Utilization of Healthcare Among Asian Origin Groups and Citizenship Status

Milkie Vu; Mary K Nielson; Lilian N Bui; Loretta Hsueh; Chi B Vu; Meng-Han Tsai

doi:10.1007/s11606-025-10066-y

Utilization of Healthcare Among Asian Origin Groups and Citizenship Status

J Gen Intern Med. 2025 Dec 2. doi: 10.1007/s11606-025-10066-y. Online ahead of print.

Authors

Milkie Vu^{1

2}, Mary K Nielson¹, Lilian N Bui¹, Loretta Hsueh³, Chi B Vu¹, Meng-Han Tsai^{4

5}

Affiliations

¹ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
² Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
³ Department of Psychology, University of Illinois Chicago, Chicago, IL, USA.
⁴ Georgia Prevention Institute, Augusta University, Augusta, GA, USA. metsai@augusta.edu.
⁵ Georgia Cancer Center, Augusta University, Augusta, GA, USA. metsai@augusta.edu.

PMID: 41331202
DOI: 10.1007/s11606-025-10066-y

Abstract

Background: Citizenship status may be a barrier to engaging in preventive care, especially among Asian origin groups.

Objective: This study examines differences in annual healthcare utilization among six different Asian-origin groups and whether these differences are influenced by citizenship status.

Design: We conducted a cross-sectional analysis of data from the 2013-2022 California Health Interview Survey.

Participants: Respondents aged 18 and older.

Main measures: The primary exposures were disaggregated Asian-origin groups (Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and others) and citizenship status (U.S.-born, naturalized citizen, non-citizen). The outcome variable was annual healthcare utilization (yes or no). Weighted multivariable logistic regression was used to examine these associations.

Key results: Among the 214,684 eligible participants, Korean respondents showed the lowest prevalence of annual healthcare utilization (76%) among Asian origin groups. U.S.-born (71.8%) and non-citizen Korean (65.5%) respondents also had the lowest rates of annual healthcare utilization. In adjusted analyses, non-citizens had a 14% lower odds of annual healthcare utilization than U.S.-born respondents. Chinese and Korean respondents had lower odds of annual healthcare utilization compared with Hispanic/Latino respondents, with lower odds ranging from 27 to 34% (p < 0.05 for all groups). Finally, naturalized citizens who were Chinese, Korean, or categorized as "other Asian," and non-citizens Chinese respondents, had 29-48% lower odds of annual healthcare utilization (p < 0.05 for all groups).

Conclusions: A lower odds of annual healthcare utilization was observed among Chinese and Korean respondents, particularly among naturalized citizens and non-citizens. This study highlights the importance of disaggregating data by Asian origin group and considering citizenship status as a key factor associated with annual healthcare utilization.