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Master of Public Health
Epidemiology & Community Health
Background: Studies have shown that racial and ethnic Minorities have poorer access to medical care when compared to Whites. Much of the research regarding Minority access to care issues reflects national data that has made it difficult to extrapolate findings to accurately reveal disparities that exist within a particular community. The purpose of this study was to determine if there was an association between race and access to medical care in the state of Virginia.Objectives: To determine if there is an association between race/ethnicity and access to medical care when comparing different Minority populations to the White population; assess any differences between Minority populations with regards to access to medical care, and identify other risk factors that may modify the association between race/ethnicity and access to medical care. Methods: Data was collected from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) for N= 4,392 Virginian respondents. Descriptive statistics and prevalences were done to assess the sample based on unweighted data. The weighted sample was then applied for univariate and multivariate analyses with 95% confidence intervals (CI) to examine the risk estimates (odds ratios/ORs) and assess the relationship between race/ethnicity and access to medical care. Pearson chi-square analyses determined which variables to control for in the logistic regression model. SPSS 13.0 software was used for all analyses.Results: Blacks and Hispanics were more likely to be at risk for not having access to medical care (crude ORs = 1.20, 95% CI = 1.19-1.21 and 1.64, 95% CI = 1.61-1.66, respectively) when compared to Whites. Relative to Whites, Asian/Pacific Islanders and Native Americans were more likely to have access to health care (crude ORs = 0.71, 95% CI = 0.70-0.73 and 0.90, 95% CI = 0.84-0.93, respectively). After adjustment for confounders, there was a significant inverse association found between Minority populations and not having access to medical care when compared to Whites. Adjusted ORs for Blacks = 0.71, 95%CI = 0.70-0.72, for Asian/Pacific Islanders 0.80, 95%CI = 0.75-0.80, for Native Americans = 0.74, 95%CI = 0.70-0.78, and Hispanics = 0.59, 95%CI = 0.58-0.60. With regard to the adjusted ORs, there were no notable differences found between the different Minority populations. The relationship between race/ethnicity and access to care appeared to be modified by other predictors in the model. Specifically, female gender, being young or of middle age, no insurance status, poor health status, and little or no income, became stronger predictors for determining those groups who were more at risk for not receiving access to medical care in Virginia as oppose to race. Conclusion: The study strongly recommends that continued surveillance is needed to monitor access to care for Minority populations in the state of Virginia. Further research would be needed to assess these populations access over time, determine how interactions between race and other risk factors affect access, and design interventions that will succeed in teaching us more about the causal pathways that lead to such racial inequalities in access to medical care.
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