Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States

Hyunmin Kim; Asos Mahmood; Satish Kedia; Deborah O Ogunsanmi; Sadikshya Sharma; David K Wyant

doi:10.1007/s40615-024-02018-9

Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States

J Racial Ethn Health Disparities. 2024 May 17. doi: 10.1007/s40615-024-02018-9. Online ahead of print.

Authors

Hyunmin Kim¹, Asos Mahmood^{2

3}, Satish Kedia⁴, Deborah O Ogunsanmi⁵, Sadikshya Sharma¹, David K Wyant⁶

Affiliations

¹ College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA.
² Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA. asos.mahmood@uthsc.edu.
³ Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. asos.mahmood@uthsc.edu.
⁴ Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA.
⁵ Tennessee Population Health Consortium and Institute for Health Outcomes and Policy Research, University of Tennessee Health Science Center, Memphis, TN, USA.
⁶ Jack C. Massey College of Business, Frist College of Medicine, Belmont University, Nashville, TN, USA.

PMID: 38758399
DOI: 10.1007/s40615-024-02018-9

Abstract

This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.

Keywords: Healthcare disparities; Healthcare utilization; Informal caregivers; Quality of care; Race; Residential segregation.