Using data from the 2006 Medical Expenditure Panel Survey and the 2000 Census, we explored whether race/ethnic disparities in healthcare use were associated with residential segregation. We used five measures of healthcare use: office based physician visits, outpatient department physician visits, visits to nurses and physician’s assistants, visits to other health professionals, and having a usual source of care (USC). For each individual, we controlled for age, gender, marital status, insurance status, income, educational attainment, employment status, region, and health status. We used the racial-ethnic composition of the zip code to control for residential segregation. Our findings suggest that disparities in healthcare utilization are related to both individuals’ racial and ethnic identity and the racial and ethnic composition of their communities. Therefore, efforts to improve access to health care services and to eliminate healthcare disparities for African Americans and Hispanics should not only focus on individual-level factors but also include community-level factors.

Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health.

Objective To examine the association between residential segregation and geographic access to primary care physicians (PCP) in MSAs. Data Sources We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic and segregation measures from the 2000 US Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA. Methods We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of greater than 3500. Using logistic regressions, we estimated the association between a zip code’s odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA. Principal Findings We found that odds of being a PCP shortage area were 67% higher for majority African American zip codes but 27% lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes, however the converse was true for majority Hispanic and Asian zip codes. Conclusions Efforts to address PCP shortages should target African American communities especially in segregated MSAs.

Foreign-born Blacks have a health advantage in allostatic load. Further research is needed that underscores a deeper understanding of the mechanisms driving this health differential to create programs that target these populations differently.