Jorge Kaufmann

Objectives. To assess whether Latino patients receiving care in community-based health centers (CHCs) in US states that expanded Medicaid eligibility regardless of immigration status to adults 50 years and older had greater insurance coverage after the eligibility amendment compared with states that did not expand eligibility. Methods. We performed a retrospective cohort study, using electronic health record data from 40 602 nonpregnant CHC patients aged 50 to 64 years living in states that expanded eligibility (OR, CA) or that did not (AK, CT, IN, MN, MT, NC, NJ, OH, WA) with a visit in both 2018–2019 (before policy change) and 2021–2023 (after policy change). Results. Among Spanish-preferring Latinas, the overall Medicaid-insured difference-in-difference estimate across all 3 years after the amendment was positively moderate (average treatment effect on treated [ATT] = +7.04; 95% confidence interval [CI] = 0.10, 13.98); however, this effect was greatest in the third year after the amendment (ATT = +21.82; 95% CI = 14.04, 29.59), and this was accompanied by a substantial drop in third year uninsured visit rates (ATT = −15.45; 95% CI = −24.77, ‒6.13). We observed the same pattern for Spanish-preferring Latinos. Conclusions. The findings suggest that expanding Medicaid eligibility regardless of immigration status improved access to health insurance for some Latino communities. ( Am J Public Health. 2025;115(6):900–909. https://doi.org/10.2105/AJPH.2025.308052 )

Background: Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion. Methods: This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020. Outcomes included up-to-date status for indicated cancer screenings at baseline; percentage of subsequent study months in which patients were up-to-date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk. Results: Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up-to-date on screenings. All cancer screenings were ordered less often for food-insecure patients. Cervical cancer screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed statistically significantly by select social risks: Cervical cancer and CRC screening rates were lower among food-insecure patients, and CRC screening rates were lower among transportation-insecure patients. The likelihood of breast cancer screening completion did not differ by social risk status. Conclusion: Social risks affect both the ordering and the receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early-detection services.

Background Studies assessing equity in the prevention of atherosclerotic cardiovascular disease (ASCVD) for Latinos living in the USA collectively yield mixed results. Latino persons are diverse in many ways that may influence cardiovascular health. The intersection of Latino nativity and ASCVD prevention is understudied. Objective To determine whether disparities in ASCVD screening, detection, and prescribing differ for US Latinos by country of birth. Design A retrospective cohort design utilizing 2014–2020 electronic health record data from a network of 320 community health centers across 12 states. Analyses occurred October 1, 2022, to September 30, 2023. Participants Non-Hispanic White and Latino adults age 20–75 years, born in Cuba, Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, and the USA. Exposures Ethnicity and country of birth. Main Measures Outcome measures included prevalence of statin eligibility, of having insufficient data to establish eligibility, odds of having a documented statin prescription, and rates of statin prescriptions and refills. We used covariate-adjusted logistic and generalized estimating equations logistic and negative binomial regressions to generate absolute and relative measures. Key Results Among 108,672 adults, 23% (n = 25,422) were statin eligible for primary or secondary prevention of ASCVD using American College of Cardiology/American Heart Association guidelines. Latinos, born in and outside the USA were more likely eligible than Non-Hispanic White patients were (US-born Latino OR = 1.55 (95% CI = 1.37–1.75); non-US-born Latino OR = 1.63 (95% CI = 1.34–1.98)). The eligibility criteria that was met differed by ethnicity and nativity. Latinos overall were less likely missing data to establish eligibility and differences were again observed by specific non-US country of origin. Among those eligible, we observed no statistical difference in statin prescribing between US-born Latinos and non-Hispanic White persons; however, disparities varied by specific non-US country of origin. Conclusion Efforts to improve Latino health in the USA will require approaches for preventing and reversing cardiovascular risk factors, and statin initiation that are Latino subgroup specific.

Context: Parental health insurance and health status are associated with their children’s health insurance and receipt of healthcare. Little is known about whether or not parental preventive service receipt impacts a child’s timely receipt of well-child care. Objective: Utilizing our validated algorithm linking children to their parents in a large population of community health center (CHC) patients, we assessed whether the odds of a child meeting well-child guidelines differ if their parents received preventive care during the observation period. Study Design: Longitudinal. Setting: OCHIN (not an acronym) network of CHCs that share a single instance of the Epic© EHR across 17 U.S. States. Population Studied: Family-units consisting of children ages 3-17 and their linked parents, each having at least one visit at a CHC providing both adult preventive care and well-child care, 2015-2018. Outcome Measures: Child having ≥1 well-child visit in an observation year analyzed using GEE logistic regression for children who could be linked to both a mother and a father. Model was adjusted for child’s age, U.S. region, and parent covariates for age, race/ethnicity, language, poverty level, insurance type, and number of chronic conditions. Results: We included 2,890 families consisting of a child linked to a mother and a father. The families were 36% Hispanic, 49% did not prefer English as their language of choice, 71% had at least one parent that was always insured during the study period, and nearly a third of both mothers and fathers had three or more unresolved chronic conditions. In 54% of families neither parent had a preventive care visit during the observation period and in only 10% of families did both parents have a preventive care visit. Children of the parents that had a preventive care visit had higher odds of receiving yearly well-child care compared to parents that lacked preventive care. If one parent had preventive care, the odds the child had a yearly well-child visit were 22% higher [Adjusted Odds Ratio (AOR)=1.22, 95% Confidence Interval (CI): 1.10-1.34] and if two parents had preventive care, the odds were 56% higher (AOR=1.56, 95% CI: 1.33-1.82) than if no preventive care was received by either parent. Conclusions: When a family is seen in the same CHC network, parental preventive care is associated with recommended well-child care. To optimize child healthcare, CHCs should consider trying to increase preventive service receipt for their parents.