Perceptions of Patient-Provider Communication Across the Six Largest Asian Subgroups in the USA.

BACKGROUND: Asians are the fastest-growing racial/ethnic minority group in the USA and many face communication barriers when seeking health care. Given that a high proportion of Asians are immigrants and have limited English proficiency, poor patient-provider communication may explain Asians' relatively low ratings of care. Though Asians are linguistically, economically, and culturally heterogeneous, research on health care disparities typically combines Asians into a single racial/ethnic category. OBJECTIVES: To estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. DESIGN AND PARTICIPANTS: Using a nationally representative sample of adults from the 2014-2017 Medical Expenditure Panel Survey (N = 136,836, round-specific response rates range from 72% to 98%), we estimate racial/ethnic differences in perceptions of provider communication, adjusted for English proficiency, immigration status, and sociodemographic characteristics. MAIN MEASURES: The main dependent variable is a 4-item scale ranging from 0 to 100 measuring how positively patients view their health care providers' communication, adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) program. Respondents report how often their providers explain things clearly, show respect, listen carefully, and spend enough time with them. KEY RESULTS: Asians, overall, had less positive perceptions of their providers' communication than either Whites or Latinxs. However, only Chinese-White differences remained after differences in English proficiency and immigration status were controlled (difference = - 2.67, 95% CI - 4.83, - 0.51). No other Asian subgroup differed significantly from Whites. CONCLUSIONS: Negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. Researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care should, if possible, avoid categorizing all Asians into a single group.

Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006-2015.

BACKGROUND: Individuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patient-provider communication for LEP individuals have been going on for decades but linguistic disparities persist. OBJECTIVE: To describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015. DESIGN: We estimated interrupted time series models for three measures of patient-provider communication, testing for differences in both means (intercepts) and trends (slopes) before and after 2010 and differences in differences by English proficiency. PARTICIPANTS: A nationally representative sample of the US non-institutionalized population with at least one office-based medical visit from the 2006-2015 Medical Expenditure Panel Survey (N = 27,001). MAIN MEASURES: Patient-provider communication is measured with three variables indicating whether individuals reported that their providers always explained things in a way that was easy to understand, showed respect for what they had to say, and listened carefully. KEY RESULTS: Although patient-provider communication improved for all groups over the study period, before 2010, it was getting worse among LEP individuals and disparities in patient-provider communication were widening. After 2010, patient-provider communication improved for LEP individuals and language disparities by English proficiency either narrowed or remained the same. For example, between 2006 and 2010, the percent of LEP individuals reporting that their provider explained things clearly declined by, on average, 1.4 percentage points per year (p value = 0.102); after 2010, it increased by 3.0 percentage points per year (p value = 0.003). CONCLUSIONS: Our study sheds light on trends in patient-provider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.

High Job Flexibility And Paid Sick Leave Increase Health Care Access And Use Among US Workers.

Job flexibility is an important yet underresearched aspect of work that has implications for health care access and use. This study explored the impact of job flexibility, including both its informal aspects and access to paid sick leave, on health care access and use. We analyzed data from a nationally representative sample of US workers responding to the Medical Expenditure Panel Survey-Household Component during 2017-19, combined with occupational data from the Occupational Information Network database, version 25.0. Results showed that a one-unit increase in job flexibility was associated with a 2.15-percentage-point increase in the likelihood of having an office-based health care visit in the past year and a 2.42-percentage-point increase in the likelihood of having a usual source of care. Access to paid sick leave was associated with a 3.83-percentage-point increase in the likelihood of having an office-based health care visit. Black and Hispanic workers, as well as workers with low-wage jobs, had less job flexibility and less access to paid sick leave. Reforms that increase job flexibility and efforts by health care providers to better accommodate people with inflexible jobs could improve access, utilization, and equity.

Associations of Rheumatoid Arthritis and Depressive Symptoms Over Time: Are There Differences by Education, Race/Ethnicity, and Gender?

OBJECTIVE: To examine associations between changes in rheumatoid arthritis (RA) symptoms and depressive symptoms adjusted for other time-varying characteristics, and to test if these associations differed by education, race/ethnicity, or gender. METHODS: Data from the 1988-1998 US National Rheumatoid Arthritis Study were analyzed (n = 854). Time-varying covariates included year of the study, pain, functional ability, household work disability, parental status, marital status, employment status, and social support. The time-invariant covariates included years since diagnosis, education, race/ethnicity, and gender. Multivariate multilevel-model analyses were used to estimate associations within people over time. RESULTS: Patients with RA experience considerable change in depressive symptoms, pain, functional disability, and household work disability over the study period. Depressive symptoms were driven more by differences between people compared to changes within people over time. Findings show that patients experienced increases in depressive symptoms over the study period. The rate of change in depressive symptoms did not differ by education, race/ethnicity, or gender. Times of worse pain, functional disability, and household disability were associated with worse depressive symptoms. The association of functional disability and depressive symptoms was stronger for men than women. CONCLUSION: Increases in pain and disability were associated with worse depressive symptoms, adjusted for covariates. It is important to monitor and treat both mental and physical health symptoms. Future research efforts should focus on collecting data reflecting the educational, gender, and racial/ethnic diversity of individuals with RA.

Medical care utilization for work-related injuries in the United States 2002-2006.

OBJECTIVE: To examine racial-ethnic/gender differences in the odds of injury and in the odds of seeking medical treatment among workers in the United States. METHODS: Logistic regression models were used to estimate the odds of having a work injury and the odds of seeking medical treatment for these injuries in a sample of non-Latino Black, Latino, and non-Latino white workers from the Medical Expenditure Panel Survey (2002-2006). RESULTS: Significant variation in the odds of injury was observed across racial-ethnic/gender groups. Although race-gender groups had significant variation in the odds of experiencing a work injury, we found few differences in treatment seeking. Among the 6 subgroups, we found that white women were significantly less likely to report an injury and significantly more likely to seek treatment when injured. Having health insurance played a key role in utilization among injured workers. The odds of seeking treatment were 33% lower for uninsured workers compared with those with private insurance. Publicly insured workers were no different from privately insured workers. CONCLUSIONS: Our study sheds light on current trends in work injuries and associated medical care utilization among a nationally representative sample of workers.

The Risk Of Severe COVID-19 Within Households Of School Employees And School-Age Children.

Across the United States, school districts are grappling with questions of whether and how to reopen and keep open elementary and secondary schools in the 2020-21 academic year. Using household data from before the pandemic (2014-17), we examined how often people who have health conditions placing them at risk for severe coronavirus disease 2019 (COVID-19) were connected to schools, either as employees or by living in the same households as school employees or school-age children. Between 42.0 percent and 51.4 percent of all school employees met the Centers for Disease Control and Prevention's (CDC's) definition of having or potentially having increased risk for severe COVID-19. Among all adults with CDC-defined risk factors for severe COVID-19, between 33.9 million and 44.2 million had direct or within-household connections to schools.

COVID-19 And Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition.

We used data from the Medical Expenditure Panel Survey to explore potential explanations for racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19 illness. However, Whites were older, on average, than Blacks. Thus, when all factors were considered, Whites tended to be at higher overall risk compared with Blacks, with Asians and Hispanics having much lower overall levels of risk compared with either Whites or Blacks. We explored additional explanations for COVID-19 disparities-namely, differences in job characteristics and how they interact with household composition. Blacks at high risk for severe illness were 1.6 times as likely as Whites to live in households containing health-sector workers. Among Hispanic adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home, versus 56.5 percent among Black adults and only 46.6 percent among White adults.

Examining Latino differences in mental healthcare use: the roles of acculturation and attitudes towards healthcare.

Latinos are less likely to use mental health services compared to non-Latino whites, but little research has examined the relative contribution of acculturation and attitudes towards healthcare. In the current study, we analyze data from a nationally representative sample of Mexicans, Cubans, Puerto Ricans and non-Latino whites from the 2002-2003 Medical Expenditure Panel Survey (n = 30,234). Findings show different utilization patterns in use of specialty, non-specialty, and any type of mental healthcare across the three Latino subgroups. The predictive efficacy of acculturation variables on ethnic group differences varies by subgroup. Self-reliant attitudes towards healthcare are associated with lower use, but these attitudes do not explain the ethnic gaps in use.

Racial/ethnic and gender differences in individual workplace injury risk trajectories: 1988-1998.

OBJECTIVES: I examined workplace injury risk over time and across racial/ethnic and gender groups to observe patterns of change and to understand how occupational characteristics and job mobility influence these changes. METHODS: I used hierarchical generalized linear models to estimate individual workplace injury and illness risk over time ("trajectories") for a cohort of American workers who participated in the National Longitudinal Survey of Youth (1988-1998). RESULTS: Significant temporal variation in injury risk was observed across racial/ethnic and gender groups. At baseline, White men had a high risk of injury relative to the other groups and experienced the greatest decline over time. Latino men demonstrated a pattern of lower injury risk across time compared with White men. Among both Latinos and non-Latino Whites, women had lower odds of injury than did men. Non-Latino Black women's injury risk was similar to Black men's and greater than that for both Latino and non-Latino White women. Occupational characteristics and job mobility partly explained these differences. CONCLUSIONS: Disparities between racial/ethnic and gender groups were dynamic and changed over time. Workplace injury risk was associated with job dimensions such as work schedule, union representation, health insurance, job hours, occupational racial segregation, and occupational environmental hazards.

Difference In Uninsurance Rates Between Full- And Part-Time Workers Declined In 2014.

Historically, part-time workers have been more likely to be uninsured than their full-time peers. Data from the 2010-15 Medical Expenditure Panel Survey show that coverage differences by work hours declined after 2014. Uninsurance declined more for part-time workers, with pathways to coverage varying by state Medicaid expansion status.

Self-Rated Health Trajectories among Married Americans: Do Disparities Persist over 20 Years?

The purpose of this study is to understand self-rated health (SRH) trajectories by social location (race/ethnicity by gender by social class) among married individuals in the United States. We estimate multilevel models of SRH using six observations from 1980 to 2000 from a nationally representative panel of married individuals initially aged 25-55 (Marital Instability Over the Life Course Study). Results indicate that gender, race/ethnicity, and social class are associated with initial SRH disparities. Women are less healthy than men; people of color are less healthy than whites; lower educated individuals are less healthy than higher educated individuals. Women's health declined slower than men's but did not differ by race/ethnicity or education. Results from complex intersectional models show that white men with any college had the highest initial SRH. Only women with any college had significantly slower declines in SRH compared to white men with any college. For married individuals of all ages, most initial SRH disparities persist over twenty years. Intersecting statuses show that education provides uneven health benefits across racial/ethnic and gender subgroups.

Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002-2009.

OBJECTIVE: To examine trends in children's health access, utilization, and expenditures over time (2002-2009) by race/ethnicity, income, and insurance status/expected payer. METHODS: Data include a nationally representative random sample of children in the United States in 2002-2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP). RESULTS: The percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total). CONCLUSIONS: Despite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002-2009. Our study sheds light on children's disparities during the most recent economic crisis.

Access to health care for nonmetro and metro Latinos of Mexican origin in the United States.

BACKGROUND: A growing number of Latinos are moving to nonmetro areas, but little research has examined how this trend might affect the Latino-disadvantage in access to healthcare. OBJECTIVE: We investigate health care access disparities between non-Latino whites and Latinos of Mexican origin, and whether the disparities differ between metro and nonmetro areas. METHODS: A series of logistic regression models provide insight on whether individuals have a usual source of care and whether they have had any physician visits in the past year. Our analyses focus on the interaction between Mexican origin descent and nonmetro residence. SUBJECTS: Nationally representative data from the 2002-2003 Medical Expenditure Panel Survey are analyzed. The sample consists of working-aged adults age 18-64, yielding a sample size of 29,875. RESULTS: The Mexican disadvantage in having a usual source of care is much greater among nonmetro residents than among those living in metro areas. The Mexican disadvantage in the likelihood of seeing a physician at least 1 time during the year does not differ across locations. Although general and ethnicity-specific predictors explain the disadvantage of Mexicans in having a usual source of care, they do not explain the added disadvantage of being Mexican and living in nonmetro areas. CONCLUSIONS: This study identifies a new challenge to the goal of eliminating health care disparities in the United States. The Latino population living in nonmetro areas is growing, and our findings suggest that Latinos in nonmetro areas face barriers to having a usual source of care that are greater than those faced by Latinos in other areas.

Predictors of first mental health service utilization among homeless and runaway adolescents.

PURPOSE: To describe and explain variations in first mental health service utilization before and after running away from home for homeless adolescents. METHODS: Survey interviews were conducted with homeless and runaway youth in several Midwestern locations. The effects of family of origin factors and street experiences on the likelihood of seeing a mental health professional for the first time before running away and after running away for the first time were examined. Bivariate and multivariate logistic regression methods are used to analyze these data. Interactions are tested across race and gender sub-groups. RESULTS: Caretaker education, caretaker rejection, and family transitions increase the probability that an adolescent first sees a mental health professional before running away from home. Post-run intervention is more likely for females, younger runaways, shelter users, youths with social support networks, and youths abused by their caretakers. A gender gap in first service use exists for Whites but not for minority youth. Minority youth who experienced family abuse were less likely than abused Whites to report ever seeing a mental health professional. CONCLUSIONS: Analyses indicate homeless youth's utilization patterns are differentiated by family of origin factors, street experiences, timing of first utilization, and by race and gender interactions. Our findings suggest that youths whose first contact with mental health service use follows running away for the first time may experience higher levels of mental distress compared with other homeless runaways. The significant differences in first service use across race and gender subgroups should be further explored. The racial-ethnic gap in first mental health intervention for abused youths indicates this sub-group is not receiving services that are available to other homeless youths. Our findings suggest that homelessness does not homogenize racial/ethnic differences in first mental health service utilization.