Dataset Information

Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status.

ABSTRACT: OBJECTIVE: We investigate health expenditure disparities between Latinos and non-Latino whites by years of United States residence and citizenship/nativity status. DATA SOURCES: We link the Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2007. The sample consists of 31,514 Latinos and 76,021 white adults (18-64 years). STUDY DESIGN: The likelihood of any health spending, total health expenditure, and the out-of-pocket (OOP) share of health expenditure are our main dependent variables. We use two-part multivariate models to adjust for confounding factors. A stratified analysis by insurance status checks for the results' robustness. The decomposition technique is implemented to estimate the share of disparities that can be explained by observed and unobserved variables. PRINCIPAL FINDINGS: Latinos are much less likely to have any health spending (68 percent), total health expenditure (57 percent), and more likely to pay OOP (6 percent) compared with the white population. Overall, disparities narrow or disappear for naturalized Latinos the longer they stay in the country. Among noncitizen Latinos, disparities remain constant or decline slightly, but they remain large over time. CONCLUSIONS: Low-health spending by foreign-born Latinos contributes to health expenditure disparities between Latinos and whites. Our findings provide preliminary evidence on health-spending convergence over time between foreign-born Latinos and that of whites.

SUBMITTER: Bustamante AV

PROVIDER: S-EPMC3419890 | biostudies-other | 2012 Apr

REPOSITORIES: biostudies-other

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Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status.

Bustamante Arturo Vargas AV Chen Jie J

Health services research 20110603 2

<h4>Objective</h4>We investigate health expenditure disparities between Latinos and non-Latino whites by years of United States residence and citizenship/nativity status.<h4>Data sources</h4>We link the Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2007. The sample consists of 31,514 Latinos and 76,021 white adults (18-64 years).<h4>Study design</h4>The likelihood of any health spending, total health expenditure, and the out-of-pocket (OOP) share of healt ...[more]

PMID: 21644969

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Project description:BACKGROUND:Although individuals classified as nonresident aliens, including undocumented immigrants, are entitled to receive emergency dialysis in the United States regardless of their ability to pay, most states do not provide them with subsidized care for maintenance dialysis or kidney transplantation. We explored whether nonresident aliens have similar outcomes to US citizens after receiving kidney transplants covered by Medicaid, a joint federal and state health insurance program. STUDY DESIGN:Retrospective observational cohort study. SETTING & PARTICIPANTS:All adult Medicaid patients in the US Renal Data System who received their first kidney transplant from 1990 to 2011. PREDICTOR:Citizenship status, categorized as US citizen, nonresident alien, or permanent resident. OUTCOME:All-cause transplant loss. MEASUREMENTS:HRs and 95% CIs estimated by applying Cox proportional hazards frailty models with transplantation center as a random effect. RESULTS:Of 10,495 patients, 8,660 (82%) were US citizens, 1,489 (14%) were permanent residents, and 346 (3%) were nonresident aliens, whom we assumed were undocumented immigrants. Nonresident aliens were younger, healthier, receiving dialysis longer, and more likely to have had a living donor. 71% underwent transplantation in California, and 61% underwent transplantation after 2005. Nonresident aliens had a lower unadjusted risk for transplant loss compared with US citizens (HR, 0.48; 95% CI, 0.35-0.65). Results were attenuated but still significant when adjusted for demographics, comorbid conditions, dialysis, and transplant-related factors (HR, 0.67; 95% CI, 0.46-0.94). LIMITATIONS:Citizenship status was self-reported, possible residual confounding. CONCLUSIONS:Our study suggests that the select group of insured nonresident aliens who undergo transplantation with Medicaid do just as well as US citizens with Medicaid. Policymakers should consider expanding coverage for kidney transplantation in nonresident aliens, including undocumented immigrants, given the associated high-quality outcomes in these patients.

Dataset Information

Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status.

Publications

Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status.

Similar Datasets

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