Access to primary and preventive care among foreign-born adults in Canada and the United States.
OBJECTIVE
To conduct cross-country comparisons and assess the effect of foreign birth on access to primary and preventive care in Canada and the United States.


METHODS
Secondary data from the 2002 to 2003 Joint Canada-United States Survey of Health.


METHODS
Descriptive and comparative analyses were conducted, and logistic regression models were used to assess the effect of immigrant status and country of residence on access to care. Outcomes included measures of health care systems and processes, utilization, and patient perceptions.


RESULTS
In adjusted analyses, immigrants in Canada fared worse than nonimmigrants regarding having timely Pap tests; in the United States, immigrants fared worse for having a regular doctor and an annual consultation with a health professional. Immigrants in Canada had better access to care than immigrants in the United States; most of these differences were explained by differences in socioeconomic status and insurance coverage across the two countries. However, U.S. immigrants were more likely to have timely Pap tests than Canadian immigrants, even after adjusting for potential confounders.


CONCLUSIONS
In both countries, foreign-born populations had worse access to care than their native-born counterparts for some indicators but not others. However, few differences in access to care were found when direct cross-country comparisons were made between immigrants in Canada versus the United States, after accounting for sociodemographic differences.
Lebrun
Lydie A
LA
Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, 624 North Broadway, Room 447, Baltimore, MD 21205, USA. llebrun@jhsph.edu
Dubay
Lisa C
LC
D000293:Adolescent; D000328:Adult; D002170:Canada; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D011320:Primary Health Care; D014171:Transients and Migrants; D014481:United States; D055815:Young Adult
J Immigr Minor Health. 2008 Dec;10(6):517-28
18386179
Can J Public Health. 2007 May-Jun;98(3):183-6
17626381
Annu Rev Public Health. 2007;28:113-26
17094769
Am J Public Health. 2001 Mar;91(3):392-9
11236403
J Can Dent Assoc. 2006 Mar;72(2):143
16545174
Annu Rev Public Health. 2005;26:367-97
15760294
Ethn Health. 1996 Mar;1(1):99-109
9395553
J Natl Cancer Inst. 1993 Apr 7;85(7):566-70
8455203
J Health Serv Res Policy. 2005 Apr;10(2):77-83
15831190
Can J Commun Ment Health. 2000 Spring;19(1):143-59
12152173
Am J Epidemiol. 2001 Feb 15;153(4):372-80
11207155
Can J Public Health. 2007 Nov-Dec;98(6):470-5
19039885
J Immigr Minor Health. 2007 Oct;9(4):323-34
17345152
Arch Ophthalmol. 2008 Aug;126(8):1121-6
18695107
Soc Sci Med. 2004 Oct;59(8):1613-27
15279920
Med Care Res Rev. 2009 Aug;66(4):355-408
19179539
J Clin Epidemiol. 1996 Sep;49(9):989-95
8780606
Can Fam Physician. 2007 Nov;53(11):1899-901
18000266
Milbank Q. 2005;83(3):457-502
16202000
BMC Health Serv Res. 2006 Apr 06;6:49
16600038
Public Health Rep. 2005 Mar-Apr;120(2):133-9
15842114
Psychiatr Serv. 2007 Jan;58(1):63-71
17215414
Health Aff (Millwood). 2007 Sep-Oct;26(5):1258-68
17848435
Health Place. 2008 Dec;14(4):623-35
18242116
J Clin Epidemiol. 2001 Feb;54(2):136-41
11166528
J Health Care Poor Underserved. 2008 May;19(2):380-90
18469411
Can J Psychiatry. 2007 May;52(5):295-304
17542380
Health Serv Res. 2002 Jun;37(3):529-50
12132594
Int J Health Serv. 2006;36(4):697-717
17175842
Obstet Gynecol. 2006 Jan;107(1):151-60
16394053
Am J Public Health. 2003 Oct;93(10):1740-7
14534231
Psychiatr Serv. 2006 May;57(5):631-9
16675755
J Gen Intern Med. 2005 Mar;20(3):290-6
15836535
Cancer Epidemiol Biomarkers Prev. 1996 Sep;5(9):721-6
8877064
Prev Med. 2002 Nov;35(5):463-73
12431895
Health Place. 2007 Sep;13(3):656-71
17174590
Womens Health Issues. 2008 Mar-Apr;18(2):85-99
18182305
Med Care. 1984 Sep;22(9):796-803
6492908
Health Aff (Millwood). 2006 Jul-Aug;25(4):1133-42
16835196
Health Soc Work. 2007 Feb;32(1):57-65
17432742
Clin Ther. 2006 Aug;28(8):1217-1224
16982299
J Obstet Gynaecol Can. 2008 Mar;30(3):229-238
18364100
Am J Psychiatry. 1999 Jun;156(6):928-34
10360134
Med Care. 2009 Nov;47(11):1136-46
19786920
Soc Sci Med. 2009 Nov;69(10):1452-9
19767135
Community Dent Oral Epidemiol. 2002 Oct;30(5):352-62
12236826
Adv Data. 1994 Feb 14;(241):1-12
10132138
Can J Public Health. 2005 Sep-Oct;96(5):369-73
16238157
Health Serv Res. 2002 Jun;37(3):751-74
12132604
Am J Public Health. 2006 Jul;96(7):1300-7
16735628
Demography. 2006 May;43(2):337-60
16889132
Soc Sci Med. 2008 Nov;67(9):1410-22
18692946
Health Aff (Millwood). 2006 Nov-Dec;25(6):1700-11
17102196
J Health Soc Behav. 1994 Dec;35(4):370-84
7844331
Prev Med. 2004 Nov;39(5):943-50
15475028
J Gen Intern Med. 2003 Dec;18(12):1028-35
14687262