Arturo Vargas Bustamante

Black Americans experience the highest prevalence of heart failure (HF) and the worst clinical outcomes of any racial or ethnic group, but little is known about end-of-life care for this population. Researchers compare treatment intensity between Black and white older adults with HF near the end of life. They compared four common measures of treatment intensity at the end of life (number of hospital admissions, receipt of care in an intensive care unit (ICU), utilization of life support, and whether the decedent died in a hospital) between Black and white HF patients, controlling for demographic, social, and health characteristics.

Findings: Racial identity was not significantly associated with the number of hospital admissions or admission to an ICU in the last 24 months of life. However, Black HF patients were more likely to spend time on life support and more likely to die in a hospital than white HF patients. Thoughtful and consistent engagement with HF patients regarding treatment preferences is an important step in addressing inequities.
 

Summary: The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and U.S.-born Latinos and non-Latino whites. This study examined whether the paradox holds after accounting for health care access and utilization.

Researchers used 2019–2020 National Health Interview Survey data. The main predictors included population groups of foreign-born and U.S.-born Latinos (Mexican or non-Mexican) versus U.S.-born non-Latino whites. 

Findings: After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than U.S.-born non-Latino whites, except overweight/obesity and diabetes. U.S.-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than U.S.-born non-Latino whites.

In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Read the Publications:

• Journal Article: Health Care Access and Utilization and the Latino Health Paradox
   

Summary: Authors examine the short-term implementation lessons from the Medi-Cal expansion to adults ages 50 and older a year after its implementation to inform the planned expansion of full-scope Medi-Cal to adults 26 to 49 years of age in 2024. They also identify policy options to address undocumented immigrant adults ages 50 and over who will continue to be ineligible for Medi-Cal coverage because their incomes exceed the 138% FPL eligibility threshold.

Data from the 2018 to 2020 California Health Interview Survey (CHIS) data was used in this study.

Findings: Authors identified three domains that provide lessons for the 2024 expansion of full-scope Medi-Cal: access to technology, language barriers, and immigration status. Authors recommended policies, including implementation of the recently approved expansion of Medi-Cal eligibility to all low-income residents regardless of immigration status; utilization of government and community-based partnerships to address technological, linguistic, and immigration barriers; and allowing undocumented immigrants with incomes above 138% of FPL to purchase subsidized health coverage through Covered California.

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• Report: Implementation Lessons From The 2022 Medi-Cal Expansion To Undocumented Adults Aged Fifty And Above

Summary: This study examined the association between food insecurity and health insurance coverage, access to care, health care utilization, and financial hardships among U.S. adults.

Authors employed a retrospective longitudinal cohort study design using panel data from the 2016–2017 Medical Expenditure Panel Survey. Linear probability models were used to examine the association between food insecurity in one year and outcomes of interest (health insurance coverage, access to care, health care utilization, and financial hardships) in the subsequent year. 

Findings: Food insecurity was associated with higher uninsured rates and lower private coverage rates as well as lower access to care, including delay in receiving necessary medical care and delay in obtaining necessary prescription drugs. Those experiencing food insecurity also had a higher rate of emergency room visits, whereas associations with inpatient, outpatient, and prescription drug use were not significant. Food insecurity was linked to greater financial hardships, such as experiencing difficulties paying medical bills.

These findings highlight the adverse consequences of food insecurity on access to and affordability of care for U.S. adults and families. Food insecurity can have far-reaching implications for the well-being of individuals and families.

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• Journal Article: Adverse Consequences of Food Insecurity Among U.S. Adults Beyond Health Outcomes