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

Findings from a national sample

Kevin Fiscella, Peter Franks, Mark P. Doescher, Barry G. Saver

Research output: Contribution to journalArticle

557 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)52-59
Number of pages8
JournalMedical Care
Volume40
Issue number1
DOIs
StatePublished - Jan 2002

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Healthcare Disparities
Language
ethnicity
health care
vaccination
contagious disease
speaking
language
mental health
Hispanic Americans
Human Influenza
physician
Mental Health
Vaccination
Causality
health insurance
health professionals
Physicians
Medicaid
Health Insurance

Keywords

  • Blacks
  • Ethnicity
  • Health care
  • Hispanic patients
  • Minority populations
  • Preventive care
  • Race

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Disparities in health care by race, ethnicity, and language among the insured : Findings from a national sample. / Fiscella, Kevin; Franks, Peter; Doescher, Mark P.; Saver, Barry G.

In: Medical Care, Vol. 40, No. 1, 01.2002, p. 52-59.

Research output: Contribution to journalArticle

Fiscella, Kevin ; Franks, Peter ; Doescher, Mark P. ; Saver, Barry G. / Disparities in health care by race, ethnicity, and language among the insured : Findings from a national sample. In: Medical Care. 2002 ; Vol. 40, No. 1. pp. 52-59.
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abstract = "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.",
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