David E. Hayes-Bautista

Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System

OBJECTIVES We estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system. METHODS We conducted a stratified cross-sectional probability sample of primary care patients in the Los Angeles County Department of Health Services. Face-to-face interviews were conducted with 1819 adult patients in 6 languages. The response rate was 80%. The study sample was racially/ethnically diverse. RESULTS Thirty-three percent reported delaying needed medical care during the preceding 12 months; 25% reported an unmet need for care because of competing priorities; and 46% had either delayed or gone without care. CONCLUSIONS Barriers to needed health care continue to exist among patients receiving care through a large safety net system. Competing priorities for basic necessities and lack of insurance contribute importantly to unmet health care needs.

Latino physician supply in California: sources, locations, and projections.

Purpose To determine the number of Latino physicians in California, identify the schools and countries where they were educated, determine the percentage located in Latino areas, and project the supply of Latino physicians to 2020. Method From a 1999 list of 74,345 licensed physicians, the authors identified Latino U.S. medical graduates (USMGs) by “heavily Hispanic” surnames and Latino international medical graduates (IMGs) by country and school of graduation. The 1999 license addresses of all physicians in Los Angeles County were analyzed against 1998 Latino-population data by zip code. A baseline projection of the supply of Latino physicians was based on the ten-year (1986 to 1995) average annual production of Latino physicians educated in California, out of state, and in Latin America. A worst-case projection assumed the continuation of recent trends: a 32% decrease in California-educated Latino USMGs, a 19% decrease in out-of-state Latino USMGs, and a reduction of Latino IMGs to five per year. Results In 1999, 3,578 Latino physicians comprised 4.8% of all Californian physicians. In contrast, Latinos made up 30.4% of the states population. Latino physicians were more likely than non-Latinos to have addresses in a heavily Latino zip code. In the baseline projection, while the overall supply of Latino physicians will increase by nearly 30% by 2020, that growth will be dwarfed by the 74% growth in the Latino population over the same time. In the worst-case projection, the actual number of Latino physicians will decrease from the 1999 figure of 3,578 to 3,448 by 2020, while the Latino population continues to grow. Conclusions (1) The Latino USMG supply must be markedly increased in the number of first-year matriculants in both California and out-of-state schools. (2) The issue of Latino IMGs requires special attention, and may provide a temporary solution to the Latino physician shortfall. (3) Non-Latino physicians need to be prepared to be culturally effective with a large and growing Latino patient population.

Latino Physicians in the United States, 1980-2010: A Thirty-Year Overview From the Censuses.

Purpose To update and extend a 2000 study on the California Latino physician workforce, the authors examined the Latino physician workforce in the 30-year time frame spanning 1980 to 2010, comparing changes in the rates of physicians per 100,000 population for the Latino and non-Hispanic white (NHW) populations in the United States as a whole and in the five states with (in 2010) the largest Latino populations. Method The authors used detailed data from the U.S. Census (Public Use Microdata Samples for 1980–2010) to identify total population, total number of physicians, and Spanish-language ability for both the Latino and NHW populations. They examined nativity for only Latinos. Results At the national level, the NHW physician rate per 100,000 of the NHW population increased from 211 in 1980 to 315 in 2010 while the Latino physician rate per 100,000 of the Latino population dropped over the same period from 135 to 105. With small variations, the same trend occurred in all five of the states examined. At the national and state levels, Latino physicians were far more likely to speak Spanish than NHW physicians. Over the 30-year period, the Latino physician population has evolved from being primarily foreign born to being about evenly split between foreign born and U.S. born. Conclusions The Latino physician shortage has worsened over the past 30 years. The authors recommend immediate action on the national and local level to increase the supply of Latino physicians.

The Latino adolescent male mortality peak revisited: attribution of homicide and motor vehicle crash death

Objective The Latino Epidemiologic Paradox describes favourable health profiles for Latinos compared to non-Latino whites despite poverty, low education, and low access to healthcare. The objective of this study was to determine if the anomaly to the Latino Epidemiological Paradox and the Latino Adolescent Male Mortality Peak in California mortality data persists. Methods Cases were California residents (1999–2006) of any race and ethnicity that died (N=1 866 743) in California from any cause of death. Mortality rates and rate ratios were calculated according to causes of death for 5 year age groups. Results For males and females combined, age adjusted mortality rates were 509 for Latinos and 681 for non-Latino whites per 100 000/year. Latino male mortality rate ratios exceeded 1.0 compared to non-Latino white males only for age groups 15–19 years (1.41, 95% CI 1.35 to 1.49) and 20–24 years (1.24, 95% CI 1.19 to 1.29). Latinas had lower mortality rates than non-Latino white females for all ages over 15 years. Male homicide rates for Latinos increased over the study period, but did not reach the rates reported for the years 1989–1997. Both male homicide and motor vehicle crash mortality rates were higher for Latinos than non-Latino whites and peaked at 20–24 years. The Latino crash mortality rate exceeded the rate for non-Latino whites overall and for each year 2003–2006. Crash mortality for males aged 15–24 years increased from 2000 to 2006. Conclusion The anomaly and the mortality peak persist, with notable attribution to homicide and crashes. Without homicide, the mortality peak would not exist. Mortality disparities for Latino adolescent males from these two causes of death in California appear to be growing.

Latinos and the 1992 Los Angeles Riots: A Behavioral Sciences Perspective

The role of Latinos in the Los Angeles civil disturbance of 1992 has not been explored. An early explanation was that Latino residents of South Central LosAngeles participated in the riots because they were CentralAmerican, poor, isolated, and unemployed. Census data from the Summary Tape File 3 show that Latinos in South Central are virtually identical to Latinos living in neglected areas outside of South Central and not markedly different from more affluent Latinos in nonneglected areas. Thus Latino participation cannot be explained by virtue of internal composition. This article suggests that Latino participation can be better explained by using a collective behavior approach. The civil disturbance occurred in two distinct phases. The arson phase was a classic replay of the long, hot summers of the mid 1960s and showed elements of the solidaristic and expressive behavior so common to that period and did not have any noticeable Latino participation. The generalized looting phase, which did include noticeable Latino involvement, was individualistic and instrumental, akin to looting that often takes place in the case of a natural disaster. In conclusion, it is noted that collective behavior can be quite useful in understanding Latino collective behavior, fads, taste, and public opinion formation.