Primary Care and Receipt of Preventive Services among Older Immigrants in California

This study examines the effects of race/ethnicity and U.S. nativity on utilization and outcome of primary care services to determine whether immigration status is associated with increased racial/ethnic disparities in primary care. The data come from the 2001 California Health Interview Survey. Access to primary care is measured by presence of a usual source of care; utilization is measured by physician visits in the past year, receipt of flu vaccination and other age appropriate tests. Also examined are rates of hospitalization and emergency department (ED) visits for ambulatory care sensitive conditions (ACS) as a marker for quality of primary care. Hospitalization and ED visits for ACS conditions such as Diabetes and Asthma indicate inadequate primary care. Elderly persons who self report the presence of these conditions constitute the population at risk for this analysis. Bi-variate analysis reveals that immigrants are significantly less likely to have access to a usual source of care and utilize less primary care services, including fewer physician visits. Despite the seeming inadequacy of primary care services, immigrants have lower rates of ACS hospitalization and ED visits. Multivariate logistic regression with race/ethnicity and nativity as predictors of ACS hospitalization/ED visit, adjusting for demographic, socioeconomic status (education, poverty level), insurance status and having a usual source or care also revealed relatively better outcome for the foreign-born population. In the next phase of this analysis I will examine whether the effect of immigration status varies by race.