Delayed Healthcare and Health Disparity Among Older Adults

Purposes:  Health disparity across ethnic and immigrant groups are well recognized.  However, there is a lack of systematic understanding about health disparity among older adults particularly giving the growing number and size of minority and/or immigrant elders in the United States.  Ageism, in conjunction with multiple barriers, ranging from language barrier, cultural mistrust associated with minority and/or immigration status, to age-related declines in functional abilities, might limit older adults’ capacity of seeking timely healthcare and thus widen the disparities in later life.  This study is to 1) document the disparities in delayed healthcare among U.S. elders with different race/ethnicity and immigration status, and 2) examine to what extent the delayed healthcare associates with physical and mental health status for each race/ethnicity and immigrant group.   

Methods:  This study used the data from the California Health Interview Survey 2011-2012, selecting 13,722 respondents age 65 and above, including seven groups: foreign-born Hispanics (n=766), Asians (n=1,026) and Whites (n=873); U.S.-born Hispanic (n=657), Asians (n=173), Whites (n=9,654), and African Americans (n=573).  Key variables include physical and mental health status, delays in seeking medical care and getting prescription, and demographics (including disabilities).  Logistic models with random effects were used for dichotomous outcomes (delays in medical care and prescription) and GLS random effects models were used for continuous dependent variables (health and mental health).  Controlling for demographics, the study also evaluated the significance of differences in delayed medical care and prescription for 15 pairwise comparisons (i.e. Black vs. other six groups, foreign-born Hispanics vs. Whites vs. Asians, U.S.-born Hispanics vs. Whites vs. Asians, and foreign-born Hispanics/Whites/Asians vs. U.S.-born Hispanics/Whites/Asians).

Results: Minority and immigration status can jointly negatively affect Hispanic elders’ behavior; foreign-born Hispanic elders reported the highest likelihood of delaying in getting prescription (B=.267, p<.05) and seeking medical care (B=.158, p<.05), which were also significantly higher than other immigrant groups after controlling demographics.  Immigration status alone could be protective as U.S.-born White (B=.198, p<.05) reported higher likelihood of delaying medical care than foreign-born Whites (B=-.361, p<.05).  It is noted that for Black and Asian elders, their behaviors were reportedly on a par with White peers.  The negative effects of delay seems more prominent in elders’ mental health than in their physical health; except for U.S.-born Asians, both delays of getting prescription and seeking medical care are significantly negatively related to elders’ mental health.  Delay in seeking medical care showed more significant effects than delay in getting prescription among immigrant groups.

Implications: Fully and timely access to health care is not assured equally to the elderly despite a universal health care system in the U.S.  Both structural and cultural factors, as well as family and community context, can play a role in older adults’ decision of getting their health care needs met.  The findings suggest racial/ethnic specific interventions for managing healthcare needs to help reduce existing health disparities among older adults.