Differences in use of high‐ and low‐value health care between immigrant and US‐born adults

Abstract

AbstractObjectiveTo examine differences in the use of high‐ and low‐value health care between immigrant and US‐born adults.Data SourceThe 2007–2019 Medical Expenditure Panel Survey.Study DesignWe split the sample into younger (ages 18–64 years) and older adults (ages 65 years and over). Our outcome measures included the use of high‐value care (eight services) and low‐value care (seven services). Our key independent variable was immigration status. For each outcome, we ran regressions with and without individual‐level characteristics.Data Collection/Extraction MethodsN/A.Principal FindingsBefore accounting for individual‐level characteristics, the use of high‐ and low‐value care was lower among immigrant adults than US‐born adults. After accounting for individual‐level characteristics, this difference decreased in both groups of younger and older adults. For high‐value care, significant differences were observed in five services and the direction of the differences was mixed. The use of breast cancer screening was lower among immigrant than US‐born younger and older adults (−5.7 [95% CI: −7.4 to −3.9] and −2.9 percentage points [95% CI: −5.6 to −0.2]) while the use of colorectal cancer screening was higher among immigrant than US‐born younger and older adults (2.6 [95% CI: 0.5 to 4.8] and 3.6 [95% CI: 0.2 to 7.0] percentage points). For low‐value care, we did not identify significant differences except for antibiotics for acute upper respiratory infection among younger adults and opioids for back pain among older adults (−3.5 [95% CI: −5.5 to −1.5] and −3.8[95% CI: −7.3 to −0.2] percentage points). Particularly, differences in socioeconomic status, health insurance, and care access between immigrant and US‐born adults played a key role in accounting for differences in the use of high‐ and low‐value health care. The use of high‐value care among immigrant and US‐born adults increased over time, but the use of low‐value care did not decrease.ConclusionDifferential use of high‐ and low‐value care between immigrant and US‐born adults may be partly attributable to differences in individual‐level characteristics, especially socioeconomic status, health insurance, and access to care.