Occupational class disparities in the use of routine preventive care for Asian Americans in the labor force

Objective: National reports document the persistence of numerous inequities in the healthcare of Asian Americans. Occupational class, an indicator of socioeconomic status, is a powerful, enduring determinant of health and contributor to health inequities. We investigated how occupational class (white-collar, blue-collar, service, unemployed looking for work) is associated with the use of routine physical check-up and eye/dental exam in the past 12 months for Asian Americans in the labor force.

Methods: We analyzed cross-sectional data from 1530 Asian respondents to the National Latino and Asian American Survey who were in the labor force (currently employed or unemployed but looking for work). We conducted multivariate logistic regression analyses weighted to accommodate the complex survey design. We controlled for predisposing (age, gender, ethnicity, nativity, education and English language proficiency), enabling (income, health insurance, having a regular doctor or place of care) and need factors (health perceptions and chronic conditions).

Results: Overall, 26% and 27% of Asian American workers in 2002-2003 reported no routine physical check-up and no routine eye/dental exam, respectively. Occupational class was strongly associated with use of routine physical check-up and eye/dental exam in the past year. Compared to white-collar workers, blue-collar and service workers had statistically significantly higher odds of reporting no routine physical check-up (unadjusted ORs = 1.69 and 2.23, 95%CIs: 1.12-2.55 and 1.63-3.04, respectively) and no routine eye/dental exam (unadjusted ORs = 2.06 and 2.00, 95%CIs: 1.22-3.50 and 1.33-3.00, respectively). For routine physical check-up, controlling for predisposing, enabling and need factors accounted for the disparity for blue-collar workers (adjusted OR=1.23, 95%CI: .71-2.11) but not for service workers (adjusted OR=2.28, 95%CI: 1.51-3.45). For eye/dental exam, odds ratios were attenuated for blue-collar and service workers (adjusted ORs =1.73 and 1.57, 95%CIs: .98-3.04 and .99-2.51, respectively).

Conclusions: Occupational class disparities exist in the use of routine preventive care for Asian American workers. Blue-collar and service workers had significantly higher odds of no routine physical check-up and no routine eye/dental exam in the past year than white-collar workers. Controlling for factors such as speaking fair/poor English, having health insurance and a regular doctor or place of care accounted for some disparities but not others.

Implications: Routine physical check-up and eye/dental exams promote early detection of disease, use of preventive care and a good doctor-patient relationship. Eliminating inequities requires targeting routine preventive care to low-income workers and addressing barriers such as health insurance and others related to labor (e.g., working hours).