Is Family Support Related to Health Service Utilization Among Chinese Older Immigrants in the United States

Background and Purpose: Low rates of health service utilization is a significant risk factor for the well-being of the burgeoning older immigrants in the Unite States. Chinese Americans, the largest Asian group in the U.S., were reported to have the lowest rates of doctor visit than the Whites across all the Asian subgroups. While numerous studies have identified structural and individual barriers against service utilization among older immigrants, the crucial context of the family has been overlooked in the prior research. Directed by the Andersen Behavioral Model, this study used the largest dataset on Chinese elderly in the U.S. to investigate the potential linkages between various family support and health service utilization among Chinese older immigrants.

Methods: Data were derived from the PINE study, a population-based study that recruited 3,159 Chinese elderly (60+) from more than 20 social agencies in the greater Chicago area between 2011 and 2013. Structured interviews were carried out in respondents’ homes in their preferred language. Health service utilization was measured by number of doctor visits and whether the respondents had any hospital stays (1 = yes, 0 = no) in the last two years. Family support was captured by six variables adopted from the HRS to assess positive support (2 – 6), negative support (2 – 6), and talking about health problems or medical concerns (1 = yes, 0 = no) with spouse and family members, respectively. Negative binomial and logistic regressions were carried out to examine relationships between family support and two outcomes, respectively, controlling for socio-demographic, physical health, and acculturation related variables.

Results: On average, the respondents had seven doctor visits (SD = 5.71) in the past two years, about half of the number for older Americans in general. About 30 percent of the respondents had at least one overnight hospital stay, which is comparable to that of the general older Americans. While positive spousal or family support was not associated with service utilization, respondents with more negative family support had significantly more doctor visits (β = .07), and were marginally more likely to use in-patient service (OR = 1.17, CI: .99– 1.37). In addition, respondents who talked to spouse for medical concerns were significantly less likely to have hospital stays (OR = .68, CI: .49 – .93).

Conclusions and Implications: Our findings showed that the family could be either an enabling or an impeding factor for Chinese older immigrants’ health service utilization. The common notion of strong family ties among the Chinese may obscure the fact that negative family support could provide a mechanism for older immigrants to turn to formal services, likely due to lack of resources within the family and desire to stay independent. Having good communication with spouse seems to reduce older immigrants’ risks of being hospitalized. Future research is needed to understand the sources of negative family support in immigrant families and its pathway to health service utilization. Programs are needed to improve conflict management skills and to promote cohesive family relations in immigrant families.