Chronic Disease Prevalence and Unmet Care Needs Among Elderly Immigrants: Population Estimates From the Pooled 2002-2008 National Health Interview Survey Data

Purpose: As the world becomes globalized, the potential impact of population mobility on health and on health service utilization in host countries has become important. There are lacks of information on racial/ethnic groups’ chronic disease prevalence and their unmet healthcare needs among elderly immigrants in the U.S. To fill this gap, this study examines the prevalence of select chronic diseases and patterns of racial/ethnic groups’ healthcare use in relation to the select chronic diseases, allowing for cross-cultural comparisons of each cluster characterized by different levels of healthcare use and examination of unmet healthcare needs.

Methods: A sample of foreign-born adults (65+) in the U.S. was drawn from the pooled 2002-2008 National Health Interview Survey data (N=9,262), consisting of four racial/ethnic groups: White, Black, Hispanic, and API.

First, K-medoids algorithm with Euclidean distance was used to optimally cluster individuals depending on levels of their healthcare service use in terms of (1) ambulatory-care use during the past two weeks and (2) inpatient-care during the past 12 months. This step was performed both with SAS for the data shrinkage process and with R statistical package for the 'pam' and 'clara' functions within the cluster package.

Next, multiple multinomial logistic regressions on the identified optimal clusters (=DV) were performed to answer the research questions.

Results: K-medois analyses identified the optimum number of clusters is four. The mean values of each cluster variable of all individuals are conceptually distinguishable from each other: 'Non-Users' (Mean=0 for both ambulatory-care and inpatient-care; 33%), 'Low-Ambulatory-and-Inpatient-Service-Users' (Low-Users; Mean=.06, Mean=.02, respectively; 30%), 'Heavy-Ambulatory-and-Inpatient-Service-Users' (Heavy-Users; Mean=2.07, Mean=6.57; 18%), and 'Heavy-Ambulatory-Service-Only-Users' (Mean=2.43, Mean=.01; 20%). 

Non-User rates were highest among Blacks (46%), followed by APIs (42%), Hispanics (34%), and White (24%). Hypertension, musculoskeletal, cardiovascular, diabetes, and cancer were the most prevalent diseases among elderly immigrants. However, the diseases with high Non-Users rates varied: COPD and dementia among Whites; musculoskeletal, diabetes, asthma, and cancer among Blacks; kidney problems among Hispanics; Cardiovascular, diabetes and kidney problems among APIs.

The diseases’ prevalence rates and service use behaviors for the diseases varied among racial/ethnic groups:

• Whites: Hypertension (43%), musculoskeletal (35%), cardiovascular (25%), cancer (16%), and diabetes (14%) were prevalent. However, they actively used both healthcare services for these diseases.
• Blacks: Hypertension (48%), musculoskeletal (36%), diabetes (18%), asthma (10%), and cancer (9%) were prevalent. Heavy–Ambulatory-Service-Only-Users tended to have hypertension or COPD; Heavy-Users, stroke; Low-Users, hypertension.
• Hispanics: Hypertension (45%), musculoskeletal (32%), diabetes (19%), cardiovascular (18%), cancer (7%), and asthma (7%) were prevalent. Those with musculoskeletal or asthma tended to use both healthcare services. Unlike other groups, Hispanics with stroke tended to be Heavy-Users.
• APIs: Hypertension (43%), musculoskeletal (24%), diabetes (18%), cardiovascular (14%), and cancer (7%) were prevalent. Heavy-Ambulatory-Service-Only-Users tended to have musculoskeletal; Heavy-Users, hypertension, COPD, or cancer; Low-Users, hypertension or stroke.

Implications: The findings suggest that healthcare providers should pay particular attention to the identified healthcare service needs of each racial/ethnic group. Knowledge about prevalence of chronic diseases and unmet healthcare needs will help to guide future interventions and research, improve elderly immigrants’ health, and reduce health disparities.