Disparities in Health Care by Race, Ethnicity, and Language Among the Insured

Findings From a National Sample

Bibliographic Data

ID9103328
AuthorsKevin Fiscella (0000-0003-3613-8012, University of Rochester, corresponding author), Peter Franks (0000-0002-9782-0181), Mark P Doescher (0000-0003-1631-0428, University of Washington), Barry G Saver (University of Washington)
Year2002
Volume40
Issue1
Pages52-59
Publication date2002-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-200201000-00007
PMID11748426
OpenAlexW2077286929
LanguageEN
Citations received175
References cited32

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

Cross-sectional study · Ethnic group · Family medicine · Health care · Health equity · Medicaid · Mental health · Multivariate analysis · Psychiatry · Public health · Vaccination · Cultural Competency in Health Care · Demography · Internal Medicine · Interpreting and Communication in Healthcare · Medicine · Migration, Health and Trauma · Nursing · Gerontology

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