Primary care visits dropped among undocumented residents around 2016 election
There was a significant decrease in primary care visits among undocumented residents between June 2015 and May 2018, according to research published in JAMA Network Open.
“Our findings demonstrate that there was a decline in primary care visits among undocumented adults and children timed with an increase in anti-immigrant rhetoric during the 2016 presidential campaign,” Joseph C. Nwadiuko, MD, MPH, MSHP, a general internal medicine fellow at the University of Pennsylvania, told Healio Primary Care.
“This is likely not accounted for by local changes in the number of enforcement arrests or by immigrants moving away from the city where the study was conducted,” he added. “This study, along with similar data around the nation, suggests that undocumented immigrants began to withdraw from care long before the 2016 election and might be pretty sensitive to shifts in political rhetoric.”
Nwadiuko and colleagues used a difference-in-differences (DID) approach in a cohort study evaluating health care utilization among both Medicaid beneficiaries and Medicaid-ineligible patients from January 1, 2014, through May 31, 2018. In the study, the researchers’ inflection point of interest was former president Donald J. Trump’s June 16, 2015, candidacy announcement, which they noted represented a rise in anti-immigration rhetoric.
The researchers compared primary care visits, ED visits and inpatient discharges before and after June 16, 2015, in a cohort of Medicaid patients and Medicaid-ineligible patients, more than 90% of whom were undocumented.
A total of 20,211 patients were included in the study, 7.4% of which were included in the Medicaid-ineligible group, and 92.6% of which were in the Medicaid group.
As of 2018, the mean age of the Medicaid-ineligible group was 38.2 years, and the mean age of the Medicaid group was 22.2 years.
Nwadiuko and colleagues assessed 336,466 primary care visits at eight clinics during the study period.
Nwadiuko and colleagues determined that, after June 16, 2015, children in the Medicaid-ineligible group had a differential decrease in visits from baseline (adjusted postperiod mean = 108.9; 43.3%) compared with children in the Medicaid group (adjusted postperiod mean = 126.3; 27.0%; DID estimate = 0.8; 95% CI, 0.7-0.9).
Among adults, they also identified a differential decrease in the Medicaid-ineligible group (adjusted postperiod mean = 116.9; 34.5%) compared with those in the Medicaid group (adjusted postperiod mean = 155.3; 19.7%; DID estimate = 0.8; 95% CI, 0.8-0.9).
They noted that these findings remained significant after restricting analyses to patients with visits in 2014, when all patients between 0 and 18 years of age as of 2018 were included, when restricting patients who were not hospitalized and when patients aged 19 to 69 years as of 2018 were excluded.
Additionally, the researchers identified a significant differential increase in ED visits among children in the Medicaid-ineligible group (DID estimate = 2.3; 95% CI, 1.1-5.0).
According to Nwadiuko and colleagues, there was also a differential decrease in inpatient discharges among adults in the Medicaid-ineligible group (DID estimate = 0.5; 95% CI, 0.4-0.7). They determined that there was not a significant change in ED visits or admission rates in Medicaid-ineligible adults.
“Undocumented patients need access to preventive care just like American citizens, whether it for BP and cancer screening or childhood vaccines,” Nwadiuko said. “As the COVID-19 pandemic has shown, if any single group is unable to access local screening, everyone is ultimately affected.”
He added that “cities and health systems must partner to ensure that immigrants feel that their ability to access primary care is not hindered by the threat of arrest by immigration enforcement.”