• Alice Guan, Salma Shariff-Marco, Kevin A Henry, Katherine Lin, Dan Meltzer, Alison J Canchola, Angel Arizpe, Aniruddha B Rathod, Amy E Hughes, Candyce H Kroenke, Scarlett L Gomez, Robert A Hiatt, Antoinette M Stroup, Paulo S Pinheiro, Francis Boscoe, Hong Zhu, and Sandi L Pruitt.
• Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
• J Gen Intern Med. 2024 Sep 16.

BackgroundHispanic or Latino populations (hereafter, "Latinos") are a rapidly expanding U.S. demographic and have documented inequities in preventable diseases and conditions. Many Latinos reside in ethnic enclaves, and understanding the context and healthcare accessibility within these places is critical.ObjectiveThis study described the neighborhood social and built environment attributes of Latino enclaves and evaluated associations between enclaves and geographic healthcare accessibility.DesignCross-sectional ecologic analysis.SubjectsOur unit of analysis was all neighborhoods (n ~ 20,000 census tracts) in California, Florida, New Jersey, New York, and Texas in years 2000 and 2010.Main MeasuresThe primary exposure of interest, "Latino enclaves," was defined using neighborhood-level data on the percentage of Latino residents, foreign-born Latinos, Spanish speakers with limited English proficiency, and linguistically isolated Spanish-speaking households. The primary outcome was a neighborhood-level measure of geographic healthcare accessibility of primary care physicians, which accounted for both the supply of physicians and population demand for healthcare (i.e., population size within driving distance).ResultsApproximately 30% of neighborhoods were classified as Latino enclaves, 87% of which were enclaves in both 2000 and 2010. Compared with non-enclaves, Latino enclaves had more markers of structural disadvantage including having higher proportions of poverty, uninsured individuals, crowded housing, and higher crime scores. Results from multivariable models suggest that more culturally distinct neighborhoods (i.e., higher enclave score) had lower healthcare accessibility, though when stratified, this association persisted only in high (≥ 20%) poverty neighborhoods.ConclusionThis study highlights several neighborhood structural disadvantages within Latino enclaves, including higher poverty, uninsured individuals, and crime compared to non-enclave neighborhoods. Moreover, our findings point to the need for interventions aimed at improving healthcare accessibility particularly within socioeconomically disadvantaged Latino enclaves. Addressing these inequities demands multifaceted approaches that consider both social and structural factors to ensure equitable healthcare access for Latino populations.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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