Immigration Status and Office-Based Physician Visit among Cancer Patients in the United States

Background: Cancer needs to be regularly monitored to achieve longer survival time among patients. Prior research suggests that immigrants utilize less health care than US natives when in need, resulting in poorer clinical outcomes. Our study contributes to the literature by examining disparities in office-based physician visits associated with cancer between immigration groups using a nationally representative database in the United States.

Methods: 2002-2011 data from Medical Expenditure Panel Survey was used, and we restricted our study population to adults aged 18 and older, who had been diagnosed with any kind of cancer in the past. The final analytical sample size was 11,413 after list-wise deletion. Respondents were categorized as US natives, naturalized citizens and noncitizens based on their place of birth and current citizenship. Our main dependent variable was office-based physician visit within past 12 months, quantified as dichotomized (whether having at least one visit or not) and count (number of visits) variables. Multivariate logistic and negative binomial regressions measured relationship of probability and frequency of having office-based physician visits for cancer within past 12 months by immigration status, controlling for age, gender, education attainment, race/ethnicity, self-reported health status, marital status, poverty status, insurance and usual source of care. All the analyses were adjusted for MEPS complex survey design. A P-value less than 0.05 was considered as statistically significant.

Results: Univariate analyses showed that only 75% of noncitizen cancer patients had office-based physician visits within past 12 months, as compared to US natives (81%) and naturalized citizens (82%). Average number of visits per patient for US natives, naturalized citizens and noncitizens were 4.70, 5.44, and 3.96, respectively. Controlling for confounding factors, multivariate logistic regression found no statistical differences between naturalized citizens (adjusted odds ratios [AOR] 1.06, 95% confidence interval [CI] 0.81-1.38), noncitizens (AOR 0.85, 95% CI 0.60-1.20) and US natives in probability of having office-based physician visits. However, negative binomial regression model showed noncitizens had 30% less in frequency of visiting a physician within past 12 months than US natives (Incidence Rate Ratio [IRR] 0.70, 95% CI 0.55-0.90).

Conclusion: Our study findings show there are disparities in office-based physician visits among cancer patients across immigration groups. Noncitizen immigrant’s less frequency of visiting a physician suggests targeted interventions that reduce socioeconomic barriers, in order to improve continuity of care and ultimately eliminate existing disparities.