Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample

UMMS Affiliation

Meyers Primary Care Institute; Department of Family Medicine and Community Health

Publication Date


Document Type



Adult; African Americans; Cross-Sectional Studies; European Continental Ancestry Group; Female; Health Care Surveys; Health Services; Health Services Accessibility; Health Services Needs and Demand; Hispanic Americans; Humans; Insurance, Health; *Language; Logistic Models; Male; Medicaid; Middle Aged; Patient Acceptance of Health Care; Socioeconomic Factors


Health Services Research | Primary Care


BACKGROUND: Racial and ethnic disparities in health care have been well documented, but poorly explained.

OBJECTIVE: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care.

RESEARCH DESIGN: Cross-sectional analysis of the Community Tracking Survey (1996-1997).

SUBJECTS: Adults 18 to 64 years with private or Medicaid health insurance.

MEASURES: Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year.

RESULTS: The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55).

CONCLUSIONS: Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.


Med Care. 2002 Jan;40(1):52-9.

Journal/Book/Conference Title

Medical care


At the time of publication, Barry Saver was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID