Systemic and Immigrant-Related Factors Influencing Physical Health Service Utilization Among Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese in Austin, United States

Abstract

Background and Purpose Disaggregated data on physical health service utilization among Asian American subgroups remain scarce compared to other racial and ethnic minority groups. While an expanding body of literature validates the effectiveness of Anderson’s health behavioral model in explaining healthcare utilization among immigrants, only a few studies have integrated immigration experiences and macrostructural influences into their analyses. Therefore, guided by Yang and Hwang’s (2016) immigrant health service utilization framework, this study investigates the extent to which macrostructural and predisposing factors, as well as immigrant-related indicators, predict health service utilization among Asian Americans. Additionally, it seeks to analyze disparities in service use and determinant differences by ethnic groups and identify the primary predictors of service utilization.

Methods Using cross-sectional data from the 2015 Asian American Quality of Life (AAQoL) survey, we used bivariate analyses to examine the disparities by Asian ethnic groups (N=2,643). Through a four-step hierarchical logistic regression model (Model 1 through Model 4), improvements in model fit were evaluated using changes in -2 log-likelihood and pseudo R² values. The primary predictors explaining use of physical health service were identified based on odds ratios (ORs) and 95% confidence intervals (CIs) in the full regression model (Model 4).

Results Subgroup disparities were evident, with Filipinos (86.3%) and Vietnamese (83.4%) reporting high utilization rates despite lower socioeconomic status. Lower utilization was observed among Asian Indians (75.6%) and Koreans (76.7%). Higher odds of physical health service utilization were associated with female gender, Filipino and Korean ethnicity, higher income, longer U.S. residency, better health knowledge and attitudes, and more satisfaction with local services. Asian Americans who perceived their ethnic community as less helpful were more likely to use formal care. The findings from hierarchical logistic regressions demonstrated a better model fit with the inclusion of macrostructural and immigrant-related factors (ΔR² = .03).

Implications: This study advances the existing understanding of immigrant health service utilization and enriches the disaggregated health data of Asian Americans. Both immigrant experiences and systemic factors play pivotal roles in shaping the health service utilization patterns of immigrant populations. The collection of disaggregated health data and the development of culturally tailored interventions are critical to addressing health disparities and promoting equitable access within diverse Asian American communities. Greater emphasis should be placed on researching the health disparities affecting this population. Future studies could comprehensively analyze immigrant health service utilization by incorporating need-based factors, enabling factors, and immigrant-specific indicators.