1
|
Estrada-Mendizabal RJ, Dhaliwal AS, Bertolo AJ, Batai K, Heimark R, Recio-Boiles A, Chipollini J. Prostate Cancer Disparities in Metastatic and Treatment Status for Hispanic Americans Based on Country of Origin Compared to Non-Hispanic Whites Using the National Cancer Database. Clin Genitourin Cancer 2024; 22:e148-e155.e1. [PMID: 37903669 DOI: 10.1016/j.clgc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Among Hispanic-American (HA) men, prostatic cancer (PCa) accounts for nearly one-quarter of the total cancer burden. We sought to identify differences in PCa presentation and treatment status for HA subgroups based on country/region of origin. MATERIAL AND METHODS Using the National Cancer Database, we identified patients with histologically confirmed prostate adenocarcinoma with reported race/ethnicity, clinical staging, Gleason score ≥ 6, and PSA level at diagnosis from 2010 to 2016. HAs were divided into 4 subgroups: Mexican, Puerto Ricans, Cubans, and Central/South Americans. Non-Hispanic White (NHW) men were used as a reference group. Statistical analysis was derived from the Kruskal-Wallis test for continuous variables and χ2 test for categorical variables. Models were constructed to evaluate the association of Hispanic country of origin with metastatic presentation and treatment status. RESULTS A total of 428,829 patients were included, with 5625 (1.3%) classified as HA. Within the Hispanic group, 2880 (51.2%) were Mexican, 999 (17.8%) Puerto Rican, 477 (8.5%) Cuban, and 1269 (22.6%) South/Central American. Mexican men presented with higher median PSA, more Gleason 8 to 10 disease, and higher rates of metastatic presentation compared to NHW and other HA subgroups (all, p < .01). Metastatic rates over the study period for Mexican, Puerto Rican, Cuban, and South/Central Americans were 6.4 (±1.2), 5.3 (±3.0), 3.2 (±2.0), and 4.6% (±1.7), respectively (p = .01). Treatment rates were 89.1, 89.6, 92.4, and 89.3% for Mexican, Puerto Rican, Cuban, and South/Central Americans, respectively (p = .19). Mexican men had higher odds of initial metastatic presentation (OR: 1.32; 95%CI: 1.07-1.63, p = .01) but lower odds of receiving treatment (0.68; 0.55-0.85, p < .01). CONCLUSION Men of Mexican origin presented with more advanced PCa when compared to NHW and other Hispanic subgroups. Our results warrant further investigation into potential biological factors affecting Hispanic patients as well as the identification of treatment barriers for this vulnerable population.
Collapse
Affiliation(s)
| | | | | | - Ken Batai
- Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ronald Heimark
- Department of Surgery, University of Arizona, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ
| | - Alejandro Recio-Boiles
- Department of Medicine, University of Arizona, AZ; University of Arizona Cancer Center, Tucson, AZ
| | | |
Collapse
|
2
|
Gaitán-Rossi P, Vilar-Compte M, Ferré-Eguiluz I, Ortiz L, Garcia E. Association between Feelings of Trust and Security with Subjective Health among Mexican Migrants in the New York City Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2981. [PMID: 36833676 PMCID: PMC9966475 DOI: 10.3390/ijerph20042981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
The size of the foreign-born population living in the United States makes migrants' health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants' health.
Collapse
Affiliation(s)
- Pablo Gaitán-Rossi
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ 07043, USA
| | - Isabel Ferré-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Luis Ortiz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Erika Garcia
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| |
Collapse
|
3
|
Bustamante AV. Post-COVID19 strategies to support the health care interactions of U.S. Mexican immigrants and return migrants with the Mexican health system. J Migr Health 2023; 7:100170. [PMID: 36938330 PMCID: PMC10015227 DOI: 10.1016/j.jmh.2023.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
Background Mexican migrants in the United States (U.S.) are twice more likely to underutilize health care and to experience low quality of care compared to the U.S.-born population. Current and former Mexican migrants in the U.S have used health services in Mexico due to lower cost, perceived quality, cultural familiarity, and the geographic proximity of the two countries. Objective This study aims to characterize the different health care interactions of current and former U.S. Mexican migrants with public and private health care organizations of the Mexican health system and to identify strategies to improve health care interactions post-COVID19. Methods We use a typology of cross-border patient mobility to analyze the facilitators and barriers to improve the health care interactions of current and former U.S. Mexican migrants with the Mexican health system. Our policy analysis framework examines how an outcome can be achieved by various configurations or combinations of independent variables. The main outcome variable is the improvement of health care interactions of U.S. Mexican migrants and return migrants with different government agencies and public and private health care providers in the Mexican health system. The main explanatory variables are availability, affordability, familiarity, perceived quality of health care and type of health coverage. Findings As the Mexican health system emerges from the COVID19 pandemic, new strategies to integrate current and former U.S. Mexican migrants to the Mexican health system could be considered such as the expansion of telehealth services, a regulatory framework for health services used by transnational patients, making enrollment procedures more flexible for return migrants and guiding return migrants as they reintegrate to the Mexican health system. Conclusions The health care interactions of U.S. Mexican migrants with the Mexican health system are likely to increase in the upcoming decades due to population ageing. Regulatory improvements and programs that address the unique needs of U.S. Mexican migrants and return migrants could substantially improve their health care interactions with the Mexican health system.
Collapse
|
4
|
Chu J, Roby DH, Boudreaux MH. Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access. Health Serv Res 2022; 57 Suppl 2:315-325. [PMID: 36053731 PMCID: PMC9660422 DOI: 10.1111/1475-6773.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children. DATA SOURCES Restricted use 2000-2016 National Health Interview Survey (NHIS). STUDY DESIGN We used a difference-in-differences design that compared changes in CHIPRA expansion states to changes in non-expansion states. DATA COLLECTION Our sample included immigrant children who were born outside the US, aged 0-18 with family income below 300% of the Federal Poverty Level (FPL). Subgroup analyses were conducted across states that did and did not have a similar state-funded option prior to CHIPRA (state-funded vs. not state-funded), by the length of time in the US (5 years vs. 5-14 years), and global region of birth (Latin American vs. Asian countries). PRINCIPLE FINDINGS We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. CONCLUSIONS CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.
Collapse
Affiliation(s)
- Jun Chu
- Department of Sociology, Anthropology and Public HealthThe University of MarylandBaltimore County
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Public HealthUniversity of CaliforniaIrvineCaliforniaUSA
| | - Michel H. Boudreaux
- Department of Health Policy and Management, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
| |
Collapse
|
5
|
Ortega AN, Chen J, Roby DH, Mortensen K, Rivera-González AC, Bustamante AV. Changes in Coverage and Cost-Related Delays in Care for Latino Individuals After Elimination of the Affordable Care Act's Individual Mandate. JAMA Netw Open 2022; 5:e221476. [PMID: 35258582 PMCID: PMC8905379 DOI: 10.1001/jamanetworkopen.2022.1476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This cross-sectional study examines changes in levels of health care coverage and cost-related delays in care for Latino individuals after elimination of the individual coverage mandate from the Affordable Care Act (ACA).
Collapse
Affiliation(s)
- Alexander N. Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine
| | - Karoline Mortensen
- Department of Health Management and Policy, Herbert Business School, University of Miami, Florida
| | - Alexandra C. Rivera-González
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| |
Collapse
|
6
|
Cruz A, Dickerson F, Pulling KR, Garcia K, Gachupin FC, Hsu CH, Chipollini J, Lee BR, Batai K. Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2050. [PMID: 35206240 PMCID: PMC8872003 DOI: 10.3390/ijerph19042050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 12/20/2022]
Abstract
Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.
Collapse
Affiliation(s)
- Alejandro Cruz
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Faith Dickerson
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kathryn R. Pulling
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kyle Garcia
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Francine C. Gachupin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85724, USA;
| | - Juan Chipollini
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Benjamin R. Lee
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| |
Collapse
|
7
|
Aranki J, Wright P, Pompa-Craven P, Lotfizadeh AD. Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables. Telemed J E Health 2022; 28:1342-1349. [PMID: 35119331 DOI: 10.1089/tmj.2021.0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.
Collapse
Affiliation(s)
- Jenna Aranki
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | | | - Paula Pompa-Craven
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | - Amin D Lotfizadeh
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| |
Collapse
|
8
|
Ortega AN, Bustamante AV, Roby DH. New Directions for Public Health Research on the Health and Health Care of Undocumented Immigrants. Am J Public Health 2021; 111:1910-1912. [PMID: 34678052 PMCID: PMC8607342 DOI: 10.2105/ajph.2021.306506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Alexander N Ortega
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Arturo Vargas Bustamante
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Dylan H Roby
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| |
Collapse
|
9
|
Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic. J Immigr Minor Health 2021; 24:65-77. [PMID: 34596830 PMCID: PMC8485317 DOI: 10.1007/s10903-021-01283-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with a georeferencing analysis and key informant interviews. Data suggested an increased vulnerability to COVID-19 given participants reported health status, health care profile and place of residence, which coincided with the georeferencing analysis. The key informant interviews confirmed the vulnerability of this population and the supporting role of VDS in helping immigrants navigate health systems and disseminate health information. Mexican immigrants had an increased vulnerability to COVID-19 at the individual, geographic and systemic levels. Trusted and culturally sensitive services are needed to overcome some of the barriers and risk factors that increase the vulnerability of URM and immigrant populations to COVID-19.
Collapse
|
10
|
Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics. Healthcare (Basel) 2021; 9:healthcare9091183. [PMID: 34574957 PMCID: PMC8471651 DOI: 10.3390/healthcare9091183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022] Open
Abstract
Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed (n = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53–5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25–4.53). HAs (OR 2.24, 95% CI: 1.07–4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32–10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.
Collapse
|
11
|
Chu J, Ortega AN, Park S, Vargas-Bustamante A, Roby DH. The Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California. Med Care 2021; 59:762-767. [PMID: 34081680 DOI: 10.1097/mlr.0000000000001586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine changes in health care access and utilization for White, Asian, and Latino immigrants associated with the implementation of the Patient Protection and Affordable Care Act (ACA) in California. STUDY DESIGN Using the 2011-2013 and 2015-2017 California Health Interview Survey, we examined changes in 2 health care access and 2 utilization measures among 3 immigrant racial/ethnic groups. We estimated the unadjusted and adjusted percentage point changes in the pre-ACA and post-ACA periods. Adjusted estimates were obtained using linear probability models controlling for predisposing, enabling, and need factors. RESULTS After the ACA was nationally implemented in 2014, rates of insurance increased for non-Latino (NL) White, NL Asian, and Latino immigrant groups in California. Latino immigrants had the largest increase in insurance coverage (14.3 percentage points), followed by NL Asian immigrants (9.9 percentage points) and NL White immigrants (9.2 percentage points). Despite benefitting from the largest increase in insurance coverage, the proportion of insured Latino immigrants was still lower than that of NL White and NL Asian immigrants. Latino immigrants reported a small but significant decrease in the usual source of care (-2.8 percentage points) and an increase in emergency department utilization (2.9 percentage points) after the ACA. No significant changes were found after the ACA in health care access and utilization among NL White and NL Asian immigrants. CONCLUSIONS Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.
Collapse
Affiliation(s)
- Jun Chu
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
| | - Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Arturo Vargas-Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Dylan H Roby
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
12
|
Allen CD, Perreira KM. Commentary on the Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California. Med Care 2021; 59:759-761. [PMID: 34425582 DOI: 10.1097/mlr.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chenoa D Allen
- Department of Health Sciences, University of Missouri School of Health Professions, Columbia, MO
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina Medical School, Chapel Hill, NC
| |
Collapse
|
13
|
Riley AR, Chen YH, Matthay EC, Glymour MM, Torres JM, Fernandez A, Bibbins-Domingo K. Excess mortality among Latino people in California during the COVID-19 pandemic. SSM Popul Health 2021; 15:100860. [PMID: 34307826 PMCID: PMC8283318 DOI: 10.1016/j.ssmph.2021.100860] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which sociodemographic subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups categorized by age, sex, nativity, country of birth, educational attainment, occupation, and combinations of these factors. Our results indicate that during the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or a Central American country (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. In sum, the COVID-19 pandemic has disproportionately impacted mortality among Latino immigrants, especially those in unprotected essential jobs. Interventions to reduce these inequities should include targeted vaccination, workplace safety enforcement, and expanded access to medical care and economic support.
Collapse
Affiliation(s)
- Alicia R. Riley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Yea-Hung Chen
- Institute for Global Health, University of California, San Francisco, CA, USA
| | - Ellicott C. Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California, San Francisco, CA, USA
| | | |
Collapse
|
14
|
Melgoza E, Beltrán-Sánchez H, Bustamante AV. Emergency Medical Service Use Among Latinos Aged 50 and Older in California Counties, Except Los Angeles, During the Early COVID-19 Pandemic Period. Front Public Health 2021; 9:660289. [PMID: 34497790 PMCID: PMC8419352 DOI: 10.3389/fpubh.2021.660289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected Latino adults aged 50 and older in California. Among adults aged 50-64, Latinos constitute approximately one-third (32%) of the population, but over half (52%) of COVID-19 cases, and more than two-thirds (64%) of COVID-related deaths as of June 2, 2021. These health disparities are also prevalent among Latinos 65 years and older who constitute 22% of the population, but 40% of confirmed COVID-19 cases and 50% of COVID-related deaths. Emergency medical services (EMS) are an essential component of the United States healthcare system and a vital sector in COVID-19 response efforts. Using data from the California Emergency Medical Services Information System (CEMSIS), this study examines racial and ethnic differences in respiratory distress related EMS calls among adults aged 50 and older in all counties except Los Angeles. This study compares the early pandemic period, January to June 2020, to the same time period in 2019. Between January and June 2019, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks, Asians, and Whites. During the early pandemic period, January to June 2020, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks but slightly higher odds compared to Whites. Differences by race/ethnicity and region were statistically significant. Understanding EMS health disparities is crucial to inform policies that create a more equitable prehospital care system for the heterogeneous population of middle aged and older adults.
Collapse
Affiliation(s)
- Esmeralda Melgoza
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- UCLA California Center for Population Research, Los Angeles, CA, United States
| | - Arturo Vargas Bustamante
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| |
Collapse
|
15
|
Bustamante AV, Chen J, Félix Beltrán L, Ortega AN. Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States. Health Aff (Millwood) 2021; 40:1028-1037. [PMID: 34228519 DOI: 10.1377/hlthaff.2021.00037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.
Collapse
Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante is a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and faculty director of research at the UCLA Latino Policy and Politics Initiative, University of California Los Angeles, in Los Angeles, California
| | - Jie Chen
- Jie Chen is a professor in the Department of Health Policy and Management, School of Public Health, University of Maryland, in College Park, Maryland
| | - Lucía Félix Beltrán
- Lucía Félix Beltrán is a research assistant in the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in the Department of Health Management and Policy, Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
| |
Collapse
|
16
|
Buchmueller TC, Levy HG. The ACA's Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care. Health Aff (Millwood) 2021; 39:395-402. [PMID: 32119625 DOI: 10.1377/hlthaff.2019.01394] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Large disparities in health insurance coverage and access to health services have long persisted in the US health care system. We considered how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. In the years since the law went into effect, insurance coverage has increased significantly for all racial/ethnic groups. Because coverage increased more for non-Hispanic blacks and Hispanics than for non-Hispanic whites, disparities in coverage have decreased. Despite these improvements, a large number of adults remain uninsured, and the uninsurance rate among blacks and Hispanics is substantially higher than the rate among whites.
Collapse
Affiliation(s)
- Thomas C Buchmueller
- Thomas C. Buchmueller ( tbuch@umich. edu ) is the Waldo O. Hildebrand Professor of Risk Management and Insurance at the Ross School of Business, University of Michigan, in Ann Arbor
| | - Helen G Levy
- Helen G. Levy is a research professor in the Institute for Social Research, University of Michigan
| |
Collapse
|
17
|
Guadamuz JS, Kapoor K, Lazo M, Eleazar A, Yahya T, Kanaya AM, Cainzos-Achirica M, Bilal U. Understanding Immigration as a Social Determinant of Health: Cardiovascular Disease in Hispanics/Latinos and South Asians in the United States. Curr Atheroscler Rep 2021; 23:25. [PMID: 33772650 PMCID: PMC8164823 DOI: 10.1007/s11883-021-00920-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The main purpose of this review is to summarize the epidemiology of cardiovascular disease and its risk factors among two of the largest and most diverse immigrant groups in the United States (Hispanics/Latinos and South Asians). RECENT FINDINGS While the migration process generates unique challenges for individuals, there is a wide heterogeneity in the characteristics of immigrant populations, both between and within regions of origin. Hispanic/Latino immigrants to the United States have lower levels of cardiovascular risk factors, prevalence, and mortality, but this assessment is limited by issues related to the "salmon bias." South Asian immigrants to the United States generally have higher levels of risk factors and higher mortality. In both cases, levels of risk factors and mortality generally increase with time of living in the United States (US). While immigration acts as a social determinant of health, associations between immigration and cardiovascular disease and its risk factors are complex and vary across subpopulations.
Collapse
Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
- Centre de Recherche Politiques et Systèmes de Santé, Université Libre de Bruxelles Ecole de Santé Publique, Brussels, Belgium
| | - Karan Kapoor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mariana Lazo
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Eleazar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| |
Collapse
|
18
|
Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data. Cancers (Basel) 2021; 13:cancers13050990. [PMID: 33673457 PMCID: PMC7956712 DOI: 10.3390/cancers13050990] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary This study assessed renal cell carcinoma disparities in American Indians/Alaska Natives and Hispanic Americans using the National Cancer Database and the Arizona Cancer Registry, focusing on advanced-stage and mortality. Renal cell carcinoma disparities in American Indians/Alaska Natives have been partially explained by neighborhood socioeconomic factors and residence (rural or urban) pattern, but not in Hispanic Americans. Greater health disparities in renal cell carcinoma stage and mortality for Hispanic Americans and renal cell carcinoma mortality for American Indians/Alaska Natives were observed at the Arizona state level compared to national levels. Abstract Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.
Collapse
|
19
|
Statin nonadherence in Latino and noncitizen neighborhoods in New York City, Los Angeles, and Chicago, 2012-2016. J Am Pharm Assoc (2003) 2021; 61:e263-e278. [PMID: 33637436 DOI: 10.1016/j.japh.2021.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Latino adults, especially immigrants without citizenship (i.e., noncitizens), experience considerable barriers to health care, including medications. Inequitable access to medications, especially statins, may exacerbate disparities in cardiovascular disease. Despite this, little is known about medication nonadherence in Latino neighborhoods, especially those with large noncitizen populations. OBJECTIVES To estimate nonadherence to statins in Latino neighborhoods and evaluate differences on the basis of their noncitizen population. METHODS We conducted a retrospective cohort study among 48,161 adults who lived in predominately Latino neighborhoods in New York City, Los Angeles, and Chicago and who initiated statin therapy from January 2012 to December 2015 using IQVIA LifeLink. Statin nonadherence was defined as a proportion of days covered amounting to less than 80% over 12 months. We focused on differences between neighborhoods with high noncitizen concentrations (areas where noncitizens are at least 35% of the adult population) and other Latino neighborhoods. We examined associations using logistic regressions adjusted for individual (e.g., payment method) and neighborhood characteristics (e.g., poverty). RESULTS Individuals living in neighborhoods with high noncitizen concentrations were more nonadherent to statins than those in Latino neighborhoods with fewer noncitizens (75.0% vs. 70.0%, adjusted odds ratio [aOR] 1.18, [95% CI 1.06-1.33]). These disparities were worse in New York City (77.7% vs. 69.1%, aOR 1.37, [95% CI 1.23-1.53]) and Chicago (76.1% vs. 68.8%, aOR 1.38, [95% CI 1.14-1.67]) than in Los Angeles (73.8% vs. 71.3%, aOR 1.10, [95% CI 1.01-1.20]). CONCLUSION Neighborhoods with large noncitizen populations have much higher rates of statin nonadherence than Latino neighborhoods with fewer noncitizens. These disparities were least pronounced in Los Angeles, where the county provides health care to all uninsured residents, including noncitizens without documentation to reside in the United States. Efforts to improve medication access in Latino neighborhoods should be multifocal and start by implementing state and local health care options for low-income residents, regardless of citizenship status.
Collapse
|
20
|
Riley AR, Chen YH, Matthay EC, Glymour MM, Torres JM, Fernandez A, Bibbins-Domingo K. Excess death among Latino people in California during the COVID-19 pandemic. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33532794 DOI: 10.1101/2020.12.18.20248434] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Methods Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups defined by age, sex, place of birth, education, occupation, and combinations of these factors. Findings During the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or Central America (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. Interpretation The pandemic has disproportionately impacted mortality among Latino immigrants and Latinos in unprotected essential jobs; Interventions to reduce these disparities should include early vaccination, workplace safety enforcement, and expanded access to medical care. Funding National Institute on Aging; UCSF. RESEARCH IN CONTEXT Evidence before this study: Several articles have suggested all-cause excess mortality estimates are superior to official COVID-19 counts for assessing the impact of the pandemic on marginalized populations that lack access to testing and healthcare. We searched PubMed, Google scholar, and the medRxiv preprint database through December 22, 2020 for studies of ("excess mortality" or "excess death") AND ("COVID-19" or "coronavirus") set in the United States and we identified two empirical studies with estimates of excess mortality among Latinos during the pandemic. The study set in California (from our research team) found per capita excess mortality was highest among Black and Latino people. The national study found percent excess mortality was significantly higher among Latino people than any other racial/ethnic group. Neither study further disaggregated the diverse Latino population or provided subgroup estimates to clarify why excess pandemic mortality is so high in this population. In the U.S., official COVID-19 statistics are rarely disaggregated by place of birth, education, or occupation which has resulted in a lack of evidence of how these factors have impacted mortality during the pandemic. No study to date of excess mortality in the U.S. has provided estimates for immigrant or occupational subgroups.Added value of this study: Our population-based observational study of all-cause mortality during the COVID-19 pandemic provides the first estimates of within-group heterogeneity among the Latino population in California - one of the populations hardest hit by COVID-19 in the U.S. We provide the first subgroup estimates by place of birth and occupational sector, in addition to combined estimates by foreign-birth and participation in an essential job and education. In doing so, we reveal that Latino immigrants in essential occupations have the highest risk of excess death during the pandemic among working-age Latinos. We highlight the heightened risk of excess mortality associated with food/agriculture and manufacturing occupational sectors, essential sectors in which workers may lack COVID-19 protections.Implications of all the available evidence: Our study revealed stark disparities in excess mortality during the COVID-19 pandemic among Latinos, pointing to the particularly high vulnerability of Latino immigrants and Latinos in essential jobs. These findings may offer insight into the disproportionate COVID-19 mortality experienced by immigrants or similarly marginalized groups in other contexts. Interventions to reduce these disparities should include policies enforcing occupational safety, especially for immigrant workers, early vaccination, and expanded access to medical care.
Collapse
|
21
|
Wilson FA, Zallman L, Pagán JA, Ortega AN, Wang Y, Tatar M, Stimpson JP. Comparison of Use of Health Care Services and Spending for Unauthorized Immigrants vs Authorized Immigrants or US Citizens Using a Machine Learning Model. JAMA Netw Open 2020; 3:e2029230. [PMID: 33306118 PMCID: PMC7733155 DOI: 10.1001/jamanetworkopen.2020.29230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Knowledge about use of health care services (health care utilization) and expenditures among unauthorized immigrant populations is uncertain because of limitations in ascertaining legal status in population data. OBJECTIVE To examine health care utilization and expenditures that are attributable to unauthorized and authorized immigrants vs US-born individuals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the data on documentation status from the Los Angeles Family and Neighborhood Survey (LAFANS) to develop a random forest classifier machine learning model. K-fold cross-validation was used to test model performance. The LAFANS is a randomized, multilevel, in-person survey of households residing in Los Angeles County, California, consisting of 2 waves. Wave 1 began in April 2000 and ended in January 2002, and wave 2 began in August 2006 and ended in December 2008. The machine learning model was then applied to a nationally representative database, the 2016-2017 Medical Expenditure Panel Survey (MEPS), to predict health care expenditures and utilization among unauthorized and authorized immigrants and US-born individuals. A generalized linear model analyzed health care expenditures. Logistic regression modeling estimated dichotomous use of emergency department (ED), inpatient, outpatient, and office-based physician visits by immigrant groups with adjusting for confounding factors. Data were analyzed from May 1, 2019, to October 14, 2020. EXPOSURES Self-reported immigration status (US-born, authorized, and unauthorized status). MAIN OUTCOMES AND MEASURES Annual health care expenditures per capita and use of ED, outpatient, inpatient, and office-based physician care. RESULTS Of 47 199 MEPS respondents with nonmissing data, 35 079 (74.3%) were US born, 10 816 (22.9%) were authorized immigrants, and 1304 (2.8%) were unauthorized immigrants (51.7% female; mean age, 47.6 [95% CI, 47.4-47.8] years). Compared with authorized immigrants and US-born individuals, unauthorized immigrants were more likely to be aged 18 to 44 years (80.8%), Latino (96.3%), and Spanish speaking (95.2%) and to have less than 12 years of education (53.7%). Half of unauthorized immigrants (47.1%) were uninsured compared with 15.9% of authorized immigrants and 6.0% of US-born individuals. Mean annual health care expenditures per person were $1629 (95% CI, $1330-$1928) for unauthorized immigrants, $3795 (95% CI, $3555-$4035) for authorized immigrants, and $6088 (95% CI, $5935-$6242) for US-born individuals. CONCLUSIONS AND RELEVANCE Contrary to much political discourse in the US, this cross-sectional study found no evidence that unauthorized immigrants are a substantial economic burden on safety net facilities such as EDs. This study illustrates the value of machine learning in the study of unauthorized immigrants using large-scale, secondary databases.
Collapse
Affiliation(s)
- Fernando A. Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City
- Department of Economics, University of Utah, Salt Lake City
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Leah Zallman
- Harvard Medical School, Boston, Massachusetts
- Institute for Community Health, Malden, Massachusetts
- Cambridge Health Alliance, Cambridge, Massachusetts
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City
| | - Alexander N. Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Yang Wang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee
| | - Moosa Tatar
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Jim P. Stimpson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
Porteny T, Ponce N, Sommers BD. Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status. J Immigr Minor Health 2020; 24:86-94. [DOI: 10.1007/s10903-020-01124-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
|
23
|
Yu M, Kelley AT, Morgan AU, Duong A, Mahajan A, Gipson JD. Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County. Health Equity 2020; 4:366-374. [PMID: 32923841 PMCID: PMC7484891 DOI: 10.1089/heq.2020.0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: Amid increasingly restrictive federal immigration and health care policies in the United States, access to health care for undocumented immigrants is highly dependent on the extent to which local and state policies and programs address the needs of this population. In Los Angeles County (LA County), home to the nation's largest undocumented immigrant population, supportive policies are in place, yet little is known about how undocumented immigrants navigate available services. Methods: To gain insight into how federal, state, and local policies overlay and contribute to the experience of health care seeking among undocumented immigrants in LA County, we interviewed 19 key informant health care workers involved in the delivery of health care services, using a purposive snowball sampling approach. Results: Three key themes emerged: (1) health care workers at all clinics sampled reported primary care appointments are readily available for undocumented immigrants; however, primary care services remain underutilized; (2) fear, misinformation, and misperceptions of coverage and immigration policies—most commonly related to the revised Public Charge Rule—may reduce program enrollment and access; and (3) frontline health care workers feel ill-equipped to address patient fears and misinformation. Conclusion: Although county programs were perceived to improve access by covering health care costs and ensuring appointment availability, new restrictive immigration policies, such as the revised Public Charge Rule, and widespread misinformation present challenges that threaten the success of these programs. Future study to improve undocumented immigrant access to care should focus on addressing barriers resulting from these policies.
Collapse
Affiliation(s)
- Matthew Yu
- North Side Christian Health Center, Pittsburgh, Pennsylvania, USA
| | - A Taylor Kelley
- Department of Internal Medicine, Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Anna U Morgan
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Andrew Duong
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Anish Mahajan
- Los Angeles County Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Jessica D Gipson
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
24
|
Guadamuz JS, Durazo-Arvizu RA, Daviglus ML, Perreira KM, Calip GS, Nutescu EA, Gallo LC, Castaneda SF, Gonzalez F, Qato DM. Immigration Status and Disparities in the Treatment of Cardiovascular Disease Risk Factors in the Hispanic Community Health Study/Study of Latinos (Visit 2, 2014-2017). Am J Public Health 2020; 110:1397-1404. [PMID: 32673107 DOI: 10.2105/ajph.2020.305745] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate treatment rates of high cholesterol, hypertension, and diabetes among Hispanic/Latino immigrants by immigration status (i.e., naturalized citizens, documented immigrants, or undocumented immigrants).Methods. We performed a cross-sectional analyses of the Hispanic Community Health Study/Study of Latinos (visit 2, 2014-2017). We restricted our analysis to Hispanic/Latino immigrants with high cholesterol (n = 3974), hypertension (n = 3353), or diabetes (n = 2406); treatment was defined as use of statins, antihypertensives, and antidiabetics, respectively.Results. When compared with naturalized citizens, undocumented and documented immigrants were less likely to receive treatment for high cholesterol (38.4% vs 14.1%; prevalence ratio [PR] = 0.37 [95% confidence interval [CI] = 0.27, 0.51] and 25.7%; PR = 0.67 [95% CI = 0.58, 0.76]), hypertension (77.7% vs 57.7%; PR = 0.74 [95% CI = 0.62, 0.89] and 68.1%; PR = 0.88 [95% CI = 0.82, 0.94]), and diabetes (60.3% vs. 50.4%; PR = 0.84 [95% CI = 0.68, 1.02] and 55.8%; PR = 0.93 [95% CI = 0.83, 1.03]); the latter did not reach statistical significance. Undocumented and documented immigrants had less access to health care, including insurance coverage or a usual health care provider, than naturalized citizens. Therefore, adjusting for health care access largely explained treatment disparities across immigration status.Conclusions. Preventing cardiovascular disease among Hispanic/Latino immigrants should focus on undertreatment of high cholesterol, hypertension, and diabetes by increasing health care access, especially among undocumented immigrants.
Collapse
Affiliation(s)
- Jenny S Guadamuz
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Ramon A Durazo-Arvizu
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Martha L Daviglus
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Krista M Perreira
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Gregory S Calip
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Edith A Nutescu
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Linda C Gallo
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Sheila F Castaneda
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Franklyn Gonzalez
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Dima M Qato
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| |
Collapse
|
25
|
Ortega AN, Pintor JK, Langellier BA, Bustamante AV, Young MEDT, Prelip ML, Alberto CK, Wallace SP. Cardiovascular disease behavioral risk factors among Latinos by citizenship and documentation status. BMC Public Health 2020; 20:629. [PMID: 32375729 PMCID: PMC7204048 DOI: 10.1186/s12889-020-08783-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/27/2020] [Indexed: 02/02/2023] Open
Abstract
Background Studies have observed that recent Latino immigrants tend to have a physical health advantage compared to immigrants who have been in the US for many years or Latinos who are born in the United States. An explanation of this phenomenon is that recent immigrants have positive health behaviors that protect them from chronic disease risk. This study aims to determine if trends in positive cardiovascular disease (CVD) risk behaviors extend to Latino immigrants in California according to citizenship and documentation status. Methods We examined CVD behavioral risk factors by citizenship/documentation statuses among Latinos and non-Latino US-born whites in the 2011–2015 waves of the California Health Interview Survey. Adjusted multivariable logistic regressions estimated the odds for CVD behavioral risk factors, and analyses were stratified by sex. Results In adjusted analyses, using US-born Latinos as the reference group, undocumented Latino immigrants had the lowest odds of current smoking, binge drinking, and frequency of fast food consumption. There were no differences across the groups for fruit/vegetable intake and walking for leisure. Among those with high blood pressure, undocumented immigrants were least likely to be on medication. Undocumented immigrant women had better patterns of CVD behavioral risk factors on some measures compared with other Latino citizenship and documentation groups. Conclusions This study observes that the healthy Latino immigrant advantage seems to apply to undocumented female immigrants, but it does not necessarily extend to undocumented male immigrants who had similar behavioral risk profiles to US-born Latinos.
Collapse
Affiliation(s)
- Alexander N Ortega
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
| | | | - Brent A Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | | | | | - Michael L Prelip
- Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
| | - Cinthya K Alberto
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Steven P Wallace
- Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
| |
Collapse
|
26
|
Langellier BA, Martínez-Donate AP, Gonzalez-Fagoaga JE, Rangel MG. The Relationship Between Educational Attainment and Health Care Access and Use Among Mexicans, Mexican Americans, and U.S.-Mexico Migrants. J Immigr Minor Health 2019; 22:314-322. [PMID: 31127434 DOI: 10.1007/s10903-019-00902-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study was to assess the relationship between educational attainment and health care access and use among Mexican-origin populations. Data from the 2012 Mexican National Health and Nutrition Study, the 2013 Project Migrante Health Care Access and Utilization Survey, and the 2013-2014 California Health Interview Survey were used to examine educational gradients in health insurance, medical home, and hospitalization among Mexicans in Mexico, northbound, southbound, and deported migrants, and U.S.-and foreign-born Mexican Americans. College graduates had greater odds of being insured relative to those with less than a high school degree among Mexicans (AOR = 1.48, p < 0.001), northbound migrants (AOR = 3.69, p < 0.001), and the foreign-born (AOR = 2.01, p < 0.01), and of having a medical home among Mexicans (AOR = 1.95, p < 0.001) and the foreign-born (AOR = 2.14, p < 0.05). Eliminating differences by educational attainment in the U.S. will require policy changes like making immigrants eligible for public insurance. In Mexico, it will require targeted outreach to enroll underserved populations in existing public insurance programs.
Collapse
Affiliation(s)
- Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana P Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - J Eduardo Gonzalez-Fagoaga
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, AZ, USA.,Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico
| | - M Gudelia Rangel
- Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico.,Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| |
Collapse
|
27
|
Patler C, Hamilton E, Meagher K, Savinar R. Uncertainty About DACA May Undermine Its Positive Impact On Health For Recipients And Their Children. Health Aff (Millwood) 2019; 38:738-745. [DOI: 10.1377/hlthaff.2018.05495] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Caitlin Patler
- Caitlin Patler is an assistant professor of sociology at the University of California Davis
| | - Erin Hamilton
- Erin Hamilton is an associate professor of sociology at the University of California Davis
| | - Kelsey Meagher
- Kelsey Meagher is a PhD candidate in sociology at the University of California Davis
| | - Robin Savinar
- Robin Savinar is a postdoctoral fellow in sociology at the University of California Davis
| |
Collapse
|
28
|
Bustamante AV, Vilar-Compte M, Ochoa Lagunas A. Social support and chronic disease management among older adults of Mexican heritage: A U.S.-Mexico perspective. Soc Sci Med 2018; 216:107-113. [PMID: 30292581 DOI: 10.1016/j.socscimed.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
This study explores the association between social support and chronic disease self-management among older adults of Mexican heritage who live in the U.S. and Mexico. We hypothesize that social support increases the ability to manage hypertension and Type 2 (T2) diabetes, regardless of place of residence. We also investigate if differences in country of residence and health system factors influence the ability to manage chronic conditions. Older adults 65 years or older from Los Angeles (LA) and Mexico City (CDMX), with diagnosed hypertension or T2 diabetes (self-reported), attending government agencies, participated in the study. The statistical analyses investigate differences between older adults in LA and CDMX; identify the association between social support and chronic disease self-management; and examine the role of T2 diabetes treatment, testing and complications on self-management. Our study findings show that social support was a statistically significant predictor of improved T2 diabetes self-management (37%-51%, p < 0.05). The association between social support and hypertension self-management was only significant (90% confidence level) for adherence to weight management and increased alcohol consumption. Our study did not identify statistically significant differences in social support between LA and CDMX. However, almost 40% of sampled older adults were at risk of social isolation, signaling a vulnerable population that needs to be targeted by health and social systems in the U.S. and Mexico. Our study also shows that social support is a strong predictor of improved T2 diabetes management in the U.S. and Mexico. While older adults in the U.S. and Mexico reported similar access to care and health insurance coverage, higher adherence to low salt diets in LA and reduced coverage of glucose testing in CDMX could signal areas of opportunity for policymakers. Health care providers in both countries need to identify ways of improving adherence to physical activity and weight management.
Collapse
Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA.
| | - Mireya Vilar-Compte
- Department of Health Studies, Universidad Iberoamricana, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, CP 01219, CDMX, Mexico.
| | - Adriana Ochoa Lagunas
- University of Sussex in Brighton, Guillermo Prieto 25 Bis, Lomas Quebradas Magdalena Contreras, CP 10000, CDMX, Mexico.
| |
Collapse
|