Chang Eva, Chan Kitty S, Han Hae-Ra
*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health †Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD.
Med Care. 2014 Sep;52(9):833-41. doi: 10.1097/MLR.0000000000000187.
Despite significant population increases, how Asian Americans ethnic subgroups vary in having a usual source of care (USC) is poorly understood.
To examine how having a USC varies among Asian American ethnic subgroups (Chinese, Filipinos, Japanese, Koreans, Vietnamese, and South Asians), and the potential factors influencing variation in having a USC.
Data were from 2005 and 2009 California Health Interview Survey. Logistic regressions and pair-wise comparisons were used to compare odds of having a USC among Asian ethnic adults (18-64 y) and to examine ethnicity-specific associations with immigration-related factors (English proficiency, length of residence, and living in an ethnically concordant neighborhood) and key enabling (employment, income, insurance), predisposing (education), and need (health status) factors. Models also adjusted for other sociodemographic factors.
Significant differences in the magnitude of the variation and factors influencing having a USC were found across Asian subgroups. Korean and Japanese adults had 52%-69% lower adjusted odds of having a USC compared with Chinese. Among all Asian subgroups, uninsured adults had 85%-94% lower adjusted odds of having a USC. Patterns of associations with USC and key factors varied by specific Asian subgroup.
Patterns of associations for USC varied by Asian subgroup, although uninsurance persisted significantly across all subgroups. Persistent variation and heterogenous associations suggest that targeted, ethnicity-specific policies and outreach are needed to improve having a USC for Asian American ethnic adults.
尽管人口显著增加,但对于亚裔美国人各亚族裔在拥有常规医疗服务来源(USC)方面如何存在差异,我们了解甚少。
研究亚裔美国人各亚族裔(华裔、菲律宾裔、日裔、韩裔、越南裔和南亚裔)在拥有USC方面的差异,以及影响拥有USC差异的潜在因素。
数据来自2005年和2009年加利福尼亚健康访谈调查。使用逻辑回归和两两比较来比较亚裔成年(18 - 64岁)人群中拥有USC的几率,并检验与移民相关因素(英语水平、居住时长和居住在种族和谐社区)以及关键促成因素(就业、收入、保险)、易患因素(教育)和需求因素(健康状况)的种族特异性关联。模型还对其他社会人口学因素进行了调整。
在亚裔各亚族裔中,发现了在拥有USC的差异程度以及影响因素方面的显著差异。与华裔相比,韩裔和日裔成年人拥有USC的调整后几率低52% - 69%。在所有亚裔亚族裔中,未参保成年人拥有USC的调整后几率低85% - 94%。与USC和关键因素的关联模式因特定亚裔亚族裔而异。
尽管所有亚族裔中未参保情况都持续显著存在,但USC的关联模式因亚裔亚族裔而异。持续的差异和异质性关联表明,需要有针对性的、针对特定种族的政策和外展活动,以改善亚裔美国成年族裔拥有USC的情况。