title: The vulnerability of middle-aged and older adults in a multiethnic, low-income area: contributions of age, ethnicity, and health insurance.
abstract: This community-partnered study was developed and fielded in partnership with key community stakeholders and describes age- and race-related variation in delays in care and preventive service utilization between middle-aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self-identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self-reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14-23) and problems obtaining needed medical care (APP=15%, 95% CI=12-20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33-56) and problems obtaining needed medical (APP=33%, 95% CI=22-45) and specialty care (APP=26%, 95% CI=16-39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.
authors.affiliation: Department of Family and Community Medicine, University of California at San Francisco, San Francisco, California, USA. odomwalkerk@fcm.ucsf.edu
authors.forename: Kara Odom
authors.initials: KO
authors.lastname: Walker
authors.forename: Neil
authors.initials: N
authors.lastname: Steers
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.forename: Nell
authors.initials: N
authors.lastname: Forge
authors.forename: Loretta
authors.initials: L
authors.lastname: Jones
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003695:Delivery of Health Care / Q000208:ethnology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology*; D008875:Middle Aged; D020380:Needs Assessment; D011203:Poverty / Q000208:ethnology*; D011204:Poverty Areas; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011788:Quality of Life; D012494:Sampling Studies; D014611:Vaccination