Disparities in health care by race, ethnicity, and language among the insured

ArticleinMedical Care 40(1):52-9 · February 2002with79 Reads
Impact Factor: 3.23 · Source: PubMed

Racial and ethnic disparities in health care have been well documented, but poorly explained. To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care. Cross-sectional analysis of the Community Tracking Survey (1996-1997). Adults 18 to 64 years with private or Medicaid health insurance. Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year. The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55). Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.

    • "Disparities caused primarily by low insurance rates among Latinos may be remedied by increasing insurance coverage, which is expected after the Affordable Care Act (ACA) enacted in 2010 gets fully implemented and families begin to enroll in insurance exchanges or the expansion of the federal Medicaid program for children in low-income households. In contrast, if limited English proficiency is the primary factor that contributes to health-care disparities, a source of disparities that is well-documented in the literature, coverage may be insufficient to narrow the gap (Clemans-Cope et al., 2012; Fiscella et al., 2002; Morales et al., 1999). In the latter scenario, resources should be allocated toward strategies to address linguistic and cultural barriers, improve communication, or intervene in other ways that will reduce barriers among parents and children with limited English proficiency. "
    [Show abstract] [Hide abstract] ABSTRACT: It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks.
    Full-text · Article · Nov 2014 · Journal of Child Health Care
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    • "The American Congress of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women (and women who expect to be pregnant during the influenza season) receive the trivalent inactivated influenza vaccination [1] [2]. Yet, vaccination rates among Hispanic and Black/African–American pregnant women are significantly lower than those of whites despite persistently higher rates of morbidity, mortality, and hospitalizations due to influenza [3] [4] [5] [6] [7] [8] [9] [10] [11]. "
    [Show abstract] [Hide abstract] ABSTRACT: A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination ("gain-frame"), or messages which emphasize negative outcomes of forgoing vaccination ("loss-frame"). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations. Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses. Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)]. Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.
    Full-text · Article · Jan 2014 · Vaccine
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    • "Compared to other ethnic groups, African American women were more likely to experience economic hardships and report being unable to meet essential food and health-related expenses (Belle & Doucet, 2003). As a group, African American women were also less likely to be insured, more likely to receive care in less than optimal organizational settings (such as the emergency room), and experience lack of continuity in the health care received (Fiscella, et al. 2002). Lack of cultural competency in health care workforce, or geographically influenced barriers (lack of transportation or strenuous distances to nearest healthcare facility) compounds the negative influences of these diseases (Wyatt, 2004; Sanders-Phillips, 2002). "
    [Show abstract] [Hide abstract] ABSTRACT: HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them.
    Full-text · Article · Jan 2014
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