Racial and Ethnic Disparities in Cost-Related Healthcare Access Barriers in Florida (2012–2024): A Joinpoint Regression and Bayesian Analysis

Introduction: Economic barriers to healthcare disproportionately affect racial and ethnic minorities. While the Affordable Care Act (ACA) aimed to reduce these disparities, the COVID-19 pandemic represented an unprecedented external shock. This study aims to quantify state-level trends in cost-related healthcare access barriers in Florida, focusing on intersectional vulnerabilities. Methods: We conducted an ecological time-series analysis using aggregated state-level data (N = 78 total data points) from the Behavioral Risk Factor Surveillance System (BRFSS) for Florida adults (2012-2024). The primary outcome was the annual prevalence of adults unable to see a doctor due to cost, stratified by sex and ethnicity (Hispanic, non-Hispanic Black, and non-Hispanic White). Bayesian paired samples analysis and frequentist inference were used to estimate structural disparities, and restricted piecewise linear regression (Joinpoint) evaluated temporal trend reversals. Results: Over the 13-year period, Hispanic women exhibited the highest temporal average barrier rate (23.81%). Bayesian paired inference demonstrated very strong evidence (Bayes factor10 = 7.18 x 104) of a structural gap, with Hispanic women facing a mean paired difference 13.02 percentage points higher than that of non-Hispanic White men (95% confidence interval of the paired difference: 10.29-15.75; p < 0.001). Trend analysis revealed a critical structural break for Hispanic women in 2020: prior to the pandemic, barriers were declining at an absolute annual change (AAC) of -2.06 (p = 0.001); post-2020, this protective trend was completely halted, shifting into an upward trajectory (+1.28 AAC, p = 0.327). Conclusions: State-level macro-trends demonstrate that the onset of the COVID-19 pandemic coincided with a pronounced structural break, abruptly halting previous gains in healthcare access for the Hispanic female cohort in Florida. These ecological findings underscore the profound intersectional vulnerability of the primary care safety net during periods of systemic disruption.