Panel Paper:
Racial and Ethnic Disparities in Health and Access to Care: A Role for Neighborhood Quality? (Panel version)
*Names in bold indicate Presenter
Methods: This study will use data from the Health Reform Monitoring Survey (HRMS), an internet-based survey of about 7,500 non-elderly adults each period. We will combine data through the March 2017 survey (available in April 2017) to examine racial and ethnic gaps in poor physical and mental health days, self-reported health, uninsurance, and having a usual source of care, having a routine checkup in the past 12 months, and having any problem accessing care in the past 12 months. We will use newly-available data on perceived overall neighborhood quality from the HRMS combined with American Community Survey data on neighborhood characteristics to measure neighborhood quality. We will conduct Oaxaca-Blinder decomposition to examine the contribution of each group of variables (health conditions, socioeconomic status, and neighborhood quality) in explaining racial and ethnic gaps in health outcomes and access to care.
Results: Preliminary results on the currently available data indicate that gaps in uninsurance between Hispanic adults, black non-Hispanic adults, and white non-Hispanic adults were well explained by differences in SES, and neighborhood quality differences did not contribute significantly to the explained portion of these gaps. However, neighborhood quality plays more of a role in explaining racial and ethnic differences in health status and measures of access to health care, including having a usual source of care and a routine check-up.
Conclusions: Preliminary results from earlier data suggest that neighborhood quality does play a role in explaining racial and ethnic gaps in health outcomes and access to care. Future research using the forthcoming March 2017 data, which will expand our sample size by 50 percent, will explore these gaps in more detail, expanding our neighborhood quality characteristics and exploring the overlap between individual SES and neighborhood quality.
Many policies and practices to address the social determinants of health have, to date, focused on neighborhood quality factors like housing affordability and quality, walkability, access to healthy food, access to transportation, and social cohesion. One important goal of these initiatives is to improve health equity. The results of this study will shed light on the extent to which racial and ethnic gaps in health outcomes and access to care relate to differences in neighborhood quality, broadening our understanding of the possible effects - and possible limits - of neighborhood quality improvements on health.
