Article

The Relationship of Immigrant Status With Access, Utilization, and Health Status for Children With Asthma

Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Ambulatory Pediatrics (Impact Factor: 2.49). 11/2007; 7(6):421-30. DOI: 10.1016/j.ambp.2007.06.004
Source: PubMed

ABSTRACT

Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.
Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.
Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.
Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.

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    • "Asthma, the leading chronic disease during childhood in the industrialized world (Shankardass et al., 2007), is a condition for which a HHP has been noted. Studies have shown that US-born Hispanic children have higher rates of asthma than Hispanic children born outside the US (Eldeirawi et al., 2005; Holguin et al., 2005), which is notable since immigrants not only tend to be economically deprived, but also experience healthcare access barriers, legal residency challenges and English-language limitations (Holguin et al., 2005; Javier et al., 2007). "
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    ABSTRACT: Prior research suggests that economic deprivation has a generally negative influence on residents' health. We employ hierarchical logistic regression modeling to test if economic deprivation presents respiratory health risks or benefits to Hispanic children living in the City of El Paso (Texas, USA) at neighborhood- and individual-levels, and whether individual-level health effects of economic deprivation vary based on neighborhood-level economic deprivation. Data come from the US Census Bureau and a population-based survey of El Paso schoolchildren. The dependent variable is children's current wheezing, an established respiratory morbidity measure, which is appropriate for use with economically-deprived children with an increased likelihood of not receiving a doctor's asthma diagnosis. Results reveal that economic deprivation (measured based on poverty status) at both neighborhood- and individual-levels is associated with reduced odds of wheezing for Hispanic children. A sensitivity analysis revealed similar significant effects of individual- and neighborhood-level poverty on the odds of doctor-diagnosed asthma. Neighborhood-level poverty did not significantly modify the observed association between individual-level poverty and Hispanic children's wheezing; however, greater neighborhood poverty tends to be more protective for poor (as opposed to non-poor) Hispanic children. These findings support a novel, multilevel understanding of seemingly paradoxical effects of economic deprivation on Hispanic health.
    Full-text · Article · Aug 2014 · International Journal of Environmental Research and Public Health
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    • "Asthma, the leading chronic disease during childhood in the industrialized world (Shankardass et al., 2007), is a condition for which a HHP has been noted. Studies have shown that US-born Hispanic children have higher rates of asthma than Hispanic children born outside the US (Eldeirawi et al., 2005; Holguin et al., 2005), which is notable since immigrants not only tend to be economically deprived, but also experience healthcare access barriers, legal residency challenges and English-language limitations (Holguin et al., 2005; Javier et al., 2007). "
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    ABSTRACT: Prior research suggests that immigrant enclaves provide respiratory health benefits for US Hispanic residents. We test if immigrant enclaves provide differential respiratory health benefits for Hispanic children in El Paso (Texas) based on individual-level factors. Results reveal that higher neighborhood immigrant density is associated with reduced odds of wheezing, but that the protective immigrant enclave effect is modified by poverty, general health status, body mass index (BMI), and caretaker nativity. Higher immigrant density is significantly more protective for poor children and those with foreign-born caretakers; conversely, it is significantly less protective for children in worse health and those with higher BMI. These findings foster a novel understanding of how immigrant enclaves may be differentially protective for Hispanic children based on individual-level factors.
    Full-text · Article · May 2014 · Health & Place
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