Primary Submission Category: Race/Ethnicity
Understanding the drivers and modifiers of race/ethnic inequities in ease of and satisfaction with access to healthcare
Authors: Amanda Simanek, Namhee Kim, Aditi Kumar, Yvette Castaneda, Melissa Chen,
Presenting Author: Amanda Simanek*
Socioeconomic barriers to healthcare access, such as cost, have declined, whereas transportation barriers have worsened over the last decade for Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) individuals in the U.S. During the same period, interpersonal and institutional racism have emerged as key barriers to accessing healthcare among racialized minorities. However, the importance of such factors in shaping race/ethnic inequities in healthcare access remains unclear. The aims of this study were to examine 1) the association between race/ethnicity and ease of healthcare access, 2) the extent to which socioeconomic factors (i.e. cost, transportation) or interpersonal (i.e. disrespect by, quality of care from, and trust of providers) and institutional (i.e., trust of medical settings) racism explain these relationships, and 3) whether associations vary across region and community type. Data were from 6748 U.S. adults in the Association of American Medical Colleges CHARGE Investigates survey. Structural equation models were used to examine total, direct, and indirect effects adjusting for age, gender, and income level, and stratified by region and community type. Transportation and trust (provider) were statistically significant mediators of dental, reproductive, specialty, mental health, long-term, and gender-affirming care for NHB versus NHW individuals. Cost, transportation, quality, and trust (provider) were statistically significant mediators for primary, emergency, pediatric, and specialty care for Hispanic versus NHW individuals. Respect and trust (provider/setting) were statistically significant mediators for primary, emergency, pediatric care, long-term, end-of-life, and gender-affirming care, for NH Other versus NHW individuals. Associations varied by region and community type. Findings suggest interventions aimed at improving access to healthcare should be tailored by race/ethnicity, region, and community type of individuals.