Utilization of Healthcare Among Asian Origin Groups and Citizenship Status.

Abstract

Citizenship status may be a barrier to engaging in preventive care, especially among Asian origin groups. This study examines differences in annual healthcare utilization among six different Asian-origin groups and whether these differences are influenced by citizenship status. We conducted a cross-sectional analysis of data from the 2013-2022 California Health Interview Survey. Respondents aged 18 and older. The primary exposures were disaggregated Asian-origin groups (Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and others) and citizenship status (U.S.-born, naturalized citizen, non-citizen). The outcome variable was annual healthcare utilization (yes or no). Weighted multivariable logistic regression was used to examine these associations. Among the 214,684 eligible participants, Korean respondents showed the lowest prevalence of annual healthcare utilization (76%) among Asian origin groups. U.S.-born (71.8%) and non-citizen Korean (65.5%) respondents also had the lowest rates of annual healthcare utilization. In adjusted analyses, non-citizens had a 14% lower odds of annual healthcare utilization than U.S.-born respondents. Chinese and Korean respondents had lower odds of annual healthcare utilization compared with Hispanic/Latino respondents, with lower odds ranging from 27 to 34% (p < 0.05 for all groups). Finally, naturalized citizens who were Chinese, Korean, or categorized as "other Asian," and non-citizens Chinese respondents, had 29-48% lower odds of annual healthcare utilization (p < 0.05 for all groups). A lower odds of annual healthcare utilization was observed among Chinese and Korean respondents, particularly among naturalized citizens and non-citizens. This study highlights the importance of disaggregating data by Asian origin group and considering citizenship status as a key factor associated with annual healthcare utilization.