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The Relationship of Immigrant Status With Access, Utilization, and Health Status for Children With Asthma

  • Joyce R. Javier
    Correspondence
    Address correspondence to Joyce R. Javier, MD, MPH, Children's Hospital of Los Angeles/University of Southern California, Keck School of Medicine, 4650 Sunset Blvd, Mailstop #76, Los Angeles, California 90027.
    Affiliations
    From the Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, Calif (Dr Javier, Dr Wise, and Dr Mendoza); and the Center for Health Policy/Primary Care and Outcomes Research, Palo Alto, Calif (Dr Wise)
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  • Paul H. Wise
    Affiliations
    From the Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, Calif (Dr Javier, Dr Wise, and Dr Mendoza); and the Center for Health Policy/Primary Care and Outcomes Research, Palo Alto, Calif (Dr Wise)
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  • Fernando S. Mendoza
    Affiliations
    From the Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, Calif (Dr Javier, Dr Wise, and Dr Mendoza); and the Center for Health Policy/Primary Care and Outcomes Research, Palo Alto, Calif (Dr Wise)
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      Objective

      Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.

      Methods

      Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.

      Results

      Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36–0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.

      Conclusions

      Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.

      Key Words

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