Latinos of Mexican ancestry comprised nearly 70% of uninsured Latinos in the US in the NHIS data (Table ). In contrast, they represented <57% of the number of insured Latinos, suggesting that Latinos of Mexican ancestry have a higher probability of lacking health insurance coverage compared to Latinos of non-Mexican ancestry. Table illustrates that uninsured Latinos are more likely to be male, single, young, foreign-born, employed, to have fewer years of schooling, to have income below the federal poverty line, to answer the interview in Spanish, to report good health and to live in the Southern region of the US. Chi-square tests indicate that each of these differences is statistically significant (P
Characteristics of Latino Study Population from the National Health Interview Survey (1999–2007)
The results in Table do not account for confounding factors that may have effects on health insurance coverage among Latino adults. Consequently, we estimated multivariable logistic regression models to control for these factors. Table shows odds ratios predicting health insurance coverage for each Latino category, using Latinos of Mexican ancestry as the reference group. Compared to Latinos of Mexican ancestry, non-Mexican Latinos consistently observe higher rates of health insurance coverage (OR
1.0). Latinos of Mexican ancestry are more likely to be uninsured, in contrast with Latino adults of Cuban and Dominican ancestry who have the highest probabilities of having health insurance coverage.
Predictors of Health Insurance Coverage for Each Latino Group*
For the remaining explanatory variables in Table , we can confirm that insured Latinos are more likely to be married, to have been born in the US and to be interviewed in English. Latinos with health insurance coverage are more likely to have finished high school, to be above the 35 years of age and to have income above the federal poverty line. With respect to health status and geographic distribution, Latinos with health insurance coverage are more likely to report their health as fair or poor and to live in the Midwest and Western regions of the US. The relative homogeneity of fixed effects control variables for survey years does not suggest any important disturbance from a time shock.
The main objective of our study was to parse out differences into observed and unobserved factors that affect health insurance coverage. Table shows the results of the decomposition analysis and provides the probability of having health insurance coverage for our reference and comparison groups, once we account for all the explanatory variables in the model. Latinos of Mexican ancestry were approximately 13% less likely to be insured than were non-Mexican Latinos (59.4% vs 72.4%, respectively). Also shown in Table , approximately 65% (8.5 percentage points of the of 13 percentage point difference) of the difference in health insurance coverage between Latinos of Mexican ancestry and non-Mexican Latinos can be explained by observed characteristics. The results in Table show that Latinos of Mexican ancestry are more likely to be young, to report better health status, to live in the Western region of the US and to be below the poverty line compared to non-Mexican Latinos. Unobserved heterogeneity still plays an important role, however, as it accounted for approximately 35% of the difference between the reference and comparison categories. Our findings are consistent with previous research5,18
and imply that socio-demographic, health status and economic differences among Latinos explain a large share of disparities in health insurance coverage.
Decomposition Estimates Between US Latinos with Mexican Ancestry and Non-Mexican Latinos
Latinos of Mexican ancestry were the population of interest in our analysis. However, it could be argued that the rest of the Latino population that was grouped into the comparison category for the decomposition analysis also differed substantially from each other, even if the multivariable logistic regression reported that each group of non-Mexican Latinos had a higher chance of getting health insurance coverage than Latinos of Mexican ancestry. For instance, all Puerto Ricans have similar entitlements to those of mainland citizens, since they are US citizens by birth. Therefore, they may not face the same restrictions to obtaining health insurance as undocumented immigrants from Latin American countries. Likewise, the majority of Cuban immigrants have immediate access to health insurance for a period of time when they first enter the US, as most of them arrive as political refugees. They also benefit from a relatively affluent and well-organized social network that smoothes their transition to the US.29,30
We thus tested the robustness of our results by estimating two additional decomposition models that (1) excluded Puerto Ricans and (2) excluded both Puerto Ricans and Cubans (Table ). This sensitivity analysis is helpful in determining whether particular subgroups of Puerto Rican and/or Cuban Latinos who may be more likely to have health insurance benefits can account for a substantial share of differences between Latinos of Mexican ancestry and non-Mexican Latinos. We examined whether the same pattern of differences between Latinos of Mexican ancestry and non-Mexican Latinos persisted after excluding these groups. The results confirmed our hypothesis: Latinos of Mexican ancestry were still more likely to be uninsured, although the difference in the probability of lacking coverage narrows from 13% for all non-Mexican Latinos to 9% when we excluded Puerto Ricans and to 6.3% when we excluded Puerto Ricans and Cubans. The size of the gap explained by observed factors also decreased somewhat, from 65% when we considered all non-Mexican Latinos to 54% when we excluded Puerto Ricans and to 60% when we excluded Puerto Ricans and Cubans.
Alternative Decomposition Estimates Between US Latinos with Mexican ancestry and Non-Mexican Latinos, Excluding Puerto Ricans and Puerto Ricans/Cubans