Occupational Therapy, Physical Therapy, and Home Health Use Among People With Intellectual and Developmental Disabilities: Measuring Their Association With Neighborhood Racial Segregation

Importance: Black people with intellectual and developmental disabilities (IDD) report poor health and lower service use compared with their White counterparts. Structural racism, neighborhood segregation in particular, has been identified as a potential barrier to equitable service use, but empirical investigations remain limited. Objective: To examine the association between race/ethnicity and neighborhood-level segregation on the use of outpatient occupational therapy and physical therapy and home health services among people with IDD. Design: A secondary data analysis, using weighted two-level logistic regression models, of the Medical Expenditure Panel Survey (2013–2020) and census tract data from the American Community Survey. Results: Sixteen percent of individuals with IDD reported use of outpatient occupational therapy and physical therapy, and 23% reported use of home health services. Race and neighborhood segregation were not significantly associated with service use; however, age and Medicaid coverage showed significant associations with both occupational therapy and physical therapy and home health care use. Individuals ages 0 to 3 yr were more likely to receive services than older cohorts, highlighting age-related disparities. Conclusions and Relevance: The findings suggest that although racial disparities were not evident in this data set, structural and age-related factors still shape service utilization. Occupational therapy scholars need larger and more nuanced data sets of people with IDD to better map associations between race and neighborhood segregation and its impact on service use along the health care pipeline. Plain-Language Summary: In this article, we introduce a novel application of neighborhood-level racial segregation measures to assess structural racism in health care access among people with intellectual and developmental disabilities (IDD). By integrating data from the Medical Expenditure Panel Survey and American Community Survey, we provide preliminary evidence on service utilization patterns for outpatient occupational therapy and physical therapy and home health care, highlighting age-related disparities and the need for more nuanced data sets. The findings underscore the importance of contextualizing service use within structural determinants and offer direction for occupational therapy practitioners and health services researchers to refine equity-driven methodologies and advocacy strategies, ensuring that all people with IDD can access the home and community-based supports they need to participate in daily life. Positionality Statement: The research team was led by Khalilah R. Johnson, an occupational scientist and occupational therapy practitioner who identifies as Black and female and has an extensive history working with Black people with IDD in participatory action research and practice. Izabela Annis, the team’s statistician and programmer, uses European ethnic classification and identifies as Slavic. In her work, she uses rigorous and comprehensive statistical methods to measure and analyze the complex effects of structural racism on health and social outcomes. Kathleen C. Thomas is a White woman whose family experience of serious mental illness shapes her understanding of stigma and its structural impacts. This lens informs her commitment to research and mentoring that focuses on reducing disparities experienced by people with mental illness and by communities marginalized by disability, poverty, rurality, and racism.