Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them.
Methods.
We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1,000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs.
Results.
We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least 5,000.
Conclusion.
This project complements federal efforts to identify medically underserved health service areas and identifies U.S. counties that need new or expanded health services for medically underserved AAPIs.
References
1.
Census Bureau (US). 2004 American Community Survey. Washington: Census Bureau; 2005.
BarnesJSBennettCE. The Asian population: 2000: Census 2000 brief. Washington: Census Bureau (US); 2002. Also available from: URL: http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf [cited 2007 Nov 30].
4.
Census Bureau (US). The Native Hawaiian and other Pacific Islander population: 2000: Census 2000 brief. Washington: Census Bureau (US); 2001. Also available from: URL: http://www.census.gov/prod/2001pubs/c2kbr01-14.pdf [cited 2007 Nov 30].
5.
GhoshC. Healthy People 2010 and Asian Americans/Pacific Islanders: defining a baseline of information. Am J Public Health2003;93:2093–8.
Centers for Disease Control and Prevention (US). Fact sheet: racial/ethnic health disparities [press release]; 2004 Apr 2 [cited 2005 Apr 30], Available from: URL: http://www.cdc.gov/od/oc/media/pressrel/fs040402.htm
8.
MillerBAKolonelLNBernsteinLYoungJLSwansonGMWestDW, editors. Racial/ethnic patterns of cancer in the United States, 1988–1992. Bethesda (MD): Department of Health and Human Services, Public Health Service, National Institutes of Health (US), National Cancer Institute, Cancer Statistics Branch; 1996. HHS publication no. (NIH) 96-4104.
9.
PamukEMakucDHeckKReubenCLochnerK. Health, United States, 1998, with socioeconomic status and health chartbook. Hyattsville (MD): National Center for Health Statistics (US); 1998. Also available from: URL: http://www.cdc.gov/nchs/data/hus/hus98.pdf [cited 2005 Apr 30].
10.
ChenMSJr. Cancer health disparities among Asian Americans: what we do and what we need to do. Cancer2005;104(12 Suppl):S2895–902.
11.
McCrackenMOlsenMChenMSJrJemalAThunMCokkinidesV. Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin2007;57:190–205.
12.
PonceNATsengWOngPShekYLOrtizSGatchellM. The state of Asian American, Native Hawaiian, and Pacific Islander health in California report. Los Angeles: University of California Asian American and Pacific Islander Policy Multi-Campus Research Program; 2009.
13.
ChenMSHawksBL. A debunking of the myth of healthy Asian Americans and Pacific Islanders. Am J Health Promot1995;9:261–8.
14.
LinM-KKKazinetsGIveySMoskowitzJM. The health of Asian Pacific Islander American adults in California: 2001–2003. Berkeley (CA): Center for Family and Community Health, University of California at Berkeley; 2006. Also available from: URL: http://cfch.berkeley.edu/reports/reports.html/APIA%20health%202001-03%20report.pdf [cited 2007 Nov 1].
15.
National Association of Community Health Centers. America's health centers. Washington: National Association of Community Health Centers; 2008.
Department of Health and Human Services, Health Resources and Services Administration (US). Guidelines for MUA and MUP designation [cited 2007 Mar 14]. Available from: URL: http://bhpr.hrsa.gov/shortage/muaguide.htm
20.
Texas Department of State Health Services. Medically underserved area (MUA) and medically underserved population (MUP): designations in Texas [cited 2007 Mar 14], Available from: URL: http://www.dshs.state.tx.us/CHS/hprc/muacovr.shtm
21.
JordanA. Briefing on the notice of proposed rulemaking for designation of underserved areas. Rockville (MD): National Association of Rural Health Clinics; 2008. Also available from: URL: http://ruralhealth.hrsa.gov/RHC/2008-03-llcall_files/frame.htm [cited 2009 Jun 21].
22.
Department of Health and Human Services (US). Designation of medically underserved populations and health professional shortage areas: proposed rule (42 C.F.R. parts 5 and 51c): Fed Reg 73(41) (2008).
23.
National Association of Community Health Centers. Summary of proposed rule on designation of medically underserved populations and health professional shortage areas: 73 Fed Reg 11232 (2008).
24.
DialTHPalsboSEBergstenCGabelJRWeinerJ. Clinical staffing in staff- and group-model HMOs. Health Aff (Millwood)1995;14:168–80.
25.
RickettsTCGoldsmithLJHolmesGMRandolphRMLeeRTaylorDH. Designating places and populations as medically underserved: a proposal for a new approach. J Health Care Poor Underserved2007;18:567–89.
26.
KehrerBHWooldridgeJ. An evaluation of criteria to designate urban health manpower shortage areas. Inquiry1983;20:264–75.
27.
LarsonEHPalazzoLBerkowitzBPiraniMJHartLG. The contribution of nurse practitioners and physician assistants to generalist care in Washington State. Health Serv Res2003;38:1033–50.
28.
GoodmanDCFisherESBubulzTAMohrJEPoageJFWennbergJE. Benchmarking the US physician workforce. An alternative to needs-based or demand-based planning [published erratum appears in JAMA 1997;277:966]. JAMA1996;276:1811–7.
29.
Department of Health and Human Services, Health Resources and Services Administration (US). Testimony to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies by HRSA Administrator Elizabeth M. Duke. 2005 Mar 15 [cited 2007 Mar 19]. Available from: URL: http://newsroom.hrsa.gov/speeches/2005/DukeHouse.htm
Federal Register. Designation of medically underserved areas and population groups. Federal Register40:40315–40320, 1975.
32.
WrightRAAndresTLDavidsonAJ. Finding the medically underserved: a need to revise the federal definition. J Health Care Poor Underserved1996;7:296–307.
33.
AndrulisDGoodmanNPryorC. What a difference an interpreter can make: health care experiences of uninsured with limited English proficiency. Boston: The Access Project; April 2002. Also available from: URL: http://www.accessproject.org/downloads/c_LEPreportENG.pdf [cited 2004 Apr 30].
34.
DouglasKCFujimotoD. Asian Pacific elders: implications for health care providers. Clin Geriatr Med1995;11:69–82.
35.
SarverJBakerDW. Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med2000;15:256–64.
36.
MansonA. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care1988;26:1119–28.
37.
NaishJBrownJDentonB. Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening. BMJ1994;309:1126–8.
38.
WoloshinSBickellNASchwartzLMGanyFWelchHG. Language barriers in medicine in the United States. JAMA1995;273:724–8.
39.
WoloshinSSchwartzLMKatzSJWelchHG. Is language a barrier to the use of preventive services?J Gen Intern Med1997;12:472–7.
40.
TakakiRT. Strangers from a different shore: a history of Asian Americans. Boston: Little Brown; 1989.
41.
PortesARumbautRG. Immigrant America: a portrait. Berkeley (CA): University of California Press; 1990.
42.
PortesARumbautRG. Legacies: the story of the immigrant second generation. Berkeley (CA): University of California Press; 2001.
43.
ShiLMacinkoJStarfieldBWuluJReganJPolitzerR. The relationship between primary care, income inequality, and mortality in US states, 1980–1995. J Am Board Fam Pract2003;16:412–22.
44.
KriegerNChenJTWatermanPDRehkopfDHSubramanianSV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures—the Public Health Disparities Geocoding Project. Am J Public Health2003;93:1655–71.
45.
ProserMShinPHawkinsD. A nation's health at risk part III: growing uninsured, budget cutbacks challenge president's initiative to put a health center in every poor county. Washington: National Association of Community Health Centers; March 2005. Also available from: URL: http://www.nachc.com/client/poorcountiesSTIB9.pdf [cited 2009 Jun 21].
46.
RickettsTCGoldsmithLJHolmesGMRandolphRLeeRTaylorDH. Designating places and populations as medically underserved: a proposal for a new approach. J Health Care Poor Underserved2007;18:567–89.
47.
Executive Office of the President, Office of Management and Budget (US). Revisions to the standards for the classification of federal data on race and ethnicity [cited 2008 Jul 12]. Available from: URL: http://www.whitehouse.gov/omb/fedreg/ombdirl5.html
