(WITHDRAWN) Inequities in Healthcare Need and Access: Longitudinal Impacts of Race and Immigration

Purpose: Previous research on health care inequities by immigrants remain inconclusive and inconsistent. This study aims to investigate whether various groups of racialized immigrants differ from their Canadian-born white counterparts in the subjective (i.e. unmet health need) and objective measures of health care access (i.e. regular care by a family physician) over an 8-year period under universal health system in Canada.

Methods: Two-wave panel data were obtained from the Canadian Longitudinal Study on Aging, including baseline (T0, 2010-2015, n=30,097) and the first follow-up data (T1, 2015-2018, n=27,699). The multivariable logistics regression model was used to estimate the crude and adjusted odds ratios (AOR) across 13 nativity/racial groups for two outcome measures. Unmet health need (T1) was operationalized as: 1) need being met; 2) unmet need due to system-levels barriers (waiting time; affordability; location; acceptability); 3) unmet need due to individual-level constraints (“felt would be inadequate”; “didn’t get around”; “decided not to seek care”; “too busy”). Regular primary care (T1) was conceptualized as: 1) none: lack a family doctor; 2) mild care: have a family doctor without past-year contact; 3) regular care: have past-year contact with a family doctor. Potential confounders in the baseline (T0) were controlled including socio-demographics (age, sex, marital status).

Results: For subjective measure of “need”, compared to Canadian-born white, Black immigrants (AOR=1.96) and Latin American immigrants (AOR=2.217) were around two times more likely to report individual-related unmet health needs. However, none of the racialized immigrant groups differed from Canadian-born Whites on reporting system-related unmet health need (p>0.05), expect for the indigenous populations (AOR=2.11). Participants in lower income groups were more like to report both individual-related unmet needs (AOR range: 1.40-1.74) and system-related unmet needs (AOR range: 1.29-1.76), compared to their peers in the highest income group.

Regarding the objective measure of “access”, only West Asian immigrants (AOR=1.80) were around twofold the odds of lacking a regular care provider than Canadian-born White, whereas other racialized immigrants were comparable to have access to regular care. Some groups of racialized immigrants even had better access than Canadian-born white. For example, South Asian immigrants (AOR=0.10) were even 90% less likely to lack a regular care provider; Black immigrants (AOR=0.30) and Southeast Asian immigrants (AOR=0.24) were less likely to have no past-year contact with a family doctor. Participants in lower income groups were more like to lack a family doctor (AOR range: 1.39-3.10) and consequently did not visit a family doctor in the previous year (AOR range: 1.18-1.61).

Conclusions: Subtle disparities by racial/immigration status were found in individual-related unmet health needs and access to regular care provider but not in system-related unmet health needs. At the policy level, our findings underscore that upstream makers of social stratification (such as income and race) which serve as proxies for hierarchies of power are still vital in shaping the process of healthcare resource distribution in a universal health system. At the practice level, our findings highlight macro-level social work practice to increase vulnerable clients' access to health care and to emancipate and empower underserved populations.