Determinants of healthcare utilization by older refugees in the United States: a modified Andersen Behavioral Model approach.

Abstract

Background and objectives: The global rise in aging populations intersects with increasing rates of forced displacement and chronic illness, prompting an urgent need to integrate older refugees into national healthcare systems. Health service use is a key means of decreasing health disparities and improving health equity, particularly among individuals with chronic illness. Yet little is known about the factors that shape healthcare use among older refugees in the US. This study uses nationally representative data to examine primary care visits among older refugees resettled between 2015 and 2019.

Design and methods: Using data from the 2020 Annual Survey of Refugees, we applied Andersen's Modified Behavioral Model of Health Service Use to examine the association of migration-related predisposing, enabling, and need factors with having a routine physical exam during the past year. Migration-specific variables included post-migration stressors, ethnic density, and arrival cohort. We conducted hierarchical logistic regression to evaluate the relative influence of each factor category, entering predisposing factors first, followed by enabling and need factors.

Results and discussion: Primary care use was significantly associated with race, religion, insurance coverage, education, and English proficiency. Muslim identity was a strong predictor, and Asian and Black refugees were more likely than White refugees to have had a physical exam. Both higher education and lower English proficiency were linked to increased use of primary care.

Implications: Findings highlight key determinants of healthcare utilization and suggest a need for targeted interventions to improve older refugees' use of health services. Notably, need-based health variables were not significantly linked to exam completion. Expanding insurance, education, culturally responsive care, and community-based interventions could enhance access. Future research should incorporate administrative health data and qualitative methods to address survey limitations and explore within-group differences in healthcare utilization.