Health care disparities in Buffalo, New York: The intersections of individual and community level factors
Niewczyk, Paulette Marie
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Race, socioeconomic status (SES), and place/area of residence have been identified in sociological research as contributing to health disparities. Because individual level variables alone do not account for the complex factors contributing to socioeconomic and racial inequalities in health care, this research used a mixed method approach to incorporate both individual and community level variables contributing to health care disparities. There are four aims for this research: (1) To investigate individual level factors contributing to health care disparities; (2) To test whether the diminishing returns theory applies to health care disparities; (3) To investigate the role of community level factors, specifically whether racial residential segregation is associated with health care disparities; (4) To understand perspectives of community members related to barriers to health care that contribute to health care disparities. Data are from a cross-sectional, strategic random sample of 1669 City of Buffalo households; US Census 2000 SF3 data; address locations of health care facilities in the Buffalo, New York area, and semi-structured, qualitative interviews of a purposive sample of Buffalo community residents. Analytical techniques include hierarchical logistic regression, multi-level modeling and Geographic Information Systems (GIS) mapping. The main study findings are: (1) Individuals with higher SES and who were white were more likely to have a medical home. (2) Controlling for SES, area of residence, and insurance coverage, minorities were less likely to have a medical home than whites. (3) Racial residential segregation was a contributing factor to having a medical home. (4) Barriers in access to health care reported by interviewees from the qualitative component support the quantitative findings that both individual and structural (community) level components such as low SES, minority race, age and gender, and low community level SES and racial residential segregation contribute to a decreased likelihood of reporting a medical home. In low income, highly racially segregated areas, residents were less likely to report having a medical home even when individual level factors---often regarded as determinant, like race and income---were controlled for in statistical models. Relative abandonment of private sector health care professionals from highly segregated, poor urban communities, despite the presence of a large, dense patient base, was demonstrated by GIS mapping. This research finding suggests a multi-tier health care system, which means many individuals may be receiving disjointed care associated with lack of having a medical home. Health care system restructuring resulting in access to basic health services would aid in reducing health and health care disparities.