Abstract
Do healthcare experiences differ among Native Hawaiian and Other Pacific Islander and Asian Medicare beneficiaries?
Megan K. Beckett, PhD1, Marc N. Elliott, PhD1, Katrin Hambarsoomian, MS1, Jacob W. Dembosky, MPP2, Shondelle Wilson-Frederick, PhD3, Sarah Gaillot, PhD3 and Steven C. Martino, PhD4
(1)RAND Corporation, Santa Monica, CA, (2)PA, (3)Centers for Medicare & Medicaid Services, Baltimore, MD, (4)RAND Corporation, Pittsburgh, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background/significance: Native Hawaiian and Other Pacific Islanders (NHOPI) adults have lower life expectancy and higher disease burden than Asians.
objective: Investigate between-plan differences and within-plan differences in NHOPI and Asian patient experience disparities.
methods: Predicted each of 6 patient experience outcomes (getting needed care, getting care quickly, doctor communication, care coordination, getting needed prescription drugs, flu immunization) using data from 2017 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) data (NHOPI n=795; Asian n=7117) from NHOPI indicator and standard CAHPS case-mix adjustors.
results: Compared with Asians, NHOPI beneficiaries reported much less difficulty getting needed care (+7 points; 0-100), customer service (+5 points), doctor communication (+5 points), getting care quickly (+4 points), and getting needed prescription drugs (+3 points). In contrast, NHOPIs reported much lower flu immunization (-15 points; p<0.05 for all reported differences). Enrollment of NHOPI beneficiaries in higher-quality plans accounts for <25% of these differences.
discussion/conclusions: We did not find worse patient experiences for NHOPI that might have explained poorer NHOPI health outcomes. Older NHOPI beneficiaries are enrolled in plans with somewhat higher overall patient experiences than Asian patients, which may in part reflect geographic patterns. They report somewhat better experiences than Asians within plans, perhaps reflecting fewer language or cultural barriers. Overall, Asians have a higher flu immunization rate than NHOPIs. Further study of NHOPI and Asian differences in patient experience may suggest means of improving the experiences of Asians. There is value in measuring NHOPI patient experience separately from that of Asians where sample sizes permit.
Epidemiology Program planning Public health or related research Social and behavioral sciences
Abstract
Disparities in Health Insurance Uptake after the Affordable Care Act By Limited English Proficient (LEP) Asians and Latinos in California
Yoon Sun Choi, B.S.1, Jun Chu, MPH2, Dylan Roby, PhD2 and Neil Sehgal, PhD, MPH2
(1)University of Maryland, College Park, College Park, MD, (2)University of Maryland, College Park, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Individuals with Limited English Proficiency (LEP) face challenges navigating the healthcare system. California has the largest LEP population in the U.S. and launched a statewide marketing campaign in 2013 to increase awareness about options under the state’s health insurance exchange (Covered California) and the Affordable Care Act (ACA). We sought to determine increases in insurance for Californians, and examine LEP and socio-demographic differences that contribute to disparities in insurance uptake. Methods: Using pooled data from California Health Interview Survey, we compared the insured rate of Asians and Latinos to non-Hispanic Whites before (2009-2012) and after (2015-2016) the ACA implementation. We used a logistic regression model and controlled for income, age, gender, employment status, and job type. Results: Overall, insured status increased for all races (N= 85,678). However, Californians with LEP were less likely to be insured than those without LEP (OR=0.385, p<0.001). After controlling for socio-demographic characteristics, disparities were found among Asians and Latinos. Latinos were less likely to be insured than Whites (OR=0.619, p<0.001), regardless of English proficiency. Asians proficient in English did not significantly differ from Whites; however, Asians with LEP were less likely to be insured than Whites (OR=0.397, p<0.001). Conclusions: Results suggest California’s marketing campaign increase the state’s overall insured rate after the ACA. However, gaps in coverage remain in the LEP population, particularly among Asians and Latinos. Language proficiency may better explain insurance status differences than other socioeconomic and demographic variables. Further investigation is needed along with analysis for LEP populations in other states.
Advocacy for health and health education Public health or related public policy Public health or related research
Abstract
A Matter of Citizenship? Exploring the Health Profiles of Non-Citizen Asian Ethnic Groups in California
Adrian Bacong, MPH and Anne Pebley, PhD
University of California, Los Angeles - Fielding School of Public Health, Los Angeles, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Asians make up the second largest group of non-citizen and undocumented immigrants. Traditionally, immigrant narratives have focused on Latinos. However, little is known about the health profiles of non-citizen and undocumented Asian ethnic groups.
Objective: To explore associations between citizenship status and health outcomes among Chinese, Japanese, Korean, Filipino, and Vietnamese individuals.
Methods: Using combined data from four separate administrations (2013 to 2016) of the California Health Interview Survey, this study explored differences in health outcomes (general health, diabetes, heart disease, hypertension, psychological distress) by citizenship status (citizen or non-citizen) among Chinese, Japanese, Korean, Filipino, and Vietnamese individuals (n = 9489). Multivariate logistic regressions further explored these effects while controlling for age and gender.
Results: After controlling for age and gender, Asian non-citizens had a higher likelihood of reporting “fair or poor” general health (OR = 1.59, 95% CI: 1.37, 1.84), but lower likelihood of diabetes (OR = 0.73, 95% CI: 0.59, 0.90) and hypertension (OR = 0.66, 95% CI: 0.57, 0.77). Further stratification revealed that Vietnamese, Japanese, and Chinese non-citizens were more likely to report “fair or poor” health compared to their citizen counterparts. Additionally, Japanese and Korean non-citizens were less likely to have diabetes or hypertension compared to their citizen counterparts.
Conclusions: Despite reporting greater “fair or poor” general health, some non-citizen Asian ethnic groups experience lower prevalence of chronic morbidities than their citizen counterparts. While these results are reflective of the “immigrant paradox”, they invite further exploration into environmental and structural factors driving this trend.
Diversity and culture Public health or related research Social and behavioral sciences
Abstract
Smoking-related conflict and family health among Asian American male smokers and their non-smoking family members
Jin Kim-Mozeleski, PhD1, Nancy J. Burke, PhD2, Ginny Gildengorin, PhD3, Stephen J. McPhee, MD3, Bang H. Nguyen, DrPH4, Tung T. Nguyen, MD3, Susan L. Stewart, PhD5, Angela Sun, PhD, MPH6 and Janice Y. Tsoh, PhD3
(1)University of Massachusetts Amherst, Amherst, MA, (2)University of California, Merced, Merced, CA, (3)University of California, San Francisco, San Francisco, CA, (4)Asian American Research Center on Health, San Francisco, CA, (5)University of California, Davis, Sacramento, CA, (6)Chinese Community Health Resource Center (CCHRC)/ Asian Alliance for Health (AAFH), San Francisco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Significance: Cigarette smoking is prevalent among Asian American immigrant men. Previously, we reported that smoking is directly associated with family conflict, negatively impacting family communication among Asian American smokers and family members.
Objective: The present study examined how smoking-related conflict impacts family health, using a measure of self-rated general health.
Method: Using a subset of data collected at baseline from Chinese and Vietnamese daily smoker and their non-smoking family participants who participated as smoker-family dyads in a smoking cessation trial (n=158 dyads; total n=316 participants), we analyzed dyads whose self-rated general health were similar to each other. We combined individual responses for family health, dichotomized as “excellent/very good/good” versus “fair/poor” family health. Each dyad member also reported frequency of smoking-related conflict within the family in the past month with responses dichotomized as “not at all/rarely,” versus “some/often/most of the time.” Logistic regression analysis, controlling for factors known to affect health status (age, education, employment, physical activity, and BMI), was used to examine how conflict was associated with family health.
Results: Smoking-related conflict was reported by 25% of smokers (mean age=54; 100% male; 44% education < HS) and 27% of family members (mean age=52; 91% female; 36% education < HS). More than half (57%) of dyads reported “fair/poor” health. Family’s report of smoking-related conflict was associated with increased odds of fair/poor health (aOR=3.66, 95%CI [1.26,10.62], p=0.02), whereas smokers’ report was not so associated (p=0.28).
Conclusion: Non-smoking family members who live with smokers may experience poorer health via conflict around smoking, affecting overall family health.
Diversity and culture Public health or related research Social and behavioral sciences