Special Issue of Medical Journal Explores Latino Health and Healthcare
The Latino population is the nation's largest minority group at an estimated 47 million in 2008 and is predicted to make up 30% of the US population by 2050. At the same time, chronic diseases among Latinos are on the rise and require long-range strategies to prevent and clinically manage. Understanding the healthcare of this fastest growing population is critical to the healthcare debate and reform initiatives.
The Network for Multicultural Research on Health and Healthcare, a consortium of researchers from major research institutions around the country, examines healthcare disparities affecting minorities with chronic diseases and has produced a special supplement of the Journal of General Internal Medicine examining Latinos and healthcare, shedding light on important issues that have been left out of the healthcare reform debate.
This issue, Confronting Inequities in Latino Health Care, comprises nine studies examining hypertension, diabetes, health insurance coverage, discrimination, quality of care, spirituality, preventive care, and other topics on Latino health and healthcare.
- Two thirds of Mexican Americans in the United States do not have a "patient-centered medical home." That means they are less likely to receive regular health care that meets basic standards for adequacy, either preventive or when they get sick, with a resulting reliance on emergency rooms or other high-cost health care to address basic health care needs.
- For Mexican Americans with hypertension, 41% are unaware of their condition and 44% of those treated have uncontrolled hypertension.
- 75% of Mexican American women and 78% of men with hypertension are overweight or obese.
- US Latinos with health insurance are 1.5 times more likely to report having excellent/good health care than their uninsured counterparts. Meanwhile, 60% of Latinos who are not US citizens or are undocumented do not have health insurance.
- Insured Latinos are more likely to be married, to have been born in the US and speak English. They are also more likely to have finished high school, to be older than 35 years of age, and to have income above the federal poverty line.
- Undocumented Latinos, compared to US-born or foreign-born Latinos, have the lowest percentage of health insurance (37% vs 77%, respectively).
- Nearly 70% of Latinos think that spiritual healing is very important in maintaining health and well being.
US-born Latinos report higher rates of discrimination and lower quality of care than foreign-born Latinos.
"The range of articles presented by our researchers in this special issue will inform the US health policy debate for an all-too-often marginalized population," stated Michael Rodriguez, MD, guest editor of the supplement and co-director of the Network for Multicultural Research on Heath and Healthcare at the UCLA David Geffen School of Medicine, Department of Family Medicine.
"Our research brings to light many quality of care issues for Latinos navigating today's healthcare system," said guest editor William Vega, PhD, co-director of the Network for Multicultural Research on Heath and Healthcare at UCLA. "The special needs of Latinos, whether US-born, foreign-born or undocumented, are too often left out of the healthcare reform discussion. Where and under what conditions will Latinos receive adequate medical care if they are not permitted to participate in new insurance programs?"
For each article, descriptors can be found below and additional information on the articles and relevant background information can be obtained by visiting http://media.multiculturalhealthcare.net/. The special issue is available online at http://www.springerlink.com/content/kh2hg676700u/?p=1ad4425d354e4ea9a437239d034064fa&pi=10.
Undocumented US Latinos Report Low Rates of Health Insurance and Healthcare Services
In this study, undocumented Latinos reported the lowest rates of healthcare services, including some preventive services that could help avoid higher-cost health care in late stage or emergency care. Undocumented Latinos compared to US-born Latinos had lowest rates of: insurance coverage (37% vs 77%, respectively); usual source of care (58% vs 79%, respectively); blood pressure checked (67% vs 87%, respectively); cholesterol checked (56% vs 83%, respectively); and self-reported excellent/good care in the past year (76% vs 80%, respectively). In addition, 40% of undocumented Latinos, compared to 20% of US-born Latinos, said they did not receive any health information from their doctor in the past year.
Rodríguez MA, Vargas Bustamante A, Ang A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med. 2009;24(suppl3):508-513.
Fewer Latinos Have Access to Primary Care Services or a Patient Centered Medical Home
The patient-centered medical home, an approach to providing comprehensive primary care for children, youth and adults, has been identified as a model that can offer high-quality health care. Researchers found that only a third of Mexican Americans and Central/South Americans living in the United States receive care in the patient center medical home. Of the groups studied, those who had access to a medical home had higher rates of preventive care and positive patient experiences.
Why This Is Important: Preventive care and positive patient experiences associated with a patient centered medical home have been found to improve health and reduce high-cost emergency room visits.
Beal A, Hernandez S, Doty M. Latino access to the patient-centered medical home. J Gen Intern Med. 2009;24(suppl3):508-513.
Disparities in Healthcare and Knowledge of Diabetes within Latinos Exist
In this national study of Latinos, having a usual source of healthcare (USHC) means better awareness and knowledge about diabetes. US Mexicans, who make up the vast majority of Latinos in the US, are also the most disadvantaged group in terms of access to USHC.
Why This Is Important: A usual source of health care provides Latino patients benefits to make more informed health decisions helping to promote health and reduce health care disparities.
González HM, Vega WA, Rodríguez MA, Tarraf W, Sribney WM. Diabetes awareness and knowledge among Latinos: does a usual source of healthcare matter? J Gen Intern Med. 2009; 24 (suppl3):528-533.
Hypertension Rates High Among Mexican American Adults
Mexican Americans were found to have low rates of hypertension awareness and treatment, especially among younger adults and the uninsured. Researchers found high rates of uncontrolled hypertension for Mexican American women and men. Even worse, 75-78% of hypertensive Mexican Americans were overweight or obese and 30% had diabetes.
Why This Is Important: Hypertension is the most common risk factor for heart disease and is referred to as the "silent killer." Patients with undetected and/or uncontrolled high blood pressure are at greater risk of heart attacks, strokes and other related conditions.
Bersamin A, Stafford RS, Winkleby MA. Predictors of hypertension awareness, treatment, and control among Mexican American women and men. J Gen Intern Med. 2009;24(suppl3):521-527.
Improving US Latinos' Ability to Manage their Health and Health Care Improves the Quality of Health Care
Researchers have shown that patients who receive more healthcare information and training have an increased ability to manage their health care (patient "activation"). In this article, data from a study on US-born and foreign-born Latinos were examined, finding that US-born Latinos had significantly greater patient activation scores than foreign-born Latinos. As might be expected, Latinos who spoke English and reported excellent health had higher activation scores compared to their Spanish-speaking counterparts and those reporting fair or poor health.
Why This Is Important: Improving Latino's activation level may help improve patient-provider communication and quality of health care, thereby helping to improve services.
Alegría M, Sribney W, Perez D, Laderman M, Keefe K. The role of patient activation on patient-provider communication and quality of care for US and foreign born Latino patients. J Gen Intern Med. 2009;24(suppl3):534-541.
Health Insurance Effects on Quality of Care for US Latinos
If you are Latino and have health insurance, you are 1.5 times more likely to have good health care than a Latino without health insurance. In this study, researchers found that more than 3 in 4 Latinos with health insurance said they had excellent/good health care compared to only 1 in 2 Latinos without health insurance. Likewise, 83% of the insured Latinos with hypertension thought they had excellent/good health care compared to only 64% of Latino hypertensive patients who were uninsured. Perceived quality of care differed most widely among the insured and uninsured with chronic medical conditions that required healthcare services more frequently.
Why This Is Important: Research has shown that patients who receive adequate health care are more likely to have better health outcomes.
Perez D, Ang A, Vega WA. Effects of health insurance on perceived quality of care among Latinos in the United States. J Gen Intern Med. 2009;24(suppl3):555-560.
What Factors Affect Rates of Health Insurance Between US-born Latino and US Latino Adults of Mexican Ancestry?
US Latinos of Mexican ancestry are less likely to have health insurance than are non-Mexican Latinos.
Insured Mexican Americans are more likely to be married, to have been born in the US and speak English. They are also more likely to have finished high school, to be older than 35 years of age, and to have income above the federal poverty line. Study researchers believe other factors associated with being insured include type of employment and company size, as well as behavioral factors, such as risk aversion and cultural differences.
Bustamante AV, Fang H, Rizzo JA, Ortega AN. Heterogeneity in health insurance coverage among US Latino adults. J Gen Intern Med. 2009;24(suppl3):561-566.
Discrimination and Its Effects on Self-Reported Health Care Among US Latinos
In this study, US-born Latinos reported higher rates of discrimination and lower quality of care than foreign-born Latinos. Using the Detroit Area Survey discrimination scale, researchers found that US-born Latinos scored 9.3 vs 4.7 on the scale. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that found in US-born Latinos.
Why This Is Important: Discrimination is related to the quality of care and as such is important to address for Latinos. Perez D, Sribney WM, Rodríguez MA. Perceived discrimination and self-reported quality of care among Latinos in the United States. J Gen Intern Med. 2009;24(suppl3):548-554.
Most US Latinos Pray for Good Health
Nearly 70% of US the Latinos interviewed in this study thought that spiritual healing is very important in maintaining health and well being. Sixty percent prayed for healing and 49% asked others to pray for healing.
Reyes-Ortiz CA, Rodriguez MA, Markides KS. The role of spirituality healing with perceptions of the medical encounter among Latinos. J Gen Intern Med. 2009;24(suppl3):542-547.
The Network for Multicultural Research on Heath and Healthcare, run through the UCLA Department of Family Medicine with support from the Robert Wood Johnson Foundation, studies healthcare disparities affecting minorities with chronic diseases. Drawing on the talents of distinguished faculty from several national universities, the Network mentors and develops a new generation of researchers who investigate how social, ethnic, linguistic and economic factors affect the way healthcare providers serve these populations; study how personal and cultural/social factors promote or impede adequate healthcare and disease management; examine healthcare system barriers to quality of care for chronic conditions; and determine which factors influence minorities' health status, including sources of health information, diet and exercise, self-management of chronic conditions, and levels of health literacy among patients and their families. Other Network institutions in addition to UCLA are the University of California, San Francisco; Harvard University; the University of Washington; the University of Texas; Stanford University, Weill Cornell Medical College, Wayne State University and the University of Southern California. For more information on the Network, visit http://multiculturalhealthcare.net/