Variation in healthcare utilization in Asian American adults by neighborhood racial/ethnic concordance

Background/Significance. Health behaviors of Asian Americans (AAs) may be influenced by the racial/ethnic composition of their neighborhoods.

Objective/Purpose. To examine whether healthcare utilization varies by prevalence of Asian ethnic subgroups (all AAs, Chinese, Filipinos, Vietnamese) in resident census tracts.

Methods. Data are from 2005, 2007, and 2009 California Health Interview Survey and 2010 U.S. Census. Four census tracts indicators were created to determine the percentage of same ethnicity residents residing in the tract (≥10%, ≥26%, ≥40%, ≥50%). Sets of logistic regressions were run to assess the tract indicators for each subgroup by outcome. Outcomes included having ≥1 doctor's visit, having a usual source of care (USC), experiencing a delay in medical care, experiencing a delay in prescription medication. Models were survey-weighted and adjusted for English proficiency, duration in US, insurance, employment, household income, education, age, gender, health status, household size, and survey year.

Results. Of the 8,057 census tracts in California, 39.7%, 13.9%, 6.9%, and 4.2% had ≥10%, ≥26%, ≥40%, and ≥50% Asians residing. AAs living in census tracts with ≥50% Asians had significantly lower odds of having a USC (OR=0.41) but lower odds of delay in medication (OR=0.07). Within ethnicities, Chinese in tracts with ≥40% and ≥50% Chinese had significantly lower odds of having a USC (OR=0.43 and 0.34) while Filipinos in tract with ≥26% Filipinos had significantly higher odds of having a USC (OR=3.93). Vietnamese in tracts with ≥50% Vietnamese had lower odds of having ≥1 visit (OR=0.46) but those in tracts ≥40% Vietnamese had lower odds of delay in care (OR=0.08).

Discussion/Conclusions. Neighborhood effects on AA healthcare utilization appear to depend on specific subgroup and how utilization is measured. AAs living in AA neighborhoods may lack USCs but seem not to experience delays in care/medication; this may result in AAs losing care coordination benefits associated with USC.