The Other US Border: Health Insurance Coverage Among Latino Immigrants In Puerto Rico

Cross-Sectional Study of Emergency Room Visits Among Hispanic Immigrants by Country of Origin

OBJECTIVE

Hispanic immigrant populations from different areas of origin vary greatly in terms of demographic and economic factors. Studying differences in emergency department (ED) use is critical to understanding unmet needs for urgent medical attention. This study aims to uncover if individuals from different Hispanic backgrounds spend more money in the ED and suggest ways to mitigate these differences.

METHODS

This cross-sectional study used the 2020 Medical Expenditure Panel Survey that collects information on ED expenditure among Hispanic adults born off the mainland USA aged 18 and above (N = 1838). We examined the association between four areas of origin (Mexico, Cuba, Puerto Rico, and the Dominican Republic) and two outcomes, including the number of ED visits per person and average expenditure. Survey-weighted multivariable regression models were conducted to evaluate how average expenditure varied by area of origin.

RESULTS

The results show that Dominicans spent $474.84 more than Mexicans per ED visit (p = 0.044). Dominicans spent the most out of the four origins, costing a total of $534.13. Average expenditures for Mexicans were negatively associated with speaking a different language than English and having a master's degree. For Puerto Ricans born on the island, average expenditures were negatively associated with low incomes (p = 0.044). Additionally, the average spending for Dominicans was negatively associated with living in the Midwest (p = 0.006).

CONCLUSION

This study demonstrates intra-ethnic differences in ED expenditures among Hispanic populations. Disaggregating data related to Hispanics is essential for identifying at-risk communities in which social outreach and preventative medicine initiatives can be targeted to prevent these differences.

HIGHLIGHTS

1. This study identifies intra-group differences among immigrants from four Latin American countries/territories in terms of ED utilization and usage, an area that was previously limited in the current literature. 2. While Puerto Ricans had the highest number of visits per person, Dominicans spent the most in the ED and is mediated by their higher education and residency in Northeast areas. 3. Because ED utilization is a key data point for the health of a population, this study illustrates new information that can better help emergency medicine physicians and educators to train front line health workers and understand the population they take care of.

The association of maternal country/region of origin and nativity with infant mortality rate among Hispanic preterm infants

OBJECTIVES

Among US-born preterm infants of Hispanic mothers, we analyzed the unadjusted and adjusted infant mortality rate (IMR) by country/region of origin and maternal nativity status.

STUDY DESIGN

Using linked national US birth and death certificate data (2005-2014), we examined preterm infants of Hispanic mothers by subgroup and nativity. Clinical and sociodemographic covariates were included and the main outcome was death in the first year of life.

RESULTS

In our cohort of 891,216 preterm Hispanic infants, we demonstrated different rates of infant mortality by country and region of origin, but no difference between infants of Hispanic mothers who were US vs. foreign-born.

CONCLUSION

These findings highlight the need to disaggregate the heterogenous Hispanic birthing population into regional and national origin groups to better understand unique factors associated with adverse perinatal outcomes in order to develop more targeted interventions for these subgroups.