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APHA Scientific Session and Event Listing

Recorded presentation

Darrell Gaskin, PhD and Thomas A. LaVeist, PhD. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 441, Baltimore, MD 21205, 443-287-5297, dgaskin@jhsph.edu

Objective: Nationally, analyses of race disparities in health care utilization do not adequately control for the impact of racial segregation on geographic access and often compare African American samples that are disproportionately low income to White samples that have higher percentages of moderate/middle and high income respondents. In this study, we try to determine if racial disparities in health care use can be attributed to residential segregation and economic inequality. We compared disparities in health care use in a national sample of adults to a sample of adults from a low income racially integrated community.

Data Sources: We used a national sample of adults from 2003 Medical Expenditure Panel Survey (MEPS), and data from the Exploring Health Disparities in Integrated Communities Project (EHDIC). The EHDIC data is a 2003 survey of adult residents from a low income urban community in a Maryland. This community has equal numbers of white non-Hispanic and African American residents. Census data shows that racial groups have similar median income and educational attainment. We also created a subsample of the MEPS by matching it to the EHDIC data by respondents' race, gender, income and educational attainment.

Study Design: Using logistic and negative binominal regression models, we estimated the impact of race on health care use in the full MEPS sample, the EHDIC sample and a matched MEPS subsample. We controlled for general health status, presence of chronic conditions, age, gender, marital status, insurance status, employment status, income and education. We compared the estimated effects of race across models to make inferences about income inequality and residential segregation on disparities in health use.

Principal Findings: We found differences in the race disparities in health care use across the datasets but some similarities too. In the MEPS data, African Americans were 15% less likely to have a health care visit compared to whites. However, in the EHDIC data, African Americans were 40% more likely to have a health care visits than whites. In MEPS data and EHDIC data, African Americans were less likely to multiple medical visits compared to whites.

Conclusion: Segregation and income inequality may explain substantial proportion of the observed race disparities in the initiation of health care use. However, differences in the amount of services use and whether individual have a regular doctor are probably due to factors related to the physician-patient interactions and individuals' experiences in the health care system.

Learning Objectives:

• To understand the impact of residential segregation on disparities in utilization
• To recognize the problem with national analyses that don't adequately control for SES differences between whites and black.

Keywords: Minority Health, Health Service

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation