2 tables omitted
Although Hispanics are the largest ethnic minority population in the
United States, they are underserved by the health-care system.1 Hispanics
are less likely to seek and receive health-care services, which might contribute
to their poorer health status and higher rates of morbidity and mortality.2 To assess differences in access to health-care and preventive services
between Hispanics and non-Hispanics, CDC analyzed 2001-2002 data from the
Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes
the results of that analysis, which indicated that disparities exist in access
to health-care and preventive services among Hispanics versus non-Hispanics.
Public health authorities and health-care providers should implement strategies
to reduce barriers to health-care and preventive services among Hispanics.
BRFSS is a state-based, random-digit–dialed telephone survey of
the U.S. civilian, noninstitutionalized population aged ≥18 years. All
50 states and the District of Columbia participated in the surveys for 2001-2002,
the latest years for which data were available. Respondents with complete
information on age, race/ethnicity, education, sex, marital status, and employment
status were included. Analyses were adjusted for respondents’ sex, marital
status (i.e., married, previously married, or never married), employment status
(i.e., employed, unemployed, unable to work, retired, or homemaker/student),
and self-rated general health status to control for potential confounders.
Respondents’ receipt of selected preventive services and access
to health care were assessed. Clinical preventive services included mammography
within 2 years among women aged ≥40 years, cervical cancer screening within
3 years among women with an intact uterus (i.e., no hysterectomy), fecal occult
blood testing within 2 years among adults aged ≥50 years, sigmoidoscopy/colonoscopy
within 5 years among adults aged ≥50 years, blood cholesterol checked within
5 years among adults aged ≥18 years, influenza vaccination within the previous
year among adults aged ≥65 years, and pneumococcal vaccination among adults
aged ≥65 years.
Data on breast and cervical cancer and medical care were collected in
2002, data on blood cholesterol were collected in 2001, and data on colorectal
cancer screening, vaccination, and health-care coverage were collected in
2001 and 2002. Interviews were conducted in English and in Spanish when applicable.
Health-care coverage was assessed by asking respondents, “Do you have
any kind of health-care coverage, including health insurance, prepaid plans
such as HMOs, or government plans such as Medicare?” Having a regular
care provider was assessed by asking, “Do you have one person you think
of as your personal doctor or health-care provider?” Persons who responded
“no” were asked, “Is there more than one or is there no
person who you think of?” To be classified as having a regular care
provider, respondents must have responded either “yes, only one”
or “more than one.” Inaccessibility to medical care at some point
during the preceding 12 months was assessed by asking, “Was there a
time in the past 12 months when you needed medical care, but could not get
it?” Having a regular place of care was assessed by asking, “When
you are sick or need advice about your health, to which one of the following
places do you usually go? Would you say: a doctor’s office, a public
health clinic or community health center, a hospital outpatient department,
a hospital emergency room, urgent care center, some other kind of place, or
no usual place?” For this analysis, having a regular place of care was
dichotomized into (1) a doctor’s office, public health clinic or community
health center, hospital outpatient department, hospital emergency room, urgent
care center, or some other kind of place and (2) no usual place.
The BRFSS data files were edited and aggregated to create a yearly sample
for each state. Each sample was weighted to the respondent’s probability
of selection and to age- and sex-specific or race-age and sex-specific population
from the most current census data. To compare Hispanics and non-Hispanics,
prevalence estimates were adjusted to the 2000 U.S. standard population. SUDAAN®
(Research Triangle Park, North Carolina) was used to account for the complex
sampling design and to calculate the standard errors and 95% confidence intervals
(CIs). All results were statistically significant (p<0.01 or p<0.05)
unless otherwise noted.
In 2002, a total of 247,964 interviews were completed; 18,152 (7.3%)
were by Hispanic respondents, and 229,812 (92.6%) were by non-Hispanic respondents.
The median response rate was 58.3% (range: 42.2%-82.6%). In 2001, a total
of 212,510 interviews were completed; 17,588 (8.3%) were by Hispanic respondents,
and 194,922 (91.7%) were by non-Hispanic respondents. The median response
rate was 51.1% (range: 33.3%-81.5%). Hispanic respondents were significantly
more likely than non-Hispanic respondents to be aged 18-44 years; have less
than a high school education; be unemployed, unable to work, or a homemaker
or student; reside in Western states*; and report fair or poor general health.
Hispanic respondents were significantly less likely than non-Hispanic
respondents to have health-care coverage (76.2% versus 90.6%), have one or
more regular personal health-care providers (68.5% versus 84.1%), or have
a regular place of care (93.4% versus 96.2%). Hispanic respondents were significantly
more likely than non-Hispanic respondents to report having needed medical
care during the preceding 12 months but could not obtain it (6.5% versus 5.0%).
Hispanics also were significantly less likely to be screened for blood cholesterol
and for breast, cervical, and colorectal cancers; to receive a pneumococcal
vaccination; and to receive an influenza vaccination within the preceding
LS Balluz, ScD, CA Okoro, MS, TW Strine, MPH, National Center for Chronic
Disease Prevention and Health Promotion, CDC.
Disparities in use of preventive services by racial/ethnic characteristics
have been documented3; minority populations, such as Hispanics,
are less likely than non-Hispanics to receive preventive services.3 This
report demonstrates that these disparities in access to health-care and screening
practices between Hispanics and non-Hispanics persist.
Substantial differences in prevalence of health-care coverage (i.e.,
having a regular personal health-care provider or a regular doctor among those
with a regular place of care) were documented among Hispanics compared with
non-Hispanics. These differences remained significant even after adjusting
for respondents’ socioeconomic factors and self-rated health status.
In the United States, access to health care is closely related to insurance
coverage, the type of insurance, and whether persons have a regular source
of care.4 Having access to health care increases the use of preventive
services.4 The lower prevalence of health-care access among Hispanics
might explain the disparities in receiving preventive services. Hispanic adults
were substantially less likely than non-Hispanic adults to receive cancer
screenings, blood cholesterol screening, or recommended vaccinations. Hispanics
face obstacles in accessing health-care services in the United States, such
as cultural differences between them and their health-care providers, language
barriers, and the administrative complexity of health plans. Such obstacles
might place Hispanics at increased risk for not seeking preventive services
and for poor quality of care.5,6
Cultural factors also might affect Hispanics’ access to preventive
services. Hispanics have less knowledge about cancer and a more fatalistic
attitude toward cancer than non-Hispanics.7,8 Cancer is increasing
among Hispanics,9 and cancer screening, an essential component
of early detection and treatment, is especially important among Hispanics.
The findings in this report are subject to at least three limitations.
First, data were based on self report and subject to recall bias. Second,
BRFSS is a telephone survey; therefore, persons without telephones were not
surveyed. Third, states that conducted the survey only in English excluded
persons who speak only Spanish.
Strategies to reduce barriers to health-care and preventive services
should be developed among Hispanics. These include using culturally appropriate
programs to advise Hispanics about the importance of screening, expanding
access to health care, and targeting specific barriers to care, such as poverty
and lack of knowledge among health-care professionals about how best to encourage
Hispanics to use preventive services.
*Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada,
New Mexico, Oregon, Utah, Washington, and Wyoming.
References: 9 available
Access to Health-Care and Preventive Services Among Hispanics and Non-Hispanics—United States, 2001-2002. JAMA. 2004;292(19):2331-2333. doi:10.1001/jama.292.19.2331