Gresenz Carole Roan, Rogowski Jeannette, Escarce José J
RAND Corporation, Arlington, VA 22202-5050, USA.
Health Serv Res. 2009 Oct;44(5 Pt 1):1542-62. doi: 10.1111/j.1475-6773.2009.00997.x. Epub 2009 Jul 13.
To explore the influence of the communities in which Hispanics live on their access to health care.
1996-2002 Medical Expenditure Panel Survey data, linked to secondary data sources and including 14,504 observations from 8,371 Mexican American respondents living in metropolitan areas.
We use multivariate probit regression models, stratified by individuals' insurance status, for analyses of four dependent variables measuring access to health care. We measure community characteristics at the zip code tabulation area level, and key independent variables of interest are the percentage of the population that speaks Spanish and percentage of the population that is immigrant Hispanic. Each of these measures is interacted with individual-level measures of nativity and length of U.S. residency.
For Mexican American immigrants, living in an area populated by relatively more Spanish speakers or more Hispanic immigrants is associated with better access to care. The associations are generally stronger for more recent immigrants compared with those who are better established. Among U.S.-born Mexican Americans who are uninsured, living in areas more heavily populated with Spanish-speaking immigrants is negatively associated with access to care.
The results suggest that characteristics of the local population, including language and nativity, play an important role in access to health care among U.S. Hispanics, and point to the need for further study, including analyses of other racial and ethnic groups, using different geographic constructs for describing the local population, and, to the extent possible, more specific exploration of the mechanisms through which these characteristics may influence access to care.
探讨西班牙裔人群居住社区对其获得医疗保健服务的影响。
1996 - 2002年医疗支出面板调查数据，与二级数据源相关联，包括来自8371名居住在大都市地区的墨西哥裔美国受访者的14504条观测数据。
我们使用多变量概率回归模型，按个体的保险状况分层，对衡量获得医疗保健服务的四个因变量进行分析。我们在邮政编码分区层面测量社区特征，感兴趣的关键自变量是讲西班牙语人口的百分比以及西班牙裔移民人口的百分比。这些指标中的每一个都与出生地和在美国居住时长的个体层面指标进行交互。
对于墨西哥裔美国移民来说，居住在西班牙语使用者相对较多或西班牙裔移民较多的地区，获得医疗服务的机会更好。与定居时间较长的移民相比，新移民的这种关联通常更强。在未参保的美国出生的墨西哥裔美国人中，居住在西班牙裔移民人口较多的地区与获得医疗服务的机会呈负相关。
结果表明，当地人口的特征，包括语言和出生地，在美国西班牙裔人群获得医疗保健服务方面发挥着重要作用，并指出需要进一步研究，包括分析其他种族和族裔群体，使用不同的地理结构来描述当地人口，并在可能的情况下，更具体地探索这些特征可能影响获得医疗服务机会的机制。
