title: The relationship of immigrant status with access, utilization, and health status for children with asthma.
abstract: OBJECTIVE
  Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.
  
  
  METHODS
  Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.
  
  
  RESULTS
  Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.
  
  
  CONCLUSIONS
  Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.
authors.affiliation: Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. jo.javier@chla.usc.edu
authors.forename: Joyce R
authors.initials: JR
authors.lastname: Javier
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Mendoza
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male