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Access to Care and Use of Preventive Services by Hispanics: State-Based Variations From 1991 to 2004

Kang-Kim, Minah PhD*; Betancourt, Joseph R. MD, MPH†‡; Ayanian, John Z. MD, MPP§¶; Zaslavsky, Alan M. PhD; Yucel, Recai M. PhD; Weissman, Joel S. PhD‡¶

doi: 10.1097/MLR.0b013e31816dd966
Original Article

Background: State-level disparities in access to physicians and preventive services between Hispanics and whites may have changed over time.

Objective: To assess state-based changes in Hispanics’ access to physicians and preventive services from 1991 to 2004.

Methods: Using data from the Behavioral Risk Factor Surveillance System in the 10 states with the largest Hispanic populations, we examined 4 preventive services for eligible adults (mammography, Papanicolaou testing, colorectal cancer screening, and cholesterol testing) and 2 measures of access to physicians (obtaining routine checkup in prior 2 years and avoiding seeing physician when needed due to cost in prior year). In each state we assessed unadjusted and adjusted Hispanic-white access gaps and changes over time.

Results: Hispanic-white access gaps persisted over time and varied widely by state. Disparities narrowed and became nonsignificant in 2 states (Arizona and California) for mammography and 3 states (Nevada, New Mexico, and New York) for Pap testing. Other disparities increased and became significant (mammography in Texas; colorectal cancer screening in California, Colorado, and Texas; cholesterol testing in Florida and Nevada; routine checkups in Arizona and New Mexico). Disparities in lacking doctor visits due to cost remained large and significant over time in all states. Insurance status and education were the main contributors to Hispanic-white disparities and their impact increased over time.

Conclusions: Although use of preventive services and access to physicians improved for both whites and Hispanics nationally, access gaps varied widely among states. Therefore, efforts to monitor and eliminate disparities should be conducted at both the national and state levels.

From the *Ewha Womans University, Seoul, Korea; †The Disparities Solutions Center, Boston Massachusetts; ‡Institute for Health Policy, Massachusetts General Hospital, Boston Massachusetts; §Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston Massachusetts; ∥Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Albany, New York; and ¶Department of Health Care Policy, Harvard Medical School, Boston Massachusetts.

Supported by The Commonwealth Fund.

Reprints: Joel S. Weissman, PhD, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.