Association of maternal characteristics with latino youth health insurance disparities in the United States: a generalized structural equation modeling approach

Abstract

Background Disparities in access to care persist for Latino youth born in the United States (US). The association of maternal characteristics, such as maternal citizenship status and insurance coverage, on youth health insurance coverage is unclear and is important to examine given the recent sociopolitical shifts occurring in the US. Methods We analyzed pooled cross-sectional data from the 2010–2018 National Health Interview Survey to examine the association of Latina maternal citizenship status on maternal insurance coverage status and youth uninsurance among US-born Latino youth. Our study sample consisted of 15,912 US-born Latino youth (ages < 18) with linked mothers. Our outcome measures were maternal insurance coverage type and youth uninsurance and primary predictor was maternal citizenship status. Generalized structural equation modeling was used to examine the relationships between maternal characteristics (maternal citizenship, maternal insurance coverage status) and youth uninsurance. Results Overall, 7% of US-born Latino youth were uninsured. Just 6% of youth with US-born mothers were uninsured compared to almost 10% of those with noncitizen mothers. Over 18% of youth with uninsured mothers were uninsured compared to 2.2% among youth with mothers who had private insurance coverage. Compared to both US-born and naturalized citizen Latina mothers, noncitizen Latina mothers had 4.75 times the odds of reporting being uninsured. Once adjusted for predisposing, enabling, and need factors, maternal uninsurance was strongly associated with youth uninsurance and maternal citizenship was weakly associated with youth uninsurance among US-born Latino youth. Conclusion Maternal citizenship was associated with both maternal uninsurance and youth uninsurance among US-born Latino youth. Federal- and state-level health policymaking should apply a two-generational approach to ensure that mothers of children are offered affordable health insurance coverage, regardless of their citizenship status, thus reducing uninsurance among US-born Latino youth.

Access to Health Insurance and Health Care for Hispanic Children in the United States

“…Only 42.5 percent of nonelderly (ages 0–64) Hispanics had insurance through employers in 2019, compared to 65.8 percent of NH whites and 47.2 percent of NH Blacks (Kaiser Family Foundation, n.d.). The relatively low rate of ESI reflects the fact that many Hispanic adults work in jobs (often low-wage, part-time jobs) that do not provide health insurance, which means that their children have less access to such coverage (Alberto, Pintor, Langellier, et al 2020). Noncitizens, especially undocumented immigrants, are particularly likely to work in these precarious, low-quality jobs (Young and Mattingly 2016; Massey, Durand, and Pren 2016).…”

“…Additionally, as Figure 4 shows, 10.4 percent of Hispanic, citizen children with a noncitizen parent were uninsured, compared to 5.3 percent of Hispanic, citizen children with U.S.-born parents. Overall, U.S.-born Hispanic children “with immigrant parents are more likely to be uninsured and to have discontinuous health coverage” (Alberto, Pintor, Langellier, et al 2020, 2).…”

“…In one national study using data collected in 2015, 80 percent of Hispanic adults indicated that they believed that there was an anti-Hispanic or anti-immigrant environment in the United States today, 45 percent worried that their friends or family members might be detained or deported due to their immigration status, and 9 percent indicated that they would avoid visiting a health care provider because they do not want to be asked about their citizenship (Sanchez, Pedraza, and Vargas 2015; Vargas and Ybarra 2017). Consequently, numerous studies have found that noncitizen Hispanic parents are more likely to delay medical care, forgo annual check-ups, and avoid ED use for their children (Alberto, Pintor, Martínez-Donate, et al 2020; Alberto, Pintor, Langellier, et al 2020, Langellier et al 2016).…”

Creation of a linked cohort of children and their parents in a large, national electronic health record dataset

“…Previous studies using large datasets were able to identify some parental factors associated with child health care. For example, maternal lack of health insurance was associated with youth lack of health insurance, [ 17 ] Affordable Care Act Medicaid expansion was associated with increased odds of well-child care for families making less than 99% FPL, [ 18 ] and parent mental illness was associated with potentially preventable child emergency department use. [ 19 ] We will expand on these studies by using this rich cohort of linked parent and child EHR data to longitudinally track measures in real-time and investigate the relationships among parental health status and health care utilization and a child's receipt of recommended services and health.…”

Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

“…A statistical analysis comprised the estimation of nonstandardized coefficients and 95% CI. Akaike's information criterion (AIC), which provides a trade between the goodness of fit and model simplicity, was calculated for all GSEM models to facilitate a comparison and identification of the best-performing model [40,41]. Given the exploratory, rather than confirmatory, nature of our analysis, it was deemed a more suitable than the alternative Bayesian information criterion [42].…”