Abstract
African immigrants and refugees—almost half of them from Somalia—account for one of the fastest-growing groups in the United States. There is reason to suspect that Somali-Americans may be at risk for low completion of recommended preventive health services. This study’s aim was to quantify disparities in preventive health services among Somali patients compared with non-Somali patients in an academic primary care practice in Rochester, Minn. It also examined the effect of medical interpreters, emergency department visits, and primary care visits on the completion of preventive services. Rates of pap smears, vaccinations (influenza, pneumococcus, and tetanus), lipid screening, colorectal cancer screening, and mammography were assessed in Somali and non-Somali patients during the second quarter of 2008. Data were collected regarding the utilization of medical interpreters, emergency services, and primary care services among Somali patients. Results were reported using standard descriptive statistics. Of the 91,557 patients identified in the database, 810 were Somali. Somali patients had significantly lower completion rates of colorectal cancer screening, mammography, pap smears, and influenza vaccination than non-Somali patients. Use of medical interpreters and primary care services were generally associated with higher completion rates of preventive services. There are significant discrepancies in the provision of preventive health services to Somali patients compared with that of non-Somali patients. These findings suggest the need to identify the root causes of these discrepancies so that interventions may be crafted to close the gap.
Similar content being viewed by others
References
Felix-Aaron K, Moy E, Kang M, Patel M, Chesley FD, Clancy C. Variation in quality of men’s health care by race/ethnicity and social class. Med Care. 2005;43(3 Suppl):I72–81.
Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–84.
Franks P, Fiscella K, Meldrum S. Racial disparities in the content of primary care office visits. J Gen Intern Med. 2005;20(7):599–603.
Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, et al. Effects of race and income on mortality and use of services among medicare beneficiaries. N Engl J Med. 1996;335(11):791–9.
O’Malley AS, Forrest CB, Feng S, Mandelblatt J. Disparities despite coverage: gaps in colorectal cancer screening among medicare beneficiaries. Arch Intern Med. 2005;165(18):2129–35.
Sambamoorthi U, McAlpine DD. Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med. 2003;37(5):475–84.
Fiscella K, Holt K, Meldrum S, Franks P. Disparities in preventive procedures: comparisons of self-report and medicare claims data. BMC Health Serv Res. 2006;6:122.
Kirk JK, D’Agostino RB Jr, Bell RA, Passmore LV, Bonds DE, Karter AJ, et al. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care. 2006;29(9):2130–6.
Samuel PS, Pringle JP, James NW, Fielding SJ, Fairfield KM. Breast, cervical, and colorectal cancer screening rates amongst female Cambodian, Somali, and Vietnamese immigrants in the USA. Int J Equity Health. 2009;8:30.
Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in medicare managed care. JAMA. 2002;287(10):1288–94.
Carroll J, Epstein R, Fiscella K, Volpe E, Diaz K, Omar S. Knowledge and beliefs about health promotion and preventive health care among Somali women in the United States. Health Care Women Int. 2007;28(4):360–80.
Dixon D. Characteristics of the African born in the United States. Migr Policy Inst: 2006. http://www.migrationinformation.org/usfocus/display.cfm?ID=366. Accessed 12 Jan 2011.
Department of Homeland Security. Yearbook of Immigration Statistics: 2008. http://www.dhs.gov/files/statistics/publications/YrBk08RA.shtm. Accessed 12 Jan 2011.
Carroll J, Epstein R, Fiscella K, Gipson T, Volpe E, Jean-Pierre P. Caring for Somali women: implications for clinician-patient communication. Patient Educ Couns. 2007;66(3):337–45.
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52–9.
CIA. The World Factbook: Somalia. http://www.cia.gov/library/publications/the-world-factbook/geos/so.html. Accessed 15 Jan 2011.
U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/recommendations.htm. Accessed 25 May 2011.
Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States. MMWR. 2010;59(1):1–4.
Smith RA, Saslow D, Sawyer KA, Burke W, Costanza ME, Evans WP 3rd, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53(3):141–69.
Pylypchuk Y, Hudson J. Immigrants and the use of preventive care in the United States. Health Econ. 2009;18(7):783–806.
Rodriguez MA, Ward LM, Perez-Stable EJ. Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas. Ann Fam Med. 2005;3(3):235–41.
Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.
Fiscella K, Dressler R, Meldrum S, Holt K. Impact of influenza vaccination disparities on elderly mortality in the United States. Prev Med. 2007;45(1):83–7.
Carrasquillo O, Pati S. The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States. Prev Med. 2004;39(5):943–50.
Siddiqi A, Zuberi D, Nguyen QC. The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada. Soc Sci Med. 2009;69(10):1452–9.
Wissink L, Jones-Webb R, DuBois D, Krinke B, Ibrahim Q. Improving health care provision to Somali refugee women. Minn Med. 2005;88(2):36–40.
Fiscella K, Holt K. Impact of primary care patient visits on racial and ethnic disparities in preventive care in the United States. J Am Board Fam Med. 2007;20(6):587–97.
Rodriguez MA, Bustamante AV, Ang A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med. 2009;24(Suppl 3):508–13.
Deshaw M. Use of the emergency department by Somali immigrants and refugees. Minn Med. 2006;89(8):42–5.
Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among medicare enrollees in a managed care organization. Med Care. 2002;40(5):395–404.
Derose KP, Baker DW. Limited English proficiency and Latinos’ use of physician services. Med Care Res Rev. 2000;57(1):76–91.
Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16(7):468–74.
Betancourt JR, Jacobs EA. Language barriers to informed consent and confidentiality: the impact on women’s health. J Am Med Womens Assoc. 2000;55(5):294–5.
Jain S, Chou CL. Use of an orientation clinic to reduce failed new patient appointments in primary care. J Gen Intern Med. 2000;15(12):878–80.
Conflict of interest
T. Ben Morrison, Mark L. Wieland, Stephen S. Cha, and Ahmed S. Rahman have no financial disclosures. Rajeev Chaudhry, MBBS, MPH is an employee of Mayo Clinic and the inventor of the GDMS software referenced in this publication. Mayo Clinic has licensed this technology to a commercial entity (VitalHealth Software) but to date has received no royalties. Dr. Chaudhry receives no royalties from the licensing of this technology.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morrison, T.B., Wieland, M.L., Cha, S.S. et al. Disparities in Preventive Health Services Among Somali Immigrants and Refugees. J Immigrant Minority Health 14, 968–974 (2012). https://doi.org/10.1007/s10903-012-9632-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-012-9632-4