Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Findings From a National Sample

Background: Racial and ethnic disparities in health care have been well documented, but poorly explained. Objective: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care. Research Design: Cross-sectional analysis of the Community Tracking Survey (1996–1997). Subjects: Adults 18 to 64 years with private or Medicaid health insurance. Measures: 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. Results: 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). Conclusions: 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.

[1]  R. Weinick,et al.  Racial/ethnic differences in children's access to care. , 2000, American journal of public health.

[2]  C. Forrest,et al.  Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices. , 2000, JAMA.

[3]  M. Doescher,et al.  Physicians' advice to quit smoking. The glass remains half empty. , 2000, The Journal of family practice.

[4]  K. Derose,et al.  Limited English Proficiency and Latinos’ Use of Physician Services , 2000, Medical care research and review : MCRR.

[5]  J. Weissman,et al.  Quality of care by race and gender for congestive heart failure and pneumonia. , 1999, Medical care.

[6]  R W Sanson-Fisher,et al.  The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. , 1999, American journal of preventive medicine.

[7]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[8]  G. Flores,et al.  Access barriers to health care for Latino children. , 1998, Archives of pediatrics & adolescent medicine.

[9]  J. Blustein,et al.  Visits to Specialists Under Medicare: Socioeconomic Advantage and Access to Care , 1998, Journal of health care for the poor and underserved.

[10]  C. Clancy,et al.  Skepticism toward medical care and health care utilization. , 1998, Medical care.

[11]  C. Clancy,et al.  Utilization of specialty and primary care: the impact of HMO insurance and patient-related factors. , 1997, The Journal of family practice.

[12]  S Sudman,et al.  Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms. , 1997, American journal of epidemiology.

[13]  C. Cleeland,et al.  Pain and Treatment of Pain in Minority Patients with Cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study , 1997, Annals of Internal Medicine.

[14]  J. Stradling,et al.  A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? , 1997, Journal of public health medicine.

[15]  R. Sanson-Fisher,et al.  The accuracy of self-reported Pap smear utilisation. , 1997, Social science & medicine.

[16]  L. Chávez,et al.  Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women. , 1996, Archives of internal medicine.

[17]  T. Mark,et al.  Pneumococcal pneumonia and influenza vaccination: access to and use by US Hispanic Medicare beneficiaries. , 1996, American journal of public health.

[18]  P. Eggers,et al.  Effects of race and income on mortality and use of services among Medicare beneficiaries. , 1996, The New England journal of medicine.

[19]  E. Paskett,et al.  Validation of self-reported breast and cervical cancer screening tests among low-income minority women. , 1996, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[20]  K. Freund,et al.  Black Women Receive Less Mammography Even with Similar Use of Primary Care , 1996, Annals of Internal Medicine.

[21]  J. Zapka,et al.  Mammography use among sociodemographically diverse women: the accuracy of self-report. , 1996, American journal of public health.

[22]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[23]  B. Hahn Children's health: racial and ethnic differences in the use of prescription medications. , 1995, Pediatrics.

[24]  R. Andersen Revisiting the behavioral model and access to medical care: does it matter? , 1995, Journal of health and social behavior.

[25]  M. Shapiro,et al.  Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. , 1995, American journal of public health.

[26]  W. Hueston,et al.  Factors Associated With the Use of Intrapartum Epidural Analgesia , 1994, Obstetrics and gynecology.

[27]  E. Keeler,et al.  Health care for black and poor hospitalized Medicare patients. , 1994, JAMA.

[28]  B. Burns,et al.  Ethnicity and the use of outpatient mental health services in a national insured population. , 1994, American journal of public health.

[29]  E. Cook,et al.  Effect of Race on the Presentation and Management of Patients with Acute Chest Pain , 1993, Annals of Internal Medicine.

[30]  K. Todd,et al.  Ethnicity as a risk factor for inadequate emergency department analgesia. , 1993, JAMA.

[31]  G. Marks,et al.  Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84. , 1990, American journal of public health.

[32]  K. Wells,et al.  Which Mexican-Americans underutilize health services? , 1987, The American journal of psychiatry.

[33]  T. J. Sullivan,et al.  Two Decades of Health Services: Social Survey Trends in Use and Expenditure. , 1978 .

[34]  K. Collins U.S. Minority Health: A Chartbook , 1999 .

[35]  Demographic characteristics of persons without a regular source of medical care--selected states, 1995. , 1998, MMWR. Morbidity and mortality weekly report.

[36]  P Kemper,et al.  The design of the community tracking study: a longitudinal study of health system change and its effects on people. , 1996, Inquiry : a journal of medical care organization, provision and financing.

[37]  M. Thun,et al.  Demographic predictors of mammography and Pap smear screening in US women. , 1993, American journal of public health.

[38]  M. Kogan,et al.  Racial differences in late prenatal care visits. , 1993, Journal of perinatology : official journal of the California Perinatal Association.

[39]  R. Scheffler,et al.  Demand analysis of mental health service use among ethnic subpopulations. , 1989, Inquiry : a journal of medical care organization, provision and financing.