Comparing continuity of care before and after disability registration: a retrospective cohort study

Persons with disabilities often encounter barriers in accessing healthcare services. However, research on the impact of disability on the continuity of care (COC) remains limited. We assessed the changes in COC among disabled individuals to monitor alterations in their healthcare accessibility.

This study used the National Health Insurance Service-National Sample Cohort 2.0 DB. The Bice-Boxerman COC Index (COCI; 0-1 range; higher values indicate greater COC) was used, with disability status of the participants determined from the registered data. Propensity-score matching was conducted for the control group. Difference-in-difference analysis was conducted to evaluate pre- and post-disability changes in COC for people with disabilities relative to those without.

COCI values were analyzed for 9702 participants with disabilities and 19 404 control individuals. On average, the disability group scored 0.0343 lower than the control group 1 year before disability registration (P = .001) relative to the disability registration year. Similar results were obtained for the physical disability, visual disability, and hearing disability subgroups, with scores of -0.0342, -0.0394, and -0.0285, respectively (P < .0001 for all groups). On the other hand, the neurological disability subgroup showed a marginal change in the COCI score, peaking 2 years before disability registration (-0.0757, P < .0001).

Individuals with physical, visual, and hearing disabilities showed low COCI scores, with a significant decline occurring 1 year before disability registration. In contrast, the control group showed no change in COC. This result highlights the need to improve healthcare continuity, particularly for individuals with the respective disabilities.