Place matters for health. Residential segregation has been linked to higher mortality, poorer access and lower quality of health care for racial/ethnic minorities. However, much remains unknown about the why place matters. In particular, the role of place-based characteristics such as rurality and income segregation in health care disparities is not well studied. A better understanding of how these place-based characteristics intersect with residential segregation by race-ethnicity to influence health care access, quality and disparities could be essential for developing interventions and policy solutions that are attentive to the local context. Our studies under the Why Place Matters research program found residents of minority communities had lower access to primary care and specialists and reduced use of physician, non-physician and mental health services compared to residents of majority white communities. Leveraging the comprehensive data resources developed through our research program, our team will conduct secondary analyses to explore the role of several important, but understudied, place characteristics on health care disparities. Specifically, our study will examine the associations of: 1) rurality, 2) income segregation, and 3) language segregation on minority health care access and utilization. We will examine these relationships for different race-ethnic groups (e.g., Blacks, Hispanics) and on care disparities between race-ethnic minority groups with Whites. We will also test whether provider availability or quality mediates these relationships. Finally, we will explore the interaction of these community characteristics with race-ethnic composition on health care access and utilization of Blacks. Descriptive, bivariate, stratified analysis, and regression models, including multilevel models will be used to examine the relationship of each place characteristic with area-level healthcare resource availability and quality and with minority health care access and use. This project will continue the research program Why Place Matters to understand the role of place on health care disparities. A better understanding of the experiences of minorities living in complex environmental contexts, with varying mix of privileges or disadvantages, could inform the development of accurately targeted health communications or interventions. This project fits within sociocultural and healthcare system domains at both individual and community levels of influence of the NIMHD Minority Health and Health Disparities Research Framework.
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