Factors Associated with Health Insurance Status in an Asian American Population in New York City: Analysis of a Community-Based Survey
Immigrants comprise approximately 13% of the US population and 33% lack health coverage. Asian Americans are the fastest growing immigrant group; many lack a usual source of care. This study examines factors associated with health insurance among Asian American immigrants living in New York City.
Community needs assessments were conducted among Asian American subgroups in New York City from 2013 to 2015; analysis was completed in 2017 and 2018. Descriptive statistics examined factors associated with health insurance status while stratifying by Asian ethnic subgroup; multivariable logistic regression models further assessed these associations (p < 0.05 significance level).
Approximately 19% of the study population (n = 1399) was uninsured. Logistic regression models adjusted for all factors. Among East Asians, insurance status was associated with female sex (OR = 2.8, p = 0.005), excellent/very good health status (OR = 3.5, p = 0.014), and seeing a private doctor when sick or injured (OR = 3.2, p = 0.033). Among South Asians, insurance status was associated with high school/some college and college education (OR = 2.6 and 2.9, respectively, p = 0.039 and p = 0.021), having a routine health check in the past year (OR = 6.4, p < 0.001), no diabetes diagnosis (OR = 2.7, p = 0.030), and a tuberculosis diagnosis (OR = 4.7, p = 0.019). Among Southeast Asians, insurance status was associated with less than high school education (p < 0.05), living in the USA > 20 years (OR = 3.7, p = 0.009), having a routine health check in the past year (OR = 5.6, p = 0.025), and seeing a private doctor when sick or injured (OR = 2.6, p = 0.018).
Health insurance status was associated with differing factors among each subgroup. Findings may inform strategies to address challenges and barriers of healthcare access to immigrants, making healthcare more accessible to this underserved population.
KeywordsHealth disparity research Racial/ethnic minority Health insurance Asian Americans Immigrants
This publication is supported in part by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands Initiative, the National Institutes of Health–National Institute on Minority Health and Health Disparities award number U54MD000538, and the National Center for Advancing Translational Sciences award number UL1TR001445. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.U.S. Census Bureau. Characteristics of the U.S. population by generational status: 2013. 2016. https://www.census.gov/content/dam/Census/library/publications/2016/demo/P23-214.pdf. Accessed 7 Dec 2017.
- 2.U.S. Census Bureau 2013 American Community Survey 1-Year Estimates. Selected population profile in the United States. 2013. https://factfinder.census.gov/bkmk/table/1.0/en/ACS/16_1YR/S0201/0100000US. Accessed 7 Dec 2017.
- 3.The Pew Research Center. Key facts about Asian Americans, a diverse and growing population. 2017. http://www.pewresearch.org/fact-tank/2017/09/08/key-facts-about-asian-americans/. Accessed 7 Dec 2017.
- 7.Islam NS, Khan S, Kwon S, Jang D, Ro M, Trinh-Shevrin C. Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J Health Care Poor Underserved. 2010;21(4):1354–81. https://doi.org/10.1353/hpu.2010.0939. PubMedPubMedCentralGoogle Scholar
- 8.Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. 2015 Contract No.: December 7, 2017.Google Scholar
- 11.Bustamante AV, Van der Wees PJ. Integrating immigrants into the U.S. health system. Virtual Mentor. 2012;14(4):318–23. https://doi.org/10.1001/virtualmentor.2012.14.4.stas1-1204.CrossRefPubMedGoogle Scholar
- 13.Ku L. New opportunities to increase legal immigrants’ health insurance coverage. In: The Commonwealth Fund Blog, editor. 2013.Google Scholar
- 15.NYC Human Resources Administration Department of Social Services. Guide to heatlh insurance and health care services for immigrants in New York City. 2016. https://www1.nyc.gov/assets/ochia/downloads/pdf/guide-to-health-insurance-for-immigrants.pdf. Accessed 8 Feb 2018.
- 16.U.S. Census Bureau. Selected population profile in the United States community survey 1-year estimates. 2010-2016. https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml. Accessed 8 Dec 2017.
- 36.Woolhandler S, Himmelstein DU. The “Cadillac Tax” on health benefits in the United States will hit the middle class hardest: refuting the myth that health benefit tax subsidies are regressive. Int J Health Serv. 2016;46(2):325–30. https://doi.org/10.1177/0020731416637163.CrossRefPubMedGoogle Scholar
- 41.Barnes PM, Adams PF, Powell-Griner E. Health characteristics of the Asian adult population: United States, 2004-2006. Adv Data. 2008;(394):1–22.Google Scholar
- 42.Centers for Disease Control and Prevention, AARP, American Medical Association. Promoting preventive services for adults 50–64: community and clinical partnerships. National Association of Chronic Disease Directors, Atlanta, GA. 2009. https://www.cdc.gov/aging/pdf/promoting-preventive-services.pdf.