title: Neighborhood socioeconomic disadvantage and access to health care.
abstract: Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an "emergent characteristic " of those areas that predicts the ability of residents to obtain health care.
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD 20850, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Kirby
authors.forename: Toshiko
authors.initials: T
authors.lastname: Kaneda
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000600:supply & distribution; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012923:Social Class; D014481:United States