An Examination of Safety Net Utilization by Race, Ethnicity, and Nativity Status

Objective: This study examines the relationship of immigrant status and race/ethnicity with using a community health center (CHC) or an emergency department (ED) as a usual source of care. Study Design: Data is obtained from the 2006 and 2007 National Health Interview Survey (NHIS). Only respondents who reported race/ethnicity as non-Hispanic White, non-Hispanic Black, or Hispanic, were aged 18 years or older, and reported having a usual source of care are included in the study (n=80,683). Logistic regression modeled race/ethnicity and nativity as predictors of using CHC or ED as a usual source of care, while adjusting for other factors. Post-estimation analyses calculate odds of CHC or ED utilization, stratifying race/ethnicity among CHC users and ED users by foreign vs. U.S. nativity and, separately, stratify nativity by race/ethnicity. Multinomial logistic regression modeled the effects of race/ethnicity, nativity, and citizenship on using one source of safety net care other another, adjusting for other factors. All analyses were conducted using STATA 10.0. Principal Findings: In the full model, foreign-born [OR=1.28 (95%CI 1.18,1.39)] and Hispanic [OR=1.92 (95%CI 1.75,2.10)] respondents are associated with higher odds of CHC use compared to U.S. natives and non-Hispanics, though not associated with ED use. In post-estimation analyses, significant association between being foreign-born and using a CHC is similar across race/ethnicity strata. There is not a significant association for being foreign-born and using an ED within any race/ethnicity. Multinomial logistic regression showed that being foreign-born Hispanic [OR=0.52(95%CI 0.32,0.85)] or Hispanic of foreign citizenship [OR=0.32(95%CI 0.17,0.61)] was associated with a lower likelihood of choosing an ED over a CHC. Conclusions: Hispanic immigrants who use the safety net prefer using a CHC to an ED. Reasons that Hispanics and immigrants use CHCs extend beyond reasons commonly attributed to health care access. After adjusting for factors typically associated with health care access, Hispanics and immigrants were still significantly more likely than non-Hispanics and U.S. natives to use a CHC. Communities seeking to expand the safety net for Hispanic immigrant populations should consider CHC expansion.