Dataset Information

Health insurance instability among older immigrants: region of origin disparities in coverage.

ABSTRACT: We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States.Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50-64 from Asia, Latin America, and Europe.We find that the likelihood of having HIC at first observation and the rates of gaining and losing coverage within a relatively short time frame are least favorable for older Latino immigrants, although immigrants from all three regions are at a disadvantage relative to native-born non-Hispanic Whites. This disparity among immigrant groups persists even when lower rates of citizenship, greater difficulty with English, and low-skill job placements are taken into account.Factors that have contributed to the lower rates and shorter durations of HIC among older immigrants, particularly those from Latin America, may not be easily resolved by the Affordable Care Act. The importance of region of origin and assimilation characteristics for the risk of being uninsured in later life argues that immigration and health care policy should be jointly addressed.

SUBMITTER: Reyes AM

PROVIDER: S-EPMC4415080 | biostudies-other | 2015 Mar

REPOSITORIES: biostudies-other

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Health insurance instability among older immigrants: region of origin disparities in coverage.

Reyes Adriana M AM Hardy Melissa M

The journals of gerontology. Series B, Psychological sciences and social sciences 20150131 2

<h4>Objectives</h4>We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States.<h4>Method</h4>Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50-64 from Asia, Latin A ...[more]

PMID: 25637934

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Project description:We aimed to investigate and compare activities of daily living (ADL), instrumental ADL (IADL), poor self-rated health and the health behaviours among immigrants and the native population in Norway. We present results from analysis of two Norwegian surveys, (Living Conditions Survey on Health from 2015, Living Conditions Survey among Immigrants 2016). Using logistic regression models, odds ratios were estimated for functional ability, self-reported health, and health behavior among immigrants, with Norwegian born being the reference category. The first model was controlled for age and gender and the second model was additionally adjusted for educational level. Our analysis included 5343 participants, 2853 men (913 immigrants), and 2481 women (603 immigrants), aged 45-79 years. The age-group 45-66 years includes n = 4187 (immigrants n = 1431, men n = 856; women n = 575) and 67-79 years n = 1147 (immigrants n = 85, men n = 57; women n = 28). The percentage of Norwegians having ≥ 14 years of education was 86%, as compared to 56% among immigrants. The percentage of immigrants with no education at all was 11%. The employment rate among the Norwegian eldest age group was nearly double (14%) as compared to the immigrant group. Adjusted for age, gender and education, immigrants had higher odds than Norwegian of ADL and IADL, chronic diseases and overweight. There were no differences between immigrants and Norwegians in prevalence of poor self-reported health and smoking. Overall elderly immigrants are worse-off than Norwegians in parameters of health and functioning. Knowledge about health and functioning of elderly immigrants can provide a basis for evidence-based policies and interventions to ensure the best possible health for a growing number of elderly immigrants. Furthermore, for a better surveillance, planning of programs, making policies, decisions and improved assessment and implementation, ADL and IADLs limitations should be included as a variable in public health studies.

Project description:ObjectiveTo improve understanding of the relationship between lack of insurance and risk of subsequent mortality.Data sourcesAdults who reported being uninsured or privately insured in the National Health Interview Survey from 1986 to 2000 were followed prospectively for mortality from initial interview through 2002. Baseline information was obtained on 672,526 respondents, age 18-64 at the time of the interview. Follow-up information on vital status was obtained for 643,001 (96 percent) of these respondents, with approximately 5.4 million person-years of follow-up.Study designRelationships between insurance status and subsequent mortality are examined using Cox proportional hazard survival analysis.Principal findingsAdjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline (hazard ratio 1.03, 95 percent confidence interval [CI], 0.95-1.12). Omitting health status as a control variable increases the estimated hazard ratio to 1.10 (95 percent CI, 1.03-1.19). Also omitting smoking status and body mass index increases the hazard ratio to 1.20 (95 percent CI, 1.15-1.24). The estimated association between lack of insurance and mortality is not larger among disadvantaged subgroups; when the analysis is restricted to amenable causes of death; when the follow-up period is shortened (to increase the likelihood of comparing the continuously insured and continuously uninsured); and does not change after people turn 65 and gain Medicare coverage.ConclusionsThe Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.

Project description:BackgroundIn the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes.ObjectiveTo describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016.DesignWe used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents.ParticipantsRespondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency.Main measuresInsurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care.Key resultsGains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency.ConclusionsDisparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.

Dataset Information

Health insurance instability among older immigrants: region of origin disparities in coverage.

Publications

Health insurance instability among older immigrants: region of origin disparities in coverage.

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