Research article

Multivariate analyses of social-behavioral factors with health insurance coverage among Asian Americans in California

  • Received: 02 May 2019 Accepted: 15 July 2019 Published: 26 July 2019
  • JEL Codes: C12, C30, C38, G22, I12, I13, I14, I18

  • This study aimed to estimate the prevalence of uninsurance among California adults and Asian Americans, and to examine the associations of social-behavioral variables with uninsurance. A total of 24,136 adults (aged 18-64) including 2,060 Asian Americans were selected from the combined 2013-2014 California Health Interview Survey. Weighted univariate and multivariate logistic regression analyses were used to estimate the associations of potential factors with uninsurance. To evaluate the relationship of independent variables, the oblique principal component cluster analysis (OPCCA) was used to classify 9 variables into disjoint clusters. For Whites, African Americans, Latinos, and Asians, the prevalence of uninsurance was 8.5%, 10.3%, 24.7%, and 12.6%, respectively. Among Asians, the prevalence of uninsurance was 15.5%, 9.2%, 6.2%, 20.8% and 12.1% for Chinese, Filipinos, Japanese, Koreans, and Vietnamese, respectively. In the whole sample, multivariate logistic regression analysis revealed that being male, non-citizen, lower education, higher poverty, and current smoking were associated with uninsurance. Among Asians, compared to Koreans, being Filipinos and Vietnamese were associated with lower odds of being uninsured; meanwhile being male, non-citizen, lower education, and higher poverty were significantly associated with increased odds of uninsurance. Elder age groups and current smoking were significantly associated with increased odds of uninsurance in bivariate analysis; however, such associations disappeared after adjusting for other factors. Nine independent variables were divided into 2 clusters, where the variables in the same cluster were strongly correlated but had weak correlations with the variables in the other cluster. In conclusion, there are differences in the prevalence of uninsurance between Asians and Whites, and among Asian subgroups. Being male, non-citizen, lower education, higher poverty and current smoking were positively significantly associated with uninsurance.

    Citation: Nianshuo Wang, Ifeoma Ozodiegwu, Shaoqing Gong, Kesheng Wang, Xin Xie. Multivariate analyses of social-behavioral factors with health insurance coverage among Asian Americans in California[J]. Quantitative Finance and Economics, 2019, 3(3): 473-489. doi: 10.3934/QFE.2019.3.473

    Related Papers:

  • This study aimed to estimate the prevalence of uninsurance among California adults and Asian Americans, and to examine the associations of social-behavioral variables with uninsurance. A total of 24,136 adults (aged 18-64) including 2,060 Asian Americans were selected from the combined 2013-2014 California Health Interview Survey. Weighted univariate and multivariate logistic regression analyses were used to estimate the associations of potential factors with uninsurance. To evaluate the relationship of independent variables, the oblique principal component cluster analysis (OPCCA) was used to classify 9 variables into disjoint clusters. For Whites, African Americans, Latinos, and Asians, the prevalence of uninsurance was 8.5%, 10.3%, 24.7%, and 12.6%, respectively. Among Asians, the prevalence of uninsurance was 15.5%, 9.2%, 6.2%, 20.8% and 12.1% for Chinese, Filipinos, Japanese, Koreans, and Vietnamese, respectively. In the whole sample, multivariate logistic regression analysis revealed that being male, non-citizen, lower education, higher poverty, and current smoking were associated with uninsurance. Among Asians, compared to Koreans, being Filipinos and Vietnamese were associated with lower odds of being uninsured; meanwhile being male, non-citizen, lower education, and higher poverty were significantly associated with increased odds of uninsurance. Elder age groups and current smoking were significantly associated with increased odds of uninsurance in bivariate analysis; however, such associations disappeared after adjusting for other factors. Nine independent variables were divided into 2 clusters, where the variables in the same cluster were strongly correlated but had weak correlations with the variables in the other cluster. In conclusion, there are differences in the prevalence of uninsurance between Asians and Whites, and among Asian subgroups. Being male, non-citizen, lower education, higher poverty and current smoking were positively significantly associated with uninsurance.


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    [1] Aggarwal V, Kosian S (2011) Feature Selection and Dimension Reduction Techniques in SAS, NESUG.
    [2] Barnett JC, Vornovitsky MS (2016) Health insurance coverage in the United States: 2015, Washington, DC: U.S. Government Printing Office.
    [3] Budhwani H, De P (2016) Disparities in influenza vaccination across the United States: Variability by minority group, Asian sub-populations, socio-economic status, and health insurance coverage. Public Health 138: 146–153. doi: 10.1016/j.puhe.2016.04.003
    [4] California Health Interview Survey (CHIS) (2016) CHIS 2013–2014 Methodology Report Series. Available from: http://healthpolicy.ucla.edu/chis/design/Documents/chis2013-2014-method-1_2017-01-12.pdf.
    [5] Carrasquillo O, Carrasquillo AI, Shea S (2000) Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health 90: 917–923. doi: 10.2105/AJPH.90.6.917
    [6] US Census Bureau (2016) Asian/Pacific American Heritage Month: May 2016. Facts for Features. Available from: http://www.census.gov/newsroom/facts-for-features/2016/cb16-ff07.html.
    [7] Cook WK, Chung C, Tseng W (2011) Demographic and socioeconomic profiles of Asian Americans, Native Hawaiians, and Pacific Islanders. Asian and Pacific Islander American Health Forum, San Francisco, CA & Washington, D.C.
    [8] Denavas-Walt C, Proctor BD, Smith JC (2012) Income, poverty, and health insurance coverage in the United States, Washington, DC: U.S. Government Printing Office.
    [9] Grieco EM, Acosta YD, Patricia de la Cruz G, et al. (2012) The foreign-born population in the United States: 2010 American community survey reports (ACS-19). Available from: https://www.census.gov/prod/2012pubs/acs-19.pdf.
    [10] Hoeffel EM, Rastogi S, Kim MO, et al. (2012) The Asian population: 2010. Washington DC: U.S. Census Bureau. 2012. Available from: https://www.census.gov/prod/cen2010/briefs/c2010br11.pdf.
    [11] Huang K, Carrasquillo O (2008) The role of citizenship, employment, and socioeconomic characteristics in health insurance coverage among Asian subgroups in the United States. Medical Care 46: 1093–1098. doi: 10.1097/MLR.0b013e318185ce0a
    [12] Jerant A, Fiscella K, Franks P (2012) Health characteristics associated with gaining and losing private and public health insurance: a national study. Med Care 50: 145–151. doi: 10.1097/MLR.0b013e31822dcc72
    [13] Johnson PJ, Blewett LA, Call KT, et al. (2010) American Indian/Alaska Native uninsurance disparities: a comparison of 3 surveys. Am J Public Health 100: 1972–1979.
    [14] Kao D (2010) Factors associated with ethnic differences in health insurance coverage and type among Asian Americans. J Commun Health 35: 142–155.
    [15] Kim J, Ford KL, Kim G (2019) Geographic Disparities in the Relation between English Proficiency and Health Insurance Status among Older Latino and Asian Immigrants. J Cross Cult Gerontol 34: 1–13. doi: 10.1007/s10823-019-09366-8
    [16] Lee SY, Poon WY, Bentler PM (1995) A two-stage estimation of structural equation models with continuous and polytomous variables. Brit J Math Stat Psy 48: 339–358. doi: 10.1111/j.2044-8317.1995.tb01067.x
    [17] Lohr SL (2009) Sampling: Design and Analysis, Second Edition, Pacific Grove, CA: Duxbury Press.
    [18] Mossaad N (2016) U.S. lawful permanent residents: 2014. Annual Flow Report. Office of Immigration Statistics. U.S. Department of Homeland Security. Available from: https://www.dhs.gov/sites/default/files/publications/LPR%20Flow%20Report%202014_508.pdf.
    [19] Muthen BDK (1985) A comparison of some methodologies for the factor analysis of non-normal Likert variables. Brit J Math Stat Psy 18: 171–189.
    [20] Nguyen D, Choi S, Park SY (2015) The Moderating Effects of Ethnicity and Employment Type on Insurance Coverage: Four Asian Subgroups in California. J Appl Gerontol 34: 858–878. doi: 10.1177/0733464813481849
    [21] Stoll OMA (2007) Redlining or Risk? A Spatial Analysis of Auto Insurance Rates in Los Angeles. J Policy Anal Manag 26: 811–829.
    [22] Park JJ, Humble S, Sommers BD, et al. (2018) Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act. JAMA Intern Med 178: 1128–1129. doi: 10.1001/jamainternmed.2018.1476
    [23] Pew Research Center (2013) The rise of Asian Americans. Washington, DC: Pew Research Center. Available from: http://www.pewsocialtrends.org/2012/06/19/the-rise-of-asian-americans/.
    [24] Ruy H, Young WB, Kwak H (2002) Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups. Int J Health Plan M 17: 55–68.
    [25] Sanche R, Lonergan K (2006) Variable Reduction for Predictive Modeling with Clustering. Available from: http://casualtyactuarialsociety.net/pubs/forum/06wforum/06w93.pdf.
    [26] Shi L (2001) The convergence of vulnerable characteristics and health insurance in the U.S. Soc Sci Med 53: 519–529. doi: 10.1016/S0277-9536(00)00357-9
    [27] Smith JC, Medalia C (2015) Health insurance coverage in the United States: 2014, Washington, DC: U.S. Government Printing Office. Available from: https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf.
    [28] Squires GD (1997) Insurance redlining: Disinvestment, reinvestment, and the evolving role of financial institutions,The Urban Insitute.
    [29] Tan C, Wyatt LC, Kranick JA, et al. (2018) Factors Associated with Health Insurance Status in an Asian American Population in New York City: Analysis of a Community-Based Survey. J Racial Ethn Health Disparities 5: 1354–1364. doi: 10.1007/s40615-018-0485-y
    [30] The Kaiser Family Foundation (2010) Summary of coverage provisions in the Patient Protection and Affordable Care Act. Available from: http://www.kff.org/healthreform/upload/8023-R.pdf.
    [31] Tung EL, Baig AA, Huang ES, et al. (2017) Racial and Ethnic Disparities in Diabetes Screening Between Asian Americans and Other Adults: BRFSS 2012–2014. J Gen Intern Med 32: 423–429. doi: 10.1007/s11606-016-3913-x
    [32] Wang KS, Liu Y, Ouedraogo Y, et al. (2018) Principal component analysis of early alcohol, drug and tobacco use with major depressive disorder in US adults. J Psychiatr Res 100: 113–120.
    [33] Wang N, Xie X (2017) The Impact of race, income, drug abuse and dependence on health insurance coverage among U.S. adults. Eur J Health Econ 18: 537–546. doi: 10.1007/s10198-016-0802-5
    [34] Wang N, Ouedraogo Y, Chu J, et al. (2019) Variable reduction of past year alcohol and drug use with unmet need of mental health service use among U.S. adults. J Affect Disorders 256: 110–116. doi: 10.1016/j.jad.2019.05.069
    [35] Ward BW, Nugent CN, Blumberg SJ, et al. (2017). Measuring the Prevalence of Diagnosed Chronic Obstructive Pulmonary Disease in the United States Using Data From the 2012–2014 National Health Interview Survey. Public Health Rep 132: 149–156. doi: 10.1177/0033354916688197
    [36] Ward BW, Clarke TC, Nugent CN, et al. (2016) Early Release of Selected Estimates Based on Data From the 2015 National Health Interview Survey. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf.
    [37] Wilper AP, Woolhander S, Lasser KE, et al. (2009) Health Insurance and Mortality in U.S. Adults. Am J Public Health 99: 2289–2295. doi: 10.2105/AJPH.2008.157685
    [38] Wolter KM (1985) Introduction to Variance Estimation, New York: Springer-Verlag.
    [39] Yi SS, Kwon SC, Wyatt L, et al. (2015) Weighing in on the hidden Asian American obesity epidemic. Prev Med 73: 6–9. doi: 10.1016/j.ypmed.2015.01.007
    [40] Young MT, Leon-Perez G, Wells CR, et al. (2017) Inclusive state immigrant policies and health insurance among Latino, Asian/Pacific Islander, Black, and White noncitizens in the United States. Ethn Health 20: 1–13.
    [41] Zhou M, Xiong YS (2005) The multifaceted American experiences of the children of Asian immigrants: lessons for segmented assimilation. Ethn Racial Stud 28: 1119–1152. doi: 10.1080/01419870500224455
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