Community demographics and access to health care among U.S. Hispanics.
OBJECTIVE
To explore the influence of the communities in which Hispanics live on their access to health care.


METHODS
1996-2002 Medical Expenditure Panel Survey data, linked to secondary data sources and including 14,504 observations from 8,371 Mexican American respondents living in metropolitan areas.


METHODS
We use multivariate probit regression models, stratified by individuals' insurance status, for analyses of four dependent variables measuring access to health care. We measure community characteristics at the zip code tabulation area level, and key independent variables of interest are the percentage of the population that speaks Spanish and percentage of the population that is immigrant Hispanic. Each of these measures is interacted with individual-level measures of nativity and length of U.S. residency.


RESULTS
For Mexican American immigrants, living in an area populated by relatively more Spanish speakers or more Hispanic immigrants is associated with better access to care. The associations are generally stronger for more recent immigrants compared with those who are better established. Among U.S.-born Mexican Americans who are uninsured, living in areas more heavily populated with Spanish-speaking immigrants is negatively associated with access to care.


CONCLUSIONS
The results suggest that characteristics of the local population, including language and nativity, play an important role in access to health care among U.S. Hispanics, and point to the need for further study, including analyses of other racial and ethnic groups, using different geographic constructs for describing the local population, and, to the extent possible, more specific exploration of the mechanisms through which these characteristics may influence access to care.
Gresenz
Carole Roan
CR
RAND Corporation, Arlington, VA 22202-5050, USA. gresenz@rand.org
Rogowski
Jeannette
J
Escarce
José J
JJ
D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003144:Communication Barriers; D003710:Demography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D007802:Language; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult