Health Status, Health Insurance and Health Care Utilization Patterns of Immigrant Black Men Jacqueline Wilson Lucas Daheia Barr-Anderson Raynard S. Kington Division of Health Interview Statistics

Background Desire for different focus on racial and ethnic disparities – black/white differences in health status Desire for different focus on racial and ethnic disparities – black/white differences in health status Project designed to look at various aspects of health in adult immigrants, with focus on non-Hispanic black and white adults Project designed to look at various aspects of health in adult immigrants, with focus on non-Hispanic black and white adults Special issue of American Journal of Public Health – focus on men’s health Special issue of American Journal of Public Health – focus on men’s health

Purpose Comparison of immigrant black men to US-born white men and US-born black men on: demographic characteristics demographic characteristics health characteristics – general health status, health care utilization, health behaviors, health insurance status health characteristics – general health status, health care utilization, health behaviors, health insurance status association of demographic and health characteristics with specific health outcomes association of demographic and health characteristics with specific health outcomes

Methods Data from the NHIS person file and sample adult files Data from the NHIS person file and sample adult files Age-adjusted bivariate analyses of socio- demographic and health data Age-adjusted bivariate analyses of socio- demographic and health data Logistic regression modeling of functional status, respondent-assessed health status, smoking status, and health insurance status, controlling for: Logistic regression modeling of functional status, respondent-assessed health status, smoking status, and health insurance status, controlling for: DEMO – family size, age, race, marital status, nativity SES – education, income GEO – region, MSA ACCULT – race/length of time in the US SUDAAN used for all statistical analyses SUDAAN used for all statistical analyses

Health Measures General health and function Respondent-assessed health (Excellent/VG/Good vs. Fair/Poor) Respondent-assessed health (Excellent/VG/Good vs. Fair/Poor) Functional status (Yes/No to having any limitation in an activity) Functional status (Yes/No to having any limitation in an activity) Health Health behaviors Smoking status (current, former, never, unknown; yes/no for logistic) Smoking status (current, former, never, unknown; yes/no for logistic) Physical activity (Some vs. none) Physical activity (Some vs. none) Alcohol use (lifetime abstainer, former drinker, current infrequent/light/mod, heavy drinker; current vs. non-drinker for logistic) Alcohol use (lifetime abstainer, former drinker, current infrequent/light/mod, heavy drinker; current vs. non-drinker for logistic)

Health Measures, cont’d Health care utilization Interval since last doctor visit (6 mo or less; >6 mo but 1 yr but 3 yrs) Interval since last doctor visit (6 mo or less; >6 mo but 1 yr but 3 yrs) Number of hospitalizations (none vs. one or more in the past year) Number of hospitalizations (none vs. one or more in the past year) Health insurance status Type of insurance coverage (private, public or other gov’t insurance, other, uninsured; insured/uninsured for logistic) Type of insurance coverage (private, public or other gov’t insurance, other, uninsured; insured/uninsured for logistic)

Age group by race/nativity Data source: CDC/NCHS, National Health Interview Survey

Family size by race/nativity Data Source: CDC/NCHS, National Health Interview Survey

Place of residence by race/nativity Data source: CDC/NCHS, National Health Interview Survey

Smoking status by race/nativity Data source: CDC/NCHS, National Health Interview Survey

Health insurance coverage by race/nativity Data source: CDC/NCHS, National Health Interview Survey

Logistic regression model format for health status measures Model 1 – DEMO (family size, age, marital status) Model 2 – Model 1 + SES (income, education) Model 3 – Model 2 + GEO (region, MSA) Model 4 – Model 3 + Acculturation (length of time in US)

Adjusted odds ratios and confidence intervals for health status measures by race/nativity, NHIS Ref group – US-born White men US-born Black men FB Black men < 5 yrs in US FB Black men 5+ yrs in US Functional Status (limited) 0.92 (0.86,1.00) 0.92 (0.86,1.00) 0.22 (0.09, 0.54)* 0.22 (0.09, 0.54)* 0.41 (0.30, 0.55)* 0.41 (0.30, 0.55)* Health Status (fair/poor) 1.31 (1.22, 1.42)* 1.31 (1.22, 1.42)* 0.28 (0.11, 0.75)* 0.28 (0.11, 0.75)* 0.80 (0.59, 1.07) 0.80 (0.59, 1.07) Smoking (current smoker) 0.72 (0.66, 0.79)* 0.72 (0.66, 0.79)* 0.24 (0.12, 0.51)* 0.24 (0.12, 0.51)* 0.41 (0.29, 0.58)* 0.41 (0.29, 0.58)* Alcohol Use (current drinker) 0.63 (0.57, 0.69)* 0.63 (0.57, 0.69)* 0.34 (0.20, 0.58)* 0.34 (0.20, 0.58)* 0.36 (0.27, 0.48)* 0.36 (0.27, 0.48)* Leisure time physical activity (Never active) 1.19 (1,09, 1.30)* 1.19 (1,09, 1.30)* 1.30 (0.75, 2.26) 1.30 (0.75, 2.26) 1.19 (0.90, 1.58) 1.19 (0.90, 1.58)

Logistic regression model format for health insurance Model 1 – DEMO (family size, age, marital status) Model 2 – Model 1 + SES (income, education) Model 3 – Model 2 + GEO (region, MSA) Model 4 – Model 3 + Employment status Model 5 – Model 4 + Acculturation (length of time in US) Model 6 – Model 5 + Health status

Adjusted odds ratios and confidence intervals for health insurance by race/nativity, NHIS Ref group – US-born White men US-born Black men Foreign-born Black men FB Black men < 5 yrs in US FB Black men 5+ yrs in US Model (1.47, 1.67)* 1.57 (1.47, 1.67)* 2.42 (2.06, 2.84)* 2.42 (2.06, 2.84)* Model (1.09, 1.23)* 1.16 (1.09, 1.23)* 2.25 (1.91, 2.66)* 2.25 (1.91, 2.66)* Model (1.01, 1.15) 1.08 (1.01, 1.15) 2.33 (1.98, 2.75)* 2.33 (1.98, 2.75)* Model (0.99, 1.12) 1.05 (0.99, 1.12) 2.28 (1.93, 2.69)* 2.28 (1.93, 2.69)* Model (1.01, 1.17) 1.09 (1.01, 1.17) (2.58, 6.03)* 3.95 (2.58, 6.03)* (1.77, 2.65)* Model (1.00, 1.16) 1.07 (1.00, 1.16) (2.65, 6.20)* 4.06 (2.65, 6.20)* (1.70, 2.68)*

Summary of findings Foreign-born black men were in much better overall health than their US-born counterparts Foreign-born black men were in much better overall health than their US-born counterparts Foreign-born black men were also less likely to report adverse health behaviors Foreign-born black men were also less likely to report adverse health behaviors Foreign born black men were much less likely to be insured than their US-born counterparts, even after adjustment for employment status and health status Foreign born black men were much less likely to be insured than their US-born counterparts, even after adjustment for employment status and health status

Conclusions Despite clear health advantages, foreign-born black men less likely to have health insurance coverage Despite clear health advantages, foreign-born black men less likely to have health insurance coverage In the long term, foreign-born black men in poor health may be adversely affected by the lack of health care coverage In the long term, foreign-born black men in poor health may be adversely affected by the lack of health care coverage

Limitations Small sample size of foreign-born black men Small sample size of foreign-born black men Unable to fully tease out patterns for foreign-born white men Unable to fully tease out patterns for foreign-born white men Little variation in health care utilization measures; other measures not available Little variation in health care utilization measures; other measures not available Minimal information on immigration status Minimal information on immigration status

Next steps Paper published in October, 2003 AJPH Paper published in October, 2003 AJPH Further analysis of immigrant health data for more data years ( ), with focus on immigrant women’s health issues, examination of foreign- born white men Further analysis of immigrant health data for more data years ( ), with focus on immigrant women’s health issues, examination of foreign- born white men Inclusion of more health behavior data, mental health status Inclusion of more health behavior data, mental health status