7.3%]; White: 8.1% [8.0-8.2%]).

These findings highlight the heterogeneity in preventive care barriers among subgroups of adults of multiple races. Identification of the subgroups at greatest risk may allow for effective and tailored interventions to increase access to preventive care for type 2 diabetes.

The online version contains supplementary material available at 10.1186/s12889-025-24692-y.