Context: Latino immigrants are the largest immigrant group in the United States, yet there is a lack of data sources that link nativity with objective health care data to study if they are receiving appropriate and timely health care. There are methodological challenges to studying immigrant populations due to language barriers, circumstances of immigration, and fear of immigration authorities which can impede data collection. Previous studies have shown that community health centers (CHCs) are viewed as trusted sites for disclosure of personal information, and therefore may have more accurate nativity information stored in electronic health records (EHRs) than other types of health care delivery sites. To motivate the utility of EHRs in studying receipt of healthcare among Latino immigrants, we considered a setting in cardiovascular disease prevention, involving several risk factors with well-documented best practices for assessment and management (including hypertension, tobacco smoking, and hyperlipidemia).
Objective: To describe differences in utilization and rates of cardiovascular risk factors between foreign-born Latinos, US-born Latinos, and non-Hispanic white patients who receive care in CHCs.
Study Design: Observational cohort study
Dataset: Electronic health record data from primary care patients seen in OCHIN CHCs in multiple US states.
Population studied: Our data contain 1,482,314 patients aged 9-79 years with ≥1 ambulatory/telehealth visit in an OCHIN clinic from 1/1/2012-12/31/2020. Of these,155,663 (10.5%) have nativity data reported in the EHR.
Outcome measures: Screening/monitoring rates of blood pressure, hyperlipidemia, HbA1c, smoking cessation service, and aspirin use per American Heart Association and United States Preventive Services Task Force recommendations, along with documentation of nativity
Results: We anticipate that foreign-born Latinos will be less likely to receive recommended cardiovascular preventive services than US-born Latinos and non-Hispanic white CHC patients.
Conclusions: Current and accurate data are necessary to identify and address health disparities. This study will help primary care clinicians and researchers identify populations who may be at risk for disparate preventive care measures.