Effect of acculturation on variation in having a usual source of care in Asian American versus non-Hispanic White adults in California

Background/Significance. Having a usual source of care (USC) is an important measure of access because of associations with better health outcomes and utilization of healthcare services. Little empirical research has been conducted on how key resources affect access to care for Asian Americans (AAs).

Objective/Purpose. To examine variations in having a USC among non-Hispanic white and AA adults (18-64 years) in California.

Methods. Data were from the 2005 and 2009 California Health Interview Survey and 2010 U.S. Census. Using a modified Anderson model of access to healthcare, hierarchical logistic regressions were used to compare the odds of having a USC between non-Hispanic white (n=38,554) and AA adults (n=7,566) and to examine associations with key enabling and predisposing resources (educational attainment, employment status, insurance status, household income) and acculturation factors (English proficiency, duration in US, ethnically concordant neighborhood). Models were survey-weighted and adjusted for age, gender, health status, household size, and survey year.

Results. Race-related disparities between AA and non-Hispanic whites in having a USC were no longer significant after acculturation factors were added to the model. Unlike non-Hispanic whites, higher levels of education, household income and insurance were not associated with better access among AAs. AAs with high school and college degrees had 41-53% lower odds of having a USC compared to AAs with graduate degrees (all p<0.05). Within insurance statuses, only the uninsured had lowers odds of having a USC (OR=0.15, p<0.01). Low English proficiency and short duration in the US (<5 years) were significantly associated with having a USC in both groups.

Discussion/Conclusions. There are key differences in how AA and non-Hispanic white adults access care. Acculturation factors are key drivers of disparities and should be included in access to care models with AAs. Insurance, household income, and education are differentially significant for AAs compared to non-Hispanic whites.