Datta Biplab Kumar, Coughlin Steven S, Majeed Ban
Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.
Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Dialogues Health. 2023 Dec;2. doi: 10.1016/j.dialog.2023.100125. Epub 2023 Mar 13.
Extant literature documented various health disparities among immigrants and racial and ethnically marginalized individuals in the United States. However, health disparities in the intersection of nativity and race are generally less visited. This cross-sectional study assessed utilization of routine preventive care among adults with overweight/obesity at the junction of their nativity, racial/ethnic identity, and socioeconomic status (i.e., income and education). Pooling data on 120,184 adults with overweight/obesity from the 2013-2018 waves of the National Health Interview Survey (NHIS), we estimated modified Poisson regressions with robust standard errors to obtain adjusted prevalence rates of preventive care visit, receiving flu shot, and having blood pressure, cholesterol and blood glucose screened. We found that immigrant adults with overweight/obesity had lower rates of utilization of all five preventive care services. However, these patterns varied by racial and ethnic sub-populations. While White immigrants had comparable rates of cholesterol and blood glucose screening, they had 2.7%, 2.9%, and 14.5% lower rates of preventive care visit, blood pressure screening, and getting a flu shot respectively, compared to native-born Whites. These patterns were similar for Asian immigrants as well. Black immigrants, on the other hand, had comparable rates of getting a flu shot and blood glucose screening, and had 5.2%, 4.9%, and 4.9% lower rates of preventive care visit, blood pressure screening, and cholesterol screening respectively. Lastly, the rates of utilization among Hispanic immigrants were significantly lower (ranging from 9.2% to 20%) than those of their native-born counterparts for all five preventive care services. These rates further varied by education, income, and length of stay in the US, within the racial and ethnic subgroups. Our findings thus suggest a complex relationship between nativity and racial/ethnic identity in relation to preventive care utilization among adults with overweight/obesity.
现有文献记录了美国移民以及种族和族裔边缘化人群之间存在的各种健康差异。然而，关于出生国与种族交叉方面的健康差异，人们普遍关注较少。这项横断面研究评估了在出生国、种族/族裔身份和社会经济地位（即收入和教育程度）交叉点上超重/肥胖成年人的常规预防保健利用情况。我们汇总了2013 - 2018年国家健康访谈调查（NHIS）各轮次中120,184名超重/肥胖成年人的数据，估计了具有稳健标准误的修正泊松回归，以获得预防保健就诊、接种流感疫苗以及进行血压、胆固醇和血糖筛查的调整患病率。我们发现，超重/肥胖的移民成年人在所有五项预防保健服务中的利用率较低。然而，这些模式因种族和族裔亚群体而异。虽然白人移民的胆固醇和血糖筛查率相当，但与本土出生的白人相比，他们的预防保健就诊率、血压筛查率和接种流感疫苗率分别低2.7%、2.9%和14.5%。亚洲移民也有类似的模式。另一方面，黑人移民的流感疫苗接种率和血糖筛查率相当，他们的预防保健就诊率、血压筛查率和胆固醇筛查率分别低5.2%、4.9%和4.9%。最后，西班牙裔移民在所有五项预防保健服务中的利用率显著低于其本土出生的同龄人（范围从9.2%到20%）。在种族和族裔亚群体中，这些利用率还因教育程度、收入和在美国的停留时间而有所不同。因此，我们的研究结果表明，在超重/肥胖成年人的预防保健利用方面，出生国与种族/族裔身份之间存在复杂的关系。
