Racial and Ethnic Differences in Access to Care Studied

In a poster at the Annual Meeting of the American Psychiatric Association in San Diego, the associations between race and ethnicity and deficits in healthcare access were presented relative to adults with chronic disease and depression.

Deficits and barriers to access to healthcare have been widely understood to lead to poorer outcomes in vulnerable populations, such as racial and ethnic minority groups.

The behavioral study, led by Jeffrey Duong, PhD, a third-year medical student at the University of California (UC) Davis School of Medicine in Sacramento, analyzed data from the Centers for Disease Control and Prevention’s 2014 Behavioral Risk Factor Surveillance System (BRFSS).

The BRFSS is an annual national telephone survey of adults that examines their health status and health-related behaviors. The analysis conducted by the UC Davis team found that patterns of healthcare access deficits among patients with chronic disease and depression were reflected by racial and ethnic groups.

Among the findings was an indication that Hispanics, Latinos, American Indians, and Native Alaskans all have a need to be connected to the usual sources of care. The project also found that compared with Caucasians, Blacks were more likely to forgo care due to costs but less likely to miss routine checkups, suggesting how these appointments offer key opportunities to help that group navigate barriers to care.

The secondary aim of the study was to assess the influence of chronic disease and depression status on associations between race and ethnicity and deficits in healthcare access. The research team pointed out that while other studies have found that racial and ethnic minorities as well as individuals with chronic disease and depression face significant barriers to care, more study in this area is needed.

“There have been far too few studies to date that have examined healthcare access deficits among racial/ethnic minorities with chronic disease and depression,” Duong said in explaining the rationale for the project.

As the data source utilized, the BRFSS sampled 464,664 adults from all 50 states, the District of Columbia, and the US territories. Broken down by race and ethnicity, data was stratified by the individual behavioral characteristics, “does not have a personal doctor,” “did not see a doctor in the past year due to cost,” and “did not have an annual checkup.” Only 13% of Caucasians did not have personal doctor, compared with 16.1% of Blacks, 19.8% of patients describing themselves as multiracial, 22.7% of Asians/Native Hawaiians/Pacific Islanders (API), 29.7% of Hispanic/Latinos, and 30.7% of American Indians/Alaskan Natives (AIAN).

The data was also stratified by chronic disease and depression status. There, the data revealed that for those with both chronic disease and depression who did not have a personal doctor, the values for adjusted odds ratio (AOR) (95% Confidence Interval [CI]), when compared with Caucasians, ranged from a nonsignificant 1.04 (95% CI 0.68-1.59) for the API group and 1.10 (95% CI 0.99-1.24) for Blacks, to significant values of 1.31 (95% CI 1.09-1.59) for multiracial patients, 1.50 (95% CI 1.27-1.78) for Hispanics/Latinos, and 2.60 (95% CI 1.82-3.71) for the AIAN group.

“We find that greater attention needs to be paid to American Indians and Alaskan Natives, a historically understudied population,” Duong concluded. “In general, more research is needed to gain clarity on the factors that explain why certain racial/ethnic minority groups, particularly those afflicted with chronic disease and depression, are more likely to have poorer health access outcomes. Until then, healthcare settings that provide integrated physical and mental healthcare services might be crucial in reducing racial/ethnic disparities in access deficits.”