The present study aimed to assess the association between medical visits and individual characteristics and socioeconomic factors among people with disabilities in Iran. This study addressed a critical gap in the literature by examining healthcare utilization patterns among people with disabilities in Iran, a region where research on this topic is sparse. Although the research question has been explored in other contexts, the unique social, cultural, and policy environment in Iran necessitates region-specific evidence. The use of data from a large disability organization enabled us to highlight factors that may differ from other settings, making our findings particularly relevant for local policy and programmatic planning.
both unadjusted and adjusted regression models indicated that gender, health insurance, severity of disability, and wealth index were associated with medical visits among people with disabilities. However, these results should be interpreted with caution, as critical health status variables, such as comorbidities and perceived health needs, were not included in the model. According to the Andersen healthcare utilization model, the inclusion of need characteristics (both perceived and evaluated) is essential to accurately predict healthcare use [28]. Therefore, future studies should aim to incorporate these variables to provide a more comprehensive understanding of healthcare utilization among people with disabilities.
In the present study, the unadjusted regression model indicated that women with disabilities had higher odds of medical visits compared to men with disabilities. Several reasons could contribute to this observation. Women may have different healthcare-seeking behaviors compared to men, such as being more proactive about seeking medical care or being more likely to visit healthcare providers for preventive services [29, 30].
Women may have specific health needs or conditions that require more frequent medical visits compared to men. For instance, women may have reproductive health concerns or conditions such as osteoporosis or autoimmune diseases that require regular monitoring and treatment [31].
In addition, social roles and caregiving responsibilities may resulted in disparity in healthcare utilization among PWDs. Women often bear a disproportionate burden of caregiving responsibilities within families and communities. As caregivers, they may be more attuned to health issues and more likely to seek medical care for themselves or their family members, including individuals with disabilities [32].
Additionally, psychosocial factors merit consideration as key determinants. Women with disabilities may encounter higher levels of psychosocial stressors, such as discrimination, violence, stigma, or social isolation, which can impact their physical and mental health and contribute to increased medical visits [33, 34].
The unadjusted model showed that health insurance coverage was significantly associated with higher odds of medical visits among individuals with disabilities in Iran. Specifically, participants covered by Military Health Insurance were more likely to have medical visits compared to those without insurance. This finding suggests that comprehensive health insurance coverage, such as military insurance, plays a crucial role in facilitating access to healthcare services for individuals with disabilities.
Moreover, wealth index was also a critical determinant of medical visits, with individuals in higher wealth quartiles exhibiting lower odds of medical visits. This paradoxical relationship could indicate that people in lower wealth categories may have a greater need for healthcare services due to poorer health conditions, leading to more frequent medical visits. However, the reduced odds of healthcare utilization among higher wealth groups may reflect better access to preventive care, reducing the need for routine medical visits. These findings align with international literature, yet specific contextual factors in Iran, such as insurance system disparities and socioeconomic inequities, shape unique patterns of healthcare utilization among the disabled population.
The influence of health insurance and SES on healthcare utilization has been widely examined in the literature, revealing distinct patterns across different settings. For instance, Verlenden et al. [35] examined healthcare utilization patterns among young adults with disabilities in the United States using data from the National Health Interview Survey [35]. Similar to our study, they found that health insurance significantly impacted healthcare access, with uninsured individuals reporting more unmet healthcare needs and delays in receiving care. Moreover, young adults with disabilities in lower income groups were more likely to use emergency rooms as their primary source of care, reflecting barriers to accessing routine healthcare services. This pattern resonates with our findings, where lower SES was associated with increased healthcare utilization. This may suggest that people in lower SES groups are more likely to seek care for acute conditions rather than engage in preventive health behaviors, both in the U.S. and Iran. However, the context of health insurance in the U.S. differs considerably from Iran, where universal coverage is not guaranteed, leading to more pronounced disparities based on insurance type and socioeconomic status.
Cross-contextual comparison of health insurance and SES effects
The role of health insurance in influencing healthcare utilization is also evident in other global contexts. For example, Sarkodie’s study in Ghana (2017) utilized the capability approach framework and found that even when resources and healthcare facilities were equally distributed, individuals with disabilities had lower healthcare utilization rates, particularly those without insurance coverage or from lower socioeconomic backgrounds. After matching for key covariates, disability was associated with a 12.4% decrease in healthcare utilization, reflecting significant barriers to care [36]. This finding is similar to our results, where the presence of comprehensive insurance coverage (e.g., Military Health Insurance) increased the likelihood of healthcare visits, while lack of insurance acted as a barrier. However, in Ghana, the type of disability further modified the relationship, with individuals experiencing hearing or speech disabilities using healthcare services more frequently than those with physical disabilities. This divergence suggests that the type of health insurance and the nature of the disability interact to shape healthcare access in nuanced ways, depending on the specific healthcare environment and available support systems.
Furthermore, studies focusing on intellectual disabilities, such as the research by Maltais et al. [37] in Canada, highlighted that individuals with intellectual disabilities often experience disparities in healthcare utilization despite the presence of public health insurance [37]. They reported increased use of some services like general medicine and psychiatry, while underutilizing others such as optometry and physiotherapy, compared to the general population. The disparity was more pronounced for those with severe intellectual disabilities, indicating that even within insured populations, the type of disability and its severity can significantly influence healthcare utilization patterns. This contrasts with our findings, where military health insurance seemed to mitigate disparities in access for people with severe disabilities. The differences may stem from the broader scope of services covered under military insurance in Iran, as well as additional supports provided for veterans and their families, which may not be available to the general population with disabilities in Canada.
Similarly, in the context of Afghanistan, Trani and Barbou-des-Courieres [38] found that health insurance and SES were critical determinants of healthcare utilization, yet the directionality differed from our results [38]. They observed a slightly pro-poor distribution of healthcare utilization, indicating that the poorest individuals were more likely to use health services. This pattern was attributed to the uniformly low SES in Afghanistan, where the absence of a structured healthcare system and the high prevalence of poverty mean that even minimal healthcare access is more readily used by those in lower SES categories. Conversely, in our study, higher wealth index was associated with reduced medical visits, which may suggest that individuals in higher SES groups have better access to preventive care or alternative healthcare sources that are not captured in routine medical visits.
In our study, we found that the severity of disability initially appeared to have a strong association with increased medicl visits among people with disabilities in Iran, which was evident in the adjusted logistic regression model. Specifically, people with more severe disabilities were more likely to have medical visits compared to those with lower levels of severity.
This finding was consistent with some international studies but diverges in key aspects. In high-income contexts like Canada and Spain, the influence of disability severity on healthcare utilization has been studied within well-resourced healthcare systems, providing a contrasting perspective. [39] found that individuals with disabilities in Canada, irrespective of severity, utilized significantly more healthcare services compared to the general population, with disability status alone being a strong predictor of healthcare use [39]. This suggests that in a more supportive healthcare environment, where socioeconomic barriers are minimized, even mild disabilities can lead to increased healthcare utilization due to the availability of accessible services. Similarly, in Spain, [40] showed that older adults with more severe disabilities had higher utilization rates, but this relationship was mediated by the type of care they received (formal vs. informal) [40]. Those without access to formal or informal care reported the highest use of medical consultations, indicating that in contexts with structured support systems, disability severity may have a more complex relationship with healthcare utilization, where the type of care plays a more defining role than the severity alone. Likewise, Murthy et al. in a systematic review in the south Asia context observed that individuals with severe disabilities had a higher prevalence of chronic conditions and made more frequent hospital visits compared to those with lower severity levels [41]. The pattern of increased healthcare utilization among people with severe disabilities is consistent across these studies, though the type of healthcare accessed and the underlying reasons (chronic disease management vs. acute care) appear to vary significantly based on local health systems and support structures.
On the contrary, our results showed some discrepancies compared to previous studies. For example, in a study conducted by [42] in South Korea, individuals with severe disabilities were found to have significantly lower attendance rates for preventive health services, such as health screenings, and longer inpatient stays compared to those with less severe disabilities [42]. This discrepancy might be explained by the different healthcare systems and accessibility challenges in the two countries. The healthcare system in South Korea, despite being highly developed, may have barriers to preventive care for those with severe disabilities, resulting in delayed care and subsequent longer hospital stays. Similarly, Rahman et al. [43] in Bangladesh identified that people with severe disabilities faced significant challenges in accessing healthcare services due to financial constraints, lack of family support, and absence of healthcare facilities in their area [43]. In their study, more severe disabilities were associated with a decreased likelihood of accessing healthcare services, highlighting the compounded effect of socioeconomic deprivation and lack of accessible infrastructure in low- and middle-income countries (LMICs). Unlike our findings where severity initially increased utilization, the context of poverty and infrastructural limitations in Bangladesh may lead to severe disability being a deterrent rather than a driver of healthcare use.
Moreover, studies from other LMIC contexts have shown similar trends. In South Africa, Vergunst et al. explored the impact of disability severity on healthcare access in a rural setting and found that people with more severe disabilities experienced significantly more barriers to healthcare services compared to those with less severe disabilities [44].
Overall, our study, along with the findings from these international studies, underscores the importance of considering broader social determinants when analyzing the impact of disability severity on healthcare utilization. While severity often predicts higher healthcare use, the magnitude and direction of this effect are heavily influenced by factors such as insurance coverage, socioeconomic status, and the availability of support services. In LMICs, where access to healthcare is fraught with barriers, severe disability may deter healthcare utilization due to increased costs and logistical challenges, as seen in Bangladesh and South Africa. In contrast, in high-income countries, supportive systems may enable more frequent healthcare visits, making even mild disabilities a significant predictor of utilization. Thus, the interplay between disability severity and healthcare access is not uniform and must be interpreted within the context of each country’s healthcare infrastructure and social policies. Future research should focus on disentangling these contextual factors to better inform policies aimed at improving healthcare access for people with disabilities worldwide.
Future research can consider different health care access-related models by including additional variables such as health status, comorbidities, and perceived health needs to provide a more holistic understanding of healthcare utilization patterns among people with disabilities. Longitudinal studies are also recommended to explore changes in healthcare utilization over time and to identify causal relationships between key factors and health service use. In terms of practical implications, policymakers should focus on enhancing health insurance coverage for people with disabilities, particularly in underserved regions. Strategies such as expanding subsidized insurance programs and ensuring equitable access to specialized healthcare services should be prioritized to reduce barriers. Additionally, targeted interventions should address the socioeconomic disparities observed in this study by providing financial support and improving healthcare infrastructure in lower socioeconomic regions.
Limitations
One limitation of this study was the use of a one-month timeframe for measuring healthcare utilization, which may not fully capture long-term healthcare access patterns. Future research should consider employing longer reference periods, such as one year, to obtain a comprehensive understanding of healthcare utilization among people with disabilities. Also, another limitation of this study was the lack of adjustment for important health status variables, such as comorbidities and perceived health needs, which were essential components in the Andersen healthcare utilization model [28]. As a result, the findings should be interpreted cautiously, and future research should aim to include these need characteristics to enhance the validity of the results. One limitation of this study is the use of a convenience sampling method, which may result in selection bias. Consequently, the findings should be interpreted with caution. Although this approach was used due to a lack of national disability data, efforts were made to include a diverse sample by selecting participants from multiple ISD branches across Iran. Future studies should consider employing probability sampling to improve the representativeness and robustness of the findings.
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