This study examined disparities in health status among individuals of different racial and ethnic groups cared for by the nation's community health centers (CHCs) and compared these results with the findings for individuals using non-CHC sites as their usual source of care. The sample consisted of CHC users from the 1994 CHC User Survey and non-CHC users from the 1994 National Health Interview Survey. Bivariate comparisons were made between individuals' race/ethnicity and their experience of healthy life, an integrated measure that incorporates both activity limitation and self-perceived health status. Multiple regressions were followed to examine the independent association of race/ethnicity with healthy life experience for both CHC and non-CHC users while controlling for sociodemographic correlates of health. Among CHC users, racial and ethnic minorities did not have worse health than whites, but among non-CHC users there were significant racial and ethnic disparities: whites experienced significantly healthier life than both blacks and non-white Hispanics. These findings persisted after controlling for sociodemographic correlates of health. The results indicate that while racial/ethnic disparities in health persist nationally, these disparities do not exist within CHCs, safety-net providers with an explicit mission to serve vulnerable populations.
Get full access to this article
View all access options for this article.
References
1.
SorlieP.Black-white mortality differences by family income. Lancet340: 346–350, 1992.
2.
AndersonR. M.GiachelloA. L., and AdayL. A.Access of Hispanics to health care and cuts in services: A state-of-the-art overview. Public Health Rep. 101: 238–252, 1986.
3.
WhittleJ.Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N. Engl. J. Med.329: 621–627, 1993.
4.
LieuT. A.NewacheckP. W., and McManusJ.Race, ethnicity, and access to ambulatory care among US adolescents. Am. J. Public Health83: 960–965, 1993.
5.
EscarceJ. J.Racial differences in the elderly use of medical procedures and diagnostic tests. Am. J. Public Health83: 939–941, 1993.
6.
WoolhandlerS.Medical care and mortality: Racial differences in preventable deaths. Int. J. Health Serv. 15: 1–11, 1985.
7.
MantonK. G.Health differentials between blacks and whites: Recent trends in mortality and morbidity. Milbank Q.65(Suppl.1): 129–199, 1987.
8.
CorneliusL. J., and AndersenR. M.Black-white differences in health status: Methods or substance. Milbank Q.65(Suppl.1): 72–99, 1987.
9.
CarlisleD. M.LeakeB. D., and ShapiroM. F.Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles county, 1986 through 1988. Am. J. Public Health85: 352–356, 1995.
10.
ZorattiF. M.Health service use by African Americans and Caucasians with asthma in a managed care setting. Am. J. Resp. Crit. Care Med. 158: 371–377, 1998.
11.
FichtenbaumR., and Gyimah-BrempongK.The effects of race on the use of physician's services. Int. J. Health Serv. 27: 139–156, 1997.
12.
BlendonR. J.Access to medical care for black and white Americans. JAMA261: 278–281, 1989.
13.
WennekerM. B., and EpsteinA. M.Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA261: 253–257, 1989.
14.
NickensH. W.The role of race/ethnic and social class in minority health status. Health Serv. Res.30: 151–162, 1995.
15.
BlusteinJ., and WeitzmanB. C.Access to hospitals with high-technology cardiac services: How is race important?Am. J. Public Health85: 345–351, 1995.
16.
NickensH. W.Race/ethnicity as a factor in health and health care. Health Serv. Res.30: 151–162, 1995.
17.
U.S. Department of Health and Human Services.Healthy People 2010 Objectives: Draft for Public Comment. U.S. Government Printing Office, Washington, D.C., September 15, 1998.
18.
AdayL. A., and AndersonR. M.The national profile of access to medical care: Where do we stand?Am. J. Public Health74: 1331, 1984.
19.
HaywardR. A.Regular source of ambulatory care and access to health services. Am. J. Public Health81: 434–438, 1990.
20.
LambrewJ. M.The effects of having a regular doctor on access to primary care. Med. Care34: 138–151, 1996.
21.
BarrettR. J.Endometrial cancer: Stage at diagnosis and associated factors in black and white patients. Am. J. Obstet. Gynecol.173: 414–423, 1995.
22.
SheaS.Correlates of nonadherence to hypertension treatment in an inner-city minority population. Am. J. Public Health82: 1607–1612, 1992.
23.
CorneliusL. J.Access to medical care for black Americans with an episode of illness. J. Natl. Med. Assoc.83: 617–626, 1991.
24.
LurieN.Termination from Medi-Cal: Does it affect health?JAMA252: 2413–2417, 1984.
25.
Institute of Medicine.Primary Care: America's Health in a New Era. National Academy Press, Washington, D.C., 1996.
26.
ForrestC. B., and WhelanE. M.Primary care safety-net providers in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices. Unpublished paper.
27.
PolitzerR.Inequality in America: Reducing and eliminating health status disparities. Unpublished paper.
28.
ReganJ.LefkowitzB., and GastonM.Cancer screening among community health center women: Eliminating the gaps. J. Ambulatory Care Manage. 22: 45–52, 1999.
29.
U.S. General Accounting Office.Community Health Centers: Challenges in Transitioning to Prepaid Managed Care. GAO/HEHS 95–138. Washington, D.C., April 1995.
30.
U.S. General Accounting Office.Community Health Centers: Adapting to Changing Health Care Environment Key to Continued Success. GAO/HEHS 00–39. Washington, D.C., March 2000.
31.
CarcagnoG. J.Community Health Center User and Visit Study Survey Methodology Report. Mathematica Policy Research, Princeton, N.J., August 29, 1997.
32.
JonesC. P.LaVeistT. A., and Lillie-BlantonM. L.‘Race’ in the epidemiologic literature: An examination, 1921–1990. Am. J. Epidemiol.134: 1079–1084, 1991.
33.
Office of Management and Budget.Director no. 15: Race and ethnic standards for federal statistics and administrative reporting. In Statistical Policy Handbook, 37–38. Office of Federal Statistics and Policy and Standards, U.S. Department of Commerce, Washington, D.C., 1978.
34.
ReiserS. J.The era of the patient: Using the experience of illness in shaping the missions of health care. JAMA269: 1012–1017, 1993.
35.
EricksonP.WilsonR., and ShannonI.Years of healthy life. Statistical Notes7: 1–14, 1995.
36.
PappasG.QueenS., and HaddenW.The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N. Engl. J. Med.329(2): 103–109, 1993.
37.
SchalickL. M.HaddenW. C., and PamukE.The widening gap in death rates among income groups in the United States from 1967 to 1986. Int. J. Health Serv. 30(1): 13–26, 2000.
38.
O'KeefeE.Equity, democracy and globalization. Crit. Public Health10(2): 167–177, 2000.
39.
WhiteisD. G.Poverty, policy, and pathogenesis: Economic justice and public health in the U.S.Crit. Public Health10(2): 257–271, 2000.
40.
WilliamsD. R., and RuckerT. D.Understanding and addressing racial disparities in health care. Health Care Financ. Rev.21(4): 75–90, 2000.
41.
FiscellaK.Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. JAMA283(19): 2579–2584, 2000.
42.
MossN.Socioeconomic disparities in health in the US: An agenda for action. Soc. Sci. Med.51: 1627–1638, 2000.
43.
LaVeistT. A.Beyond dummy variables and sample selection: What health services researchers ought to know about race as a variable. Health Serv. Res.29: 1–16, 1994.
44.
AndersonN. B.Macrosocial and environmental influences on minority health. Health Psychol. 14: 601–612, 1995.
45.
SchulmanK. A.The roles of race and socioeconomic factors in health services research. Health Serv. Res.30: 179–195, 1995.
