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.


METHODS
Cross-sectional analysis of the Community Tracking Survey (1996-1997).


METHODS
Adults 18 to 64 years with private or Medicaid health insurance.


METHODS
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.
Fiscella
Kevin
K
Department of Family Medicine, University of Rochester School of Medicine, New York, USA. Kevin_Fiscella@URMC.rochester.edu
Franks
Peter
P
Doescher
Mark P
MP
Saver
Barry G
BG
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007802:Language; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*