Chronic disease diagnosis and usual source of care among older American Indians and Alaska natives
Marshall, LaTisha Love
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Despite the United States having a unique responsibility to provide healthcare for American Indians and Alaska Natives (AI/AN), they continue to face disparities in healthcare access and poor health outcomes, such as heart disease and diabetes. Older populations are particularly vulnerable to these diseases, their associated comorbidities and functional limitations. As the population continues to age, there is a need to focus and target the health of older AI/AN. This dissertation has two purposes that are addressed by two manuscripts. The first study seeks to assess the factors related to chronic disease diagnosis among older AI/AN age 45 years and older. The second study seeks to assess the predictors of having a usual source of care among older AI/AN to better understand where they are going for care and how best to reach them in order to prevent and manage chronic diseases, such as heart disease and diabetes. Both studies used secondary data from the California Health Interview Survey (CHIS), a multistage and population-based Random Digit Dial (RDD) telephone (landline and cell phone) survey. The first study found that 74.4% had neither been diagnosed with heart disease nor diabetes, 10.5% were diagnosed with heart disease and 15.1% were diagnosed with diabetes. In addition, age and self-rated health were the primary factors related to these diagnoses. The second study found that 91% of AI/AN had a usual source of care and utilized a doctor’s office/Kaiser/HMO (65%), followed by a clinic/health center/hospital clinic (26%). The remaining 9% did not have a usual source of care. In addition, predisposing (i.e. age, marital status and education) and enabling (i.e. being an enrolled member of a state or federally recognized tribe, having insurance, and poverty level) factors were the most significant determinants of having a usual source of care. Multilevel interventions and policies are needed to address the social determinants of health that heavily impact the health status and healthcare access of older AI/AN. This study discusses possible opportunities and strategies to intervene on improving diabetes, heart disease and usual source of care among older AI/AN and underscores the need for action.