Abstract P531: Immigrants Prioritize Language Over Geography When Accessing Health Care

Abstract

Introduction: Nationally, New York City (NYC) has one of the largest immigrant populations and highest gentrification rates. Satellite ethnic enclaves are increasingly prevalent as residents relocate to more affordable neighborhoods. Ethnic immigrant communities already face unique challenges to accessing health care, including linguistic and cultural discordance regarding health-related beliefs and norms. Residence outside of ethnic enclaves may further hinder health care utilization, as culturally appropriate services may become less accessible. Characterization of immigrants visiting doctors’ offices within and outside of ethnic enclaves may inform efforts to retain these populations in care. Hypothesis: We compared immigrants accessing health care within major ethnic enclaves to immigrants accessing care elsewhere to ascertain differences in 1) demographic characteristics; 2) reasons for choosing health care facilities; and 3) distances traveled for health care. Methods: Data were from the 2018 Examining Norms and Behaviors Linked to Eating (ENABLE) Pilot Study. Chinese American participants were recruited using venue-based and snowball sampling methods, with assistance from NYC community-based organizations. Surveys included detailed questions on demographics and health-related factors. Participants were included in the analysis if doctor’s office and home zip code data were available (n=143). Data were analyzed using RStudio v.1.2.5 and STATA v.15.0. Results: The majority of participants saw a Chinatown-based doctor (64%; 92 of 143); and were not Chinatown residents (81%; 116 of 143). A greater number of individuals who saw Chinatown-based doctor had less than a college education; were living with food insecurity; were on public insurance; and were less acculturated. Individuals accessing care in Chinatown prioritized doctor’s offices where doctors and medical staff spoke their language more so than individuals accessing care elsewhere. Overall, people who saw a Chinatown-based doctor traveled significantly further (β=1.51 miles [approximately 15 minutes via subway]; 95% CI 0.25, 2.77). Of people who saw a Chinatown-based doctor, 75% (69 of 92) were not Chinatown residents. On average, these individuals traveled 5.14 miles (SD=3.38) to the doctor. Conclusion: In conclusion, there is a need to expand in-language services for immigrant communities. Immigrants visiting doctors in ethnic enclaves are demographically different and travel further distances for health care. Accessing in language services is a priority for these individuals. Immigrants may prioritize language access over geographic access when choosing their health care providers. Strategies to strengthen community-clinical linkages, including connecting community members with bilingual community health workers, may increase healthcare access of under-served, ethnic populations.