Barriers to care and comorbidities along the U.S.-Mexico border

Hendrik de Heer, Hector Guillermo Balcázar, Osvaldo F. Morera, Lisa Lapeyrouse, Josiah McC Heyman, Jennifer Salinas, Ruth E. Zambrana

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective. While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities. Methods. We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009-2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions. Results. Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7% of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR53.65, 95% confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR51.71, 95% CI 1.10, 2.66, p50.017), being confused about arrangements (OR51.82, 95% CI 1.04, 3.21, p50.037), and not being treated with respect in medical settings (OR51.63, 95% CI 1.05, 2.53, p50.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers. Conclusion. A substantial proportion of adults reported comorbidities. Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.

Original languageEnglish (US)
Pages (from-to)480-488
Number of pages9
JournalPublic Health Reports
Volume128
Issue number6
StatePublished - Nov 2013

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Mexico
Comorbidity
Confidence Intervals
Health
Demography
Health Insurance
Health Surveys
Research
Cross-Sectional Studies
Odds Ratio
Delivery of Health Care
Costs and Cost Analysis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

de Heer, H., Balcázar, H. G., Morera, O. F., Lapeyrouse, L., Heyman, J. M., Salinas, J., & Zambrana, R. E. (2013). Barriers to care and comorbidities along the U.S.-Mexico border. Public Health Reports, 128(6), 480-488.

Barriers to care and comorbidities along the U.S.-Mexico border. / de Heer, Hendrik; Balcázar, Hector Guillermo; Morera, Osvaldo F.; Lapeyrouse, Lisa; Heyman, Josiah McC; Salinas, Jennifer; Zambrana, Ruth E.

In: Public Health Reports, Vol. 128, No. 6, 11.2013, p. 480-488.

Research output: Contribution to journalArticle

de Heer, H, Balcázar, HG, Morera, OF, Lapeyrouse, L, Heyman, JM, Salinas, J & Zambrana, RE 2013, 'Barriers to care and comorbidities along the U.S.-Mexico border', Public Health Reports, vol. 128, no. 6, pp. 480-488.
de Heer H, Balcázar HG, Morera OF, Lapeyrouse L, Heyman JM, Salinas J et al. Barriers to care and comorbidities along the U.S.-Mexico border. Public Health Reports. 2013 Nov;128(6):480-488.
de Heer, Hendrik ; Balcázar, Hector Guillermo ; Morera, Osvaldo F. ; Lapeyrouse, Lisa ; Heyman, Josiah McC ; Salinas, Jennifer ; Zambrana, Ruth E. / Barriers to care and comorbidities along the U.S.-Mexico border. In: Public Health Reports. 2013 ; Vol. 128, No. 6. pp. 480-488.
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abstract = "Objective. While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities. Methods. We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009-2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions. Results. Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7{\%} of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR53.65, 95{\%} confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR51.71, 95{\%} CI 1.10, 2.66, p50.017), being confused about arrangements (OR51.82, 95{\%} CI 1.04, 3.21, p50.037), and not being treated with respect in medical settings (OR51.63, 95{\%} CI 1.05, 2.53, p50.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers. Conclusion. A substantial proportion of adults reported comorbidities. Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.",
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AU - Heyman, Josiah McC

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AU - Zambrana, Ruth E.

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N2 - Objective. While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities. Methods. We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009-2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions. Results. Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7% of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR53.65, 95% confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR51.71, 95% CI 1.10, 2.66, p50.017), being confused about arrangements (OR51.82, 95% CI 1.04, 3.21, p50.037), and not being treated with respect in medical settings (OR51.63, 95% CI 1.05, 2.53, p50.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers. Conclusion. A substantial proportion of adults reported comorbidities. Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.

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