Modifiable determinants of healthcare utilization within the African-American population

George Rust, MD, MPH; George E. Fryer, MSW, PhD; Robert L. Phillips, Jr., MD, MSPH; Elvan Daniels, MD; Harry Strothers, MD, MMM; and David Satcher, MD, PhD

BACKGROUND: Significant health disparities directly affect the African-American population. Most previous studies of disparities in access to and utilization of health care have focused on black-white differences rather than focusing on “within-group” analysis of African-Americans. OBJECTIVE: To tease out the differential effects of modifiable risk factors (such as health insurance, usual source of care, and poverty) from personal characteristics (age, gender, rural residence) on health care utilization within the African-American population. METHODS: Secondary data analysis of 3,462 records from African-American respondents to the 1999 Medical Expenditure Panel Survey (MEPS) Household File, a nationally-representative survey of the civilian, non-institutionalized U.S. population in 1999. RESULTS: We found significant variation in the number of office visits, outpatient clinic visits, hospital discharges, days hospitalized, and fills of prescribed medication among 3,462 African-American respondents, who represent a U.S. population of 36,538,639 persons. Personal non-modifiable characteristics such as age and gender were significantly related to health care utilization. Poverty and rural residence were also significantly correlated, but the strongest modifiable predictors of health care utilization for African-American persons in 1999 were whether or not individuals had health insurance and/or a usual source of care. Emergency department visits were the only form of care that showed remarkably little variation based on these modifiable risk factors. CONCLUSIONS: The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients, and could be independently targeted for intervention

Rust G, Fryer GE, Phillips RL, Daniels E, Strothers H, Satcher D. Modiafiable determinants of healthcare utilization within the African-American poulation. JNMA 2004;96:1169-1177.