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