Background: Neighborhood context is critical to healthcare access, especially among immigrants. Despite having prominent ethnic neighborhoods in the U.S, no studies examine how the neighborhood affects South Asian health access. This study examined how neighborhood context was associated with health insurance status among South Asian Americans.

Methods: The study used the 2020 American Community Survey. The sample included Californians aged 18 years and older (N=1,444,781). Neighborhood context was assessed using aggregate co-ethnic density (i.e. percent South Asian in a neighborhood), foreign-born density, and socioeconomic status (i.e. percent college-educated and home ownership and median household income). A theoretically informed neighborhood typology was created using these measures. Weighted multivariate logistic regression models were used to examine the role of neighborhood context (as individual measures and the typology) on health insurance status. Wald tests were used to assess if neighborhood context was an important predictor of health insurance status. Analyses were conducted in STATA 18.

Results: Compared to Whites, South Asians had higher odds of being insured (p<0.001) and lower odds of having private health insurance (p<0.001). Suburban residence and high co-ethnic density significantly increased the odds of any health insurance among South Asians (p<0.05)  and living in a central city and high neighborhood-level socioeconomic status increased odds of private health insurance (p<0.05). Wald Tests indicated that select neighborhood factors were better predictors of private health insurance than the neighborhood typology.

 Discussion: The study demonstrated that the neighborhood, especially factors like co-ethnic density and neighborhood-level socioeconomic status, can influence health access. Researchers should continue to assess the role of the neighborhood when examining health disparities in the South Asian immigrant community.