Preferred source of safety net care among Hispanic immigrants: Community health centers compared to emergency departments

Research Objective: This study examines the relationship of race, Hispanic ethnicity, and nativity with using a Community Health Center (CHC) compared to an emergency department (ED) as a usual source of safety net care. Study Design: Data is obtained from the 2006 and 2007 National Health Interview Surveys (NHIS). Only respondents reporting race/ethnicity as non-Hispanic White, non-Hispanic Black, or Hispanic, aged 18 years or older and reporting a usual source of acute care are included in the study (n=80,683). Analyses were conducted using STATA 10.0. Logistic regression modeled race/ethnicity and nativity as predictors of using a CHC or an ED as a usual source of care, compared to another site for care. Post-estimation analyses calculate the odds of CHC or ED utilization within the past year, comparing patients of foreign nativity to patients of U.S. nativity within race/ethnicity strata, and making comparisons among racial/ethnic groups within nativity strata. Multinomial logit regression modeled the effects of race/ethnicity, nativity, and citizenship on using an ED compared to a CHC. All models adjusted for the effects of socioeconomic, health access, and health status factors. Principal Findings: Multinomial logit analysis found foreign-born Hispanic (vs. U.S.-born non-Hispanic) significantly less likely to use an ED compared to a CHC [OR=0.52 (95%CI 0.32,0.85)]. In the full logistic model, foreign-born and Hispanic are significantly associated with CHC use compared to U.S. natives [(OR=1.40(95%CI 1.21,1.61)] and non-Hispanic [(OR=1.41(95%CI 1.23,1.61)], while Black race (vs. white) was not predictive [(OR=0.96 (95%CI 0.83,1.01)]. Post-estimation analyses found significant association between using a CHC and being foreign-born [White OR=1.35 (95% CI 1.18,1.53), Black OR=1.35 (95% CI 1.11,1.59), Hispanic OR=1.35 (95% CI 1.15,1.56)] and Hispanic [foreign born OR=1.27 (95% CI 1.08,1.46) U.S. born OR=1.27 (95% CI 1.10,1.43)]. Hispanic ethnicity [OR=1.39 (95%CI 0.86,2.23)] and foreign nativity [OR=0.89 (95%CI 0.54,1.47) were not predictive of ED use in logistic analysis, while Black race was predictive [OR=3.36 (95%CI 2.35,4.79)]. Conclusions: Hispanic immigrants who rely on the safety net for care prefer CHCs to EDs. Reasons that Hispanic immigrants use CHCs extend beyond reasons commonly attributed to health care access. After adjusting for factors typically associated with immigrants' health care access, Hispanic immigrants were still significantly more likely than non-Hispanic U.S. natives to use a CHC over an ED. Communities seeking to expand access for Hispanic immigrants should identify and incorporate into their health systems the aspects of CHC health care delivery that make it attractive to this population.