Family Perceptions of the Usual Source of Care among Children with Asthma by Race/Ethnicity, Language, and Family Income

Abstract

A usual source of care (USC) can serve as the foundation for good primary health care and is critical for children living with a chronic health condition. This study applies national data to the following objectives: (1) describe family reports of the presence and characteristics of the USC for children with asthma; (2) examine evidence of systematic differences in the USC for these children with asthma by race/ethnicity, English language proficiency in Hispanic respondents, and family income; and (3) conduct multivariate analysis adjusting for possible confounding factors to examine independent effects of race/ethnicity, language, and income. Data from the 1996–2000 Medical Expenditure Panel Survey (MEPS) were analyzed. Overall, 95% of children with asthma had a USC, with Spanish-speaking Hispanics least likely to report a USC (89%). There were significant differences in USC attributes by race/ethnicity, language, and income, with the largest differences by type of provider and accessibility. Hispanics with poor English language proficiency had the greatest accessibility barriers.

Keywords:

• asthma
• childhood
• usual source of care
• race/ethnicity
• language
• family income

Notes

¹Among Hispanic children, percent distribution of the unweighted sample was similar across language of interview by Hispanic origin category as represented by Mexican American, Puerto Rican, Cuban, and other Hispanic/Latin America: interviewed in English 62%, 24%, 3%, 11%; and interviewed in Spanish 60%, 19%, 6%, 16%, respectively.

²Poverty thresholds vary by family size and composition and are updated annually by the U.S. Bureau of the Census. For example, the average poverty threshold for a family of four in 1996 was $16,036 and was $17,603 in 2000 (http://www.census.gov/hhes/poverty/threshld.html). The variable indicating family income as a percent of the federal poverty level was created by MEPS for each year of this multi-year sample.

³Contrasting these children with asthma to the entire sample of children age 0–17 years in MEPS shows that children with asthma were generally more likely to report a USC (95% of children with asthma vs 91% of all children, results not in tables). There were also larger disparities in report of a USC by race-ethnicity-language and family income among all children than were found for children with asthma. Among all children in the pooled MEPS sample (n = 30,923), 72% of Spanish-speaking Hispanics had a USC, followed by 87% of English-speaking Hispanics, 88% of blacks, and 94% of whites. Similarly, considering all children in MEPS, children in families with lower incomes were less likely to report a USC (86%, 87%, 92% and 95%, respectively) than were children with asthma. Therefore, children with asthma were more likely to report a USC and had smaller disparities by race-ethnicity-language and family income than children overall.

⁴The success of programs to provide insurance to disadvantaged children with asthma should be noted. Contrasting these children with asthma to the entire sample of children age 0–17 in MEPS shows greater social disparities in the presence of any insurance among the entire sample. In the entire sample, fully 38% of Spanish-speaking Hispanics had no insurance at the interview, followed by 23% of English-speaking Hispanics, 16% of blacks, and 12% of whites. Disparities were also greater for the respective income groups: 22%, 25%, 13% and 0.1%, respectively.