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Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA

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Abstract

Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011–2012 National Survey of Children’s Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such as clinics, and hospital outpatient departments, instead of pediatric physician’s offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician’s offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician’s offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.

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References

  1. Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966–2007. Prev Chronic Dis. 2009;6:10.

    Google Scholar 

  2. Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: a review of food deserts literature. Health Place. 2010;16:876–84. https://doi.org/10.1016/j.healthplace.2010.04.013.

    Article  PubMed  Google Scholar 

  3. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117:417–24. https://doi.org/10.1542/peds.2005-0058.

    Article  PubMed  Google Scholar 

  4. Anderson KF. Racial residential segregation and the distribution of health-related organizations in urban neighborhoods. Soc Probl. 2017;64:256–76. https://doi.org/10.1093/socpro/spw058.

    Article  Google Scholar 

  5. Dai D. Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health Place. 2010;16:1038–52. https://doi.org/10.1016/j.healthplace.2010.06.012.

    Article  PubMed  Google Scholar 

  6. Dinwiddie GY, Gaskin DJ, Chan KS, Norrington J, McCleary R. Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health. Soc Sci Med. 2013;80:67–75. https://doi.org/10.1016/j.socscimed.2012.11.024.

    Article  PubMed  Google Scholar 

  7. White K, Haas JS, Williams DR. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res. 2012;47:1278–99. https://doi.org/10.1111/j.1475-6773.2012.01410.x.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gaskin DJ, Dinwiddie GY, Chan KS, McCleary RR. Residential segregation and the availability of primary care physicians. Health Serv Res. 2012;47:2353–76. https://doi.org/10.1111/j.1475-6773.2012.01417.x.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hayanga AJ, Kaiser HE, Sinha R, Berenholtz SM, Makary M, Chang D. Residential segregation and access to surgical care by minority populations in US counties. J Am Coll Surg. 2009;208:1017–22. https://doi.org/10.1016/j.jamcollsurg.2009.01.047.

    Article  PubMed  Google Scholar 

  10. Anderson KF. Residential segregation, neighborhood health care organizations, and children’s health care utilization: the case of the Phoenix Urbanized Area. City & Community. 2020;19:771–801.

  11. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404–16. https://doi.org/10.1016/s0033-3549(04)50068-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Anderson KF, Fullerton AS. Residential segregation, health, and health care: answering the Latino question. Race Soc Probl. 2014;6:262–79. https://doi.org/10.1007/s12552-014-9125-2.

    Article  Google Scholar 

  13. Chang VW. Racial residential segregation and weight status among US adults. Soc Sci Med. 2006;63:1289–303. https://doi.org/10.1016/j.socscimed.2006.03.049.

    Article  PubMed  Google Scholar 

  14. Do DP, Frank R, Iceland J. Black-white metropolitan segregation and self-rated health: investigating the role of neighborhood poverty. Soc Sci Med. 2017;187:85–92. https://doi.org/10.1016/j.socscimed.2017.06.010.

    Article  PubMed  Google Scholar 

  15. Ellen IG, Cutler DM, Dickens W. Is segregation bad for your health?: the case of low birth weight. Brookings-Wharton Papers on Urban Affairs. 2000;1:203–38. https://doi.org/10.1353/urb.2000.0002.

    Article  Google Scholar 

  16. Hart KD, Kunitz SJ, Sell RR, Mukamel DB. Metropolitan governance, residential segregation, and mortality among African Americans. Am J Public Health. 1998;88:434–8. https://doi.org/10.2105/ajph.88.3.434.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch SM. Residential segregation and Latino, Black and White mortality in New York City. J Urban Health-Bull N Y Acad Med. 2006;83:406–20. https://doi.org/10.1007/s11524-006-9035-8.

    Article  Google Scholar 

  18. Polednak AP. Segregation, poverty, and mortality in urban African Americans. New York: Oxford University Press; 1997.

    Google Scholar 

  19. Subramanian SV, Acevedo-Garcia D, Osypuk TL. Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis. Soc Sci Med. 2005;60:1667–79. https://doi.org/10.1016/j.socscimed.2004.08.040.

    Article  CAS  PubMed  Google Scholar 

  20. Berkowitz RL, Mujahid M, Pearl M, Poon V, Reid CK, Allen AM. Protective places: the relationship between neighborhood quality and preterm births to Black women in Oakland, California (2007–2011). J Urban Health. 2022;99:492–505. https://doi.org/10.1007/s11524-022-00624-8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Planey AM, Grady SC, Fetaw R, McLafferty SL. Spaces of segregation and health: complex associations for black immigrant and US-born mothers in New York City. J Urban Health. 2022;99:469–81. https://doi.org/10.1007/s11524-022-00634-6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Algert SJ, Agrawal A, Lewis DS. Disparities in access to fresh produce in low-income neighborhoods in Los Angeles. Am J Prev Med. 2006;30:365–70. https://doi.org/10.1016/j.amepre.2006.01.009.

    Article  PubMed  Google Scholar 

  23. Evans A, Banks K, Jennings R, Nehme E, Nemec C, Sharma S, Hussaini A, Yaroch A. Increasing access to healthful foods: a qualitative study with residents of low-income communities. Int J Behav Nutr Phys Act. 2015;12:S5. https://doi.org/10.1186/1479-5868-12-S1-S5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Havewala F. The dynamics between the food environment and residential segregation: an analysis of metropolitan areas. Food Policy. 2021;103:102015. https://doi.org/10.1016/j.foodpol.2020.102015.

    Article  Google Scholar 

  25. Lovasi GS, Johnson NJ, Altekruse SF, Hirsch JA, Moore KA, Brown JR, Rundle AG, Quinn JW, Neckerman K, Siscovick DS. Healthy food retail availability and cardiovascular mortality in the United States: a cohort study. BMJ Open. 2021;11:e048390. https://doi.org/10.1136/bmjopen-2020-048390.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96:325–31. https://doi.org/10.2105/AJPH.2004.058040.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Morland K, Wing S, Roux AD. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92:1761–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cooksey-Stowers K, Schwartz M, Brownell KD. Food swamps predict obesity rates better than food deserts in the United States. Int J Environ Res Public Health. 2017;14(11):1366. https://doi.org/10.3390/ijerph14111366.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ekenga CC, Tian R. Promoting food equity in the context of residential segregation. Environ Justice. 2021;15:346–51. https://doi.org/10.1089/env.2021.0029.

    Article  Google Scholar 

  30. Estabrooks PA, Lee RE, Gyurcsik NC. Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med. 2003;25:100–4. https://doi.org/10.1207/s15324796abm2502_05.

    Article  PubMed  Google Scholar 

  31. Dahmann N, Wolch J, Joassart-Marcelli P, Reynolds K, Jerrett M. The active city? Disparities in provision of urban public recreation resources. Health Place. 2010;16:431–45. https://doi.org/10.1016/j.healthplace.2009.11.005.

    Article  PubMed  Google Scholar 

  32. Duncan DT, Aldstadt J, Whalen J, White K, Castro MC, Williams DR. Space, race, and poverty: spatial inequalities in walkable neighborhood amenities? Demogr Res. 2012;S13:409–48.

    Article  Google Scholar 

  33. Moore LV, Roux AVD, Evenson KR, McGinn AP, Brines SJ. Availability of recreational resources in minority and low socioeconomic status areas. Am J Prev Med. 2008;34:16–22. https://doi.org/10.1016/j.amepre.2007.09.021.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Namin S, Xu W, Zhou Y, Beyer K. The legacy of the Home Owners’ Loan Corporation and the political ecology of urban trees and air pollution in the United States. Soc Sci Med. 2020;246:112758. https://doi.org/10.1016/j.socscimed.2019.112758.

    Article  CAS  PubMed  Google Scholar 

  35. Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, wealth, and health care utilization: a geographic assessment. J Urban Health. 2012;89:828–47. https://doi.org/10.1007/s11524-012-9689-3.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Gaskin DJ, Price A, Brandon DT, LaVeist TA. Segregation and disparities in health services use. Med Care Res Rev. 2009;66:578–89. https://doi.org/10.1177/1077558709336445.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mayfield CA, de Hernandez BU, Geraci M, Eberth JM, Dulin M, Merchant AT. Residential segregation and emergency department utilization among an underserved urban emergency department sample in North Carolina. N C Med J. 2022;83:48–57. https://doi.org/10.18043/ncm.83.1.48.

    Article  PubMed  Google Scholar 

  38. Thomas-Hawkins C, Flynn L, Zha P, Savage B. Associations among race, residential segregation, community income, and emergency department use by adults with end-stage renal disease. Public Health Nurs. 2019;36:645–52. https://doi.org/10.1111/phn.12644.

    Article  PubMed  Google Scholar 

  39. Caldwell JT, Ford CL, Wallace SP, Wang MC, Takahashi LM. Racial and ethnic residential segregation and access to health care in rural areas. Health Place. 2017;43:104–12. https://doi.org/10.1016/j.healthplace.2016.11.015.

    Article  PubMed  Google Scholar 

  40. Anderson KF. Racial residential segregation and the distribution of auxiliary health care practitioners across urban space. Res Sociol Health Care. 2017;35:145–67.

    Article  Google Scholar 

  41. Anderson KF. Racial/ethnic residential segregation, the distribution of physician’s offices and access to health care: the case of Houston, Texas. Soc Sci. 2018;7:119.

    Article  Google Scholar 

  42. Archibald ME, Putnam Rankin C. A spatial analysis of community disadvantage and access to healthcare services in the U.S. Soc Sci Med. 2013;90:11–23. https://doi.org/10.1016/j.socscimed.2013.04.023.

    Article  PubMed  Google Scholar 

  43. Gaskin DJ, Dinwiddie GY, Chan KS, McCleary R. Residential segregation and disparities in health care services utilization. Med Care Res Rev. 2012;69:158–75. https://doi.org/10.1177/1077558711420263.

    Article  PubMed  Google Scholar 

  44. Ko M, Ponce NA. Community residential segregation and the local supply of federally qualified health centers. Health Serv Res. 2013;48:253–70. https://doi.org/10.1111/j.1475-6773.2012.01444.x.

    Article  PubMed  Google Scholar 

  45. Allard SW, Tolman RM, Rosen D. Proximity to service providers and service utilization among welfare recipients: the interaction of place and race. J Policy Anal Manage. 2003;22:599–613. https://doi.org/10.1002/pam.10157.

    Article  PubMed  Google Scholar 

  46. Allard SW, Rosen D, Tolman RM. Access to mental health and substance abuse services among women receiving welfare in Detroit. Urban Affairs Rev. 2003;38:787–807. https://doi.org/10.1177/1078087403038006002.

    Article  Google Scholar 

  47. Fortney J, Rost K, Zhang M, Warren J. The impact of geographic accessibility on the intensity and quality of depression treatment. Med Care. 1999;37(9):884–93. https://doi.org/10.1097/00005650-199909000-00005.

    Article  CAS  PubMed  Google Scholar 

  48. Fortney JC, Booth BM, Blow FC, Bunn JY, Loveland Cook CA. The effects of travel barriers and age on the utilization of alcoholism treatment aftercare. Am J Drug Alcohol Abuse. 1995;21:391–406. https://doi.org/10.3109/00952999509002705.

    Article  CAS  PubMed  Google Scholar 

  49. Goodman DC, Fisher E, Stukel TA, Chang C. The distance to community medical care and the likelihood of hospitalization: is closer always better? Am J Public Health. 1997;87:1144–50. https://doi.org/10.2105/ajph.87.7.1144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Starfield B. Measuring the uniqueness of primary care. J Ambul Care Manage. 1979;2:91–9.

    CAS  PubMed  Google Scholar 

  52. Starfield BH. Primary care in the United States. Int J Health Serv. 1986;16:179–98.

    Article  CAS  PubMed  Google Scholar 

  53. Valderas JM, Starfield BH, Forrest CB, Sibbald B, Roland M. Ambulatory care provided by office-based specialists in the United States. Ann Fam Med. 2009;7:104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Mehrotra A, Wang MC, Lave JR, Adams JL, McGlynn EA. Retail clinics, primary care physicians, and emergency departments: a comparison of patients’ visits. Health Aff. 2008;27:1272–82. https://doi.org/10.1377/hlthaff.27.5.1272.

    Article  Google Scholar 

  55. Weiner JP, Starfield BH. Measurement of the primary care roles of office-based physicians. Am J Public Health. 1983;73(6):666–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Valderas JM, Starfield BH, Forrest CB, Rajmil L, Roland M, Sibbald B. Routine care provided by specialists to children and adolescents in the United States (2002–2006). BMC Health Serv Res. 2009;9:221–221.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Massey DS, Denton NA. The dimensions of residential segregation. Soc Forces. 1988;67:281–315. https://doi.org/10.2307/2579183.

    Article  Google Scholar 

  58. Reardon SF, O’Sullivan D. Measures of spatial segregation. Sociol Methodol. 2004;34:121–62.

    Article  Google Scholar 

  59. Roberto E. The spatial proximity and connectivity method for measuring and analyzing residential segregation. Sociol Methodol. 2018;48:182–224. https://doi.org/10.1177/0081175018796871.

    Article  Google Scholar 

  60. Anselin L. Local indicators of spatial association—LISA. Geogr Anal. 1995;27:93–115. https://doi.org/10.1111/j.1538-4632.1995.tb00338.x.

    Article  Google Scholar 

  61. Anselin L, Florax RJGM, Rey SJ. Advances in spatial econometrics : methodology, tools and applications. Berlin: Springer-Verlag; 2004.

    Book  Google Scholar 

  62. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918–24. https://doi.org/10.1126/science.277.5328.918.

    Article  CAS  PubMed  Google Scholar 

  63. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks, CA: SAGE Publications; 2002.

    Google Scholar 

  64. Anderson KF. Residential segregation and health outcomes in the United States: moving beyond Black and White. Popul Rev. 2016;55:45–74.

    Google Scholar 

  65. Walton E. Resurgent ethnicity among Asian Americans: ethnic neighborhood context and health. J Health Soc Behav. 2012;53:378–94. https://doi.org/10.1177/0022146512455426.

    Article  PubMed  Google Scholar 

  66. Satcher LA. (Un) Just deserts: examining resource deserts and the continued significance of racism on health in the urban south. Sociol Race Ethn. 2022;8:483–502. https://doi.org/10.1177/23326492221112424.

    Article  Google Scholar 

  67. Ma A, Sanchez A, Ma M. The impact of patient-provider race/ethnicity concordance on provider visits: updated evidence from the medical expenditure panel survey. J Racial Ethn Health Disparities. 2019;6:1011–20. https://doi.org/10.1007/s40615-019-00602-y.

    Article  CAS  PubMed  Google Scholar 

  68. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older Black and White adults. Am J Public Health. 2009;99:1293–9.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Nazione S, Perrault EK, Keating DM. Finding common ground: can provider-patient race concordance and self-disclosure bolster patient trust, perceptions, and intentions? J Racial Ethn Health Disparities. 2019;6:962–72. https://doi.org/10.1007/s40615-019-00597-6.

    Article  PubMed  Google Scholar 

  70. Brown TN, Ueno K, Smith CL, Austin NS, Bickman L. Communication patterns in medical encounters for the treatment of child psychosocial problems: does pediatrician–parent concordance matter? Health Commun. 2007;21:247–56. https://doi.org/10.1080/10410230701307717.

    Article  PubMed  Google Scholar 

  71. Gibbons J. The effect of segregated cities on ethnoracial minority healthcare system distrust. City Community. 2019;18:321–43. https://doi.org/10.1111/cico.12370.

    Article  Google Scholar 

  72. Gibbons J, Yang T-C. Searching for silver linings: is perceived medical discrimination weaker in segregated areas? Appl Spat Anal Policy. 2018;11:37–58. https://doi.org/10.1007/s12061-016-9211-5.

    Article  PubMed  Google Scholar 

  73. Morenoff JD, House JS, Hansen BB, Williams DR, Kaplan GA, Hunte HE. Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context. Soc Sci Med. 2007;65:1853–66. https://doi.org/10.1016/j.socscimed.2007.05.038.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Saunders MR, Lee H, Maene C, Schuble T, Cagney KA. Proximity does not equal access: racial disparities in access to high quality dialysis facilities. J Racial Ethn Health Disparities. 2014;1:291–9. https://doi.org/10.1007/s40615-014-0036-0.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Support for this study was provided through the Sociology Program of the National Science Foundation (SES-2147450), project title: racial/ethnic residential segregation, health-promoting organizations, and health-related outcomes in the USA; PI: Kathryn Freeman Anderson. Additional support was provided by the Grants to Enhance Research on Racism program at the University of Houston.

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  1. Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA

    Kathryn Freeman Anderson & Caroline Wolski

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  1. Kathryn Freeman Anderson
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All authors contributed to the study conception and design. Material preparation and data analysis were performed by Anderson. Literature review was performed by Wolski. The first draft of the manuscript was written by Anderson, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kathryn Freeman Anderson.

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Anderson, K.F., Wolski, C. Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01766-4

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