Access to health care and Access to health care and health care utilization among health care utilization among Hispanic/Latino women in the Hispanic/Latino women in the

United States, 2000-2002United States, 2000-2002

Gulnur Scott, M.P.A.Gulnur Scott, M.P.A.Margaret Lethbridge-Çejku, PhDMargaret Lethbridge-Çejku, PhDDivision of Health Interview Division of Health Interview StatisticsStatistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

BackgroundBackground Access to health care is an important determinant of the Access to health care is an important determinant of the

quality of health care, the quality and years of healthy quality of health care, the quality and years of healthy life and the presence or absence of health disparitieslife and the presence or absence of health disparities

Race/ethnicity is one of the key factors that contributes Race/ethnicity is one of the key factors that contributes to disparities in health and health care utilizationto disparities in health and health care utilization

Hispanic/Latinos are more likely to lack access to health Hispanic/Latinos are more likely to lack access to health care than persons of other racial and ethnic groupscare than persons of other racial and ethnic groups

The Hispanic/Latino population in the US is very diverseThe Hispanic/Latino population in the US is very diverse Understanding differences among Hispanic/Latino Understanding differences among Hispanic/Latino

subpopulations will help inform health policies and subpopulations will help inform health policies and programs programs

ObjectivesObjectivesTo assess subgroup differences in To assess subgroup differences in

access to care and health care access to care and health care utilization among Hispanic/Latino utilization among Hispanic/Latino women by examining:women by examining:

Health insurance coverageHealth insurance coverage Having a usual place of health careHaving a usual place of health care Experiencing unmet medical need due Experiencing unmet medical need due

to costto cost

Access to health careAccess to health careHealth Insurance:Health Insurance:

Insured: Covered by private or public (Medicaid, Insured: Covered by private or public (Medicaid, Medicare, or other public) health insuranceMedicare, or other public) health insurance

Uninsured: Not covered by any kind of Uninsured: Not covered by any kind of comprehensive health insurance or health care comprehensive health insurance or health care plan – includes women with only IHSplan – includes women with only IHS

Usual source of care:Usual source of care: One or more places to go, other than hospital One or more places to go, other than hospital

emergency room, when sick or in need of health emergency room, when sick or in need of health adviceadvice

Unmet medical needs:Unmet medical needs: Could not afford medical care, prescription Could not afford medical care, prescription

medication, eye glasses, dental care, mental medication, eye glasses, dental care, mental health care or counselinghealth care or counseling

Delayed care because of costDelayed care because of cost

Hispanic/Latino women in the Hispanic/Latino women in the National Health Interview SurveyNational Health Interview Survey

Black and Hispanic/Latino populations over-Black and Hispanic/Latino populations over-sampledsampled

Three data years combined to provide Three data years combined to provide estimates for Hispanic/Latino subpopulationsestimates for Hispanic/Latino subpopulations

Hispanic/Latino women in the US, ages 18 + Hispanic/Latino women in the US, ages 18 + Hispanic/Latino subpopulations:Hispanic/Latino subpopulations:

Mexican or Mexican-AmericanMexican or Mexican-American Puerto Rican Puerto Rican Cuban or Cuban AmericanCuban or Cuban American Central or South AmericanCentral or South American Other Hispanic (Dominican Republic, Other Latin Other Hispanic (Dominican Republic, Other Latin

American, Other Hispanic/Latino)American, Other Hispanic/Latino)

Data analysisData analysis SUDAAN softwareSUDAAN software Estimates weighted to reflect national estimatesEstimates weighted to reflect national estimates Annualized sample size=3027 Hispanic/Latino Annualized sample size=3027 Hispanic/Latino

women per yearwomen per year Annualized weighted estimate =11,159,088 Annualized weighted estimate =11,159,088

(~11% of women in US population)(~11% of women in US population) Non-Hispanic black women and non-Hispanic Non-Hispanic black women and non-Hispanic

white women used as reference populationswhite women used as reference populations Three risk factors for lack of access to care Three risk factors for lack of access to care

investigated: poverty (as defined by US Census), investigated: poverty (as defined by US Census), lack of high school education, and family size of 6 lack of high school education, and family size of 6 or more membersor more members

58%

11%

6%

17%

8%

Hispanic/Latino women in the U.S.Hispanic/Latino women in the U.S.

Mexican

Puerto Rican

Cuban

Central or SouthAmerican

Other HispanicData Source: National Health Interview Survey 2000-2002 Preliminary Data

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENNo health insurance coverageNo health insurance coverage

Data Source: National Health Interview Survey 2000-2002

0

5

10

15

20

25

30

35

40

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENNo usual place of careNo usual place of care

Data Source: National Health Interview Survey 2000-2002

0

5

10

15

20

25

30

35

40

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENUnmet medical needsUnmet medical needs

Data Source: National Health Interview Survey 2000-2002

0

5

10

15

20

25

30

35

40

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENPoor women withoutPoor women without health insurance

%

0

10

20

30

40

50

60

70

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH Black

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENPoor women with Poor women with no usual place of care

0

5

10

15

20

25

30

35

40

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENPoor women with Poor women with unmet medical needs

0

5

10

15

20

25

30

35

40

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENLess thanLess than HS education without health without health

insuranceinsurance

0

10

20

30

40

50

60

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENLess thanLess than HS education with no usual place of with no usual place of

carecare

0

5

10

15

20

25

30

35

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMENLess than Less than HS education with unmet medical with unmet medical

needsneeds

0

5

10

15

20

25

30

35

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN 6+ family members without6+ family members without health insurance

0

10

20

30

40

50

60

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN6+ family members with no usual place of 6+ family members with no usual place of

carecare

0

5

10

15

20

25

30

35

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

Data Source: National Health Interview Survey 2000-2002

ACCESS TO CARE AMONG US HISPANIC/LATINO WOMENACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN6+ family members with unmet medical needs6+ family members with unmet medical needs

0

5

10

15

20

25

30

35

Mexican PuertoRican

Cuban Central/South

American

OtherHispanic

Hispanic NH white NH black

%

Preliminary Data

SummarySummary 34% of Hispanic/Latino women were uninsured, 22% 34% of Hispanic/Latino women were uninsured, 22%

had no usual place of care, and 22% had unmet had no usual place of care, and 22% had unmet medical needsmedical needs

Poverty, having less than a HS education, and large Poverty, having less than a HS education, and large family size were associated with lack of health family size were associated with lack of health insurance and lacking a usual place of care in all insurance and lacking a usual place of care in all women, but appear to have a greater impact on women, but appear to have a greater impact on Hispanic/Latino womenHispanic/Latino women

Mexican and Central / South American women were Mexican and Central / South American women were disproportionately represented among Hispanic/Latino disproportionately represented among Hispanic/Latino women who lacked insurance, a usual place of care, women who lacked insurance, a usual place of care, and who had unmet medical needsand who had unmet medical needs

75% of Hispanic/Latino women in the US are Mexican or 75% of Hispanic/Latino women in the US are Mexican or Central/South American; 58% are MexicanCentral/South American; 58% are Mexican

41% of Mexican women were poor, 50% had less than a 41% of Mexican women were poor, 50% had less than a HS education, and 19% had large families of 6 or moreHS education, and 19% had large families of 6 or more

ConclusionsConclusions Disparities in access to care and health care Disparities in access to care and health care

utilization were found among subgroups of utilization were found among subgroups of Hispanic/Latino women in the USHispanic/Latino women in the US

Much of the disparity in access to care between Much of the disparity in access to care between Hispanic women and non-Hispanic white and black Hispanic women and non-Hispanic white and black women is driven by lack of access to care among women is driven by lack of access to care among Mexican and Central and South American women in Mexican and Central and South American women in the USthe US

Even among women who shared characteristics Even among women who shared characteristics shown to be associated with a lack of health care shown to be associated with a lack of health care access - poverty, lack of education, and large access - poverty, lack of education, and large family size – a greater proportion of Mexican and family size – a greater proportion of Mexican and Central/South American women were adversely Central/South American women were adversely impacted compared with other Hispanic/Latino impacted compared with other Hispanic/Latino women, and compared with non-Hispanic black and women, and compared with non-Hispanic black and white women white women

2000 2001 2002 % % %

Hispanic/Latino 10.7 11.0 11.3Non-Hispanic white 76.9 76.5 76.2Non-Hispanic black 12.4 12.5 12.5

Percentage of Hispanic/Latino and Percentage of Hispanic/Latino and non-Hispanic women in the U.S.non-Hispanic women in the U.S.

Data Source: National Health Interview Survey 2000-2002 Preliminary Data