title: Barriers to care and comorbidities along the U.S.-Mexico border.
abstract: OBJECTIVE
  While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities.
  
  
  METHODS
  We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009-2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions.
  
  
  RESULTS
  Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7% of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR=3.65, 95% confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR=1.71, 95% CI 1.10, 2.66, p=0.017), being confused about arrangements (OR=1.82, 95% CI 1.04, 3.21, p=0.037), and not being treated with respect in medical settings (OR=1.63, 95% CI 1.05, 2.53, p=0.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥ 2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers.
  
  
  CONCLUSIONS
  A substantial proportion of adults reported comorbidities. Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.
authors.affiliation: Northern Arizona University, Department of Physical Therapy and Athletic Training, Flagstaff, AZ.
authors.forename: Hendrik Dirk
authors.initials: HD
authors.lastname: de Heer
authors.forename: Hector Guillermo
authors.initials: HG
authors.lastname: Balcázar
authors.forename: Osvaldo F
authors.initials: OF
authors.lastname: Morera
authors.forename: Lisa
authors.initials: L
authors.lastname: Lapeyrouse
authors.forename: Josiah McC
authors.initials: JM
authors.lastname: Heyman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Salinas
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Zambrana
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003144:Communication Barriers; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005249:Fees and Charges; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D015995:Prevalence; D013781:Texas / Q000453:epidemiology; D014186:Transportation; D055815:Young Adult