The vulnerability of middle-aged and older adults in a multiethnic, low-income area: contributions of age, ethnicity, and health insurance

Abstract

This community-partnered study was developed and fielded in partnership with key community stakeholders and describes age- and race-related variation in delays in care and preventive service utilization between middle-aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self-identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self-reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14-23) and problems obtaining needed medical care (APP=15%, 95% CI=12-20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33-56) and problems obtaining needed medical (APP=33%, 95% CI=22-45) and specialty care (APP=26%, 95% CI=16-39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.

Figure 1

Study Sample Note: The sample of 2,976 phone numbers was randomly selected from all listed household sample of phone numbers most likely to be within South Los Angeles zip codes. To be included in the survey, respondents had to be 50 years or older, had to identify themselves as African American or Latino, indicate a language preference of English or Spanish and be willing to complete the survey. Call attempts were made up to 15 times at different times of the day and different days of the week. All telephone numbers were classified into standard telephone survey categories, including known household, non-working numbers, fax lines, etc (See Supplement 1 for more details). Data collection was concluded after obtaining a 60% response rate. The survey was completed by 708 participants representing 55% of contacted telephone numbers. If eligibility rates were similar among participants we could not reach, the response rate among eligible participants would be 63% (7.1% refusal rate; 93% cooperation rate).