Do Residential Segregation and Economic Inequality Explain Race Disparities in Health Services Use?
- Presenter:
Chair: James Marton; Discussant: Patricia Ryan Mon June 5, 2006 10:45-12:15 Room 235
Authors: Darrell J. Gaskin (dgaskin@jhsph.edu), Adrian Price (adrian.price@ccaix.jsums.edu), Dwayne T. Brandon (dbrandon@jhsph.edu) Thomas A. LaVeist (tlaveist@jshph.edu)
Title: Does Residential Segregation and Economic Inequality Explain Race Disparities in Health Services Use?
Rationale: Nationally, disparities in health care utilization between African Americans and whites are well documented. Even after controlling for health status and health insurance coverage, African Americans still have lower rates of use of medical services. However, national analyses are unable to adequately control for the impact of racial segregation on geographic access and often compare African American samples that are disproportionately low income to White samples that have higher percentages of moderate/middle and high income respondents.
Objective: To determine if racial disparities in health care use can be attributed to residential segregation and economic inequality, we compared disparities in health care use in a national sample of adults to a sample of adults from a low income racially integrated community.
Methods: We estimated models of health care use using data from Medical Expenditure Panel Survey (MEPS), a national sample of adults conducted by the Agency for Health Research and Quality, and data from the Exploring Health Disparities in Integrated Communities Project (EHDIC). The EHDIC data is a 2003 survey of residents from a low income urban community in a northeastern state. This community has equal numbers of white non-Hispanic and African American residents. Census data shows that racial groups have similar median income and educational attainment. We conducted analyses of the full MEPS sample and a matched subsample, created by matching MEPS respondents to EHDIC respondents by race, gender, income and educational attainment. The MEPS and the EHDIC databases contain information on health services utilization: number of health care visits, emergency room use, usual source of care and whether the respondent has a regular doctor. For each dataset, we estimated the effects of race on each utilization measure and controlling for general health status, presence of chronic conditions, age, gender, marital status, insurance status, employment status, income and education.
Finding: We found differences in the race disparities in health care use across the datasets but some similarities too. In the MEPS data, African Americans were 15% less likely to have a health care visit compared to whites. However, in the EHDIC data, African Americans were 40% more likely to have a health care visits than whites. However, in the MEPS and EHDIC, African Americans were about 10% less likely to have a regular doctor compared to whites. In MEPS data, African Americans were 25% less likely to multiple medical visits compared to whites. In the EHDIC data, African Americans were 20% less likely to have multiple medical visits.
Conclusion: Segregation and income inequality may explain substantial proportion of the observed race disparities in the initiation of health care use. However, differences in the amount of services use and whether individual have a regular doctor are probably due to factors related to the physician-patient interactions and individuals’ experiences in the health care system.
