JAMA Netw Open. 2026 Mar 2;9(3):e260237. doi: 10.1001/jamanetworkopen.2026.0237.
ABSTRACT
IMPORTANCE: Cost-related delayed or forgone care is an issue affecting Latino adults and may lead to increased emergency department (ED) visits.
OBJECTIVES: To examine the association between cost-related delayed or forgone physical and mental health care and ED visits among Latino adults aged 18 to 64 years in the US and to estimate within-group differences in ED visits by language, place of birth, heritage, citizenship status, and insurance status, after adjusting for delayed or forgone care.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed pooled data from January 1, 2019, to December 31, 2024 (2019-2024 waves) in the National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents. The analytic sample included Latino adults aged 18 to 64 years.
EXPOSURE: Self-reported cost-related delayed or forgone physical and mental health care.
MAIN OUTCOME AND MEASURES: The primary outcome consisted of self-reported ED visits in the past 12 months (yes or no). Weighted multivariable logistic regression models estimated adjusted odds ratios (AORs) and 95% CIs, controlling for survey year and sociodemographic, health-related, and geographic factors.
RESULTS: A total of 17 344 Latino adults were included, with a median age of 36.7 (IQR, 26,0-48.1) years. In weighted proportions, 50.7% were female, 58.5% had a high school education or less, and 16.9% reported delayed or forgone care. Respondents who reported cost-related delayed or forgone care had significantly higher odds of reporting at least 1 ED visit in the past 12 months (AOR, 1.78; 95% CI, 1.59-2.01) compared with those who did not report delaying or forgoing care. Females (AOR, 1.33; 95% CI, 1.21-1.47) and individuals with lower educational attainment (AOR for less than high school vs college graduate, 1.60; 95% CI, 1.34-1.92), public insurance (AOR, 1.69; 95% CI, 1.49-1.91), non-Mexican heritage (AOR, 1.18; 95% CI, 1.07-1.30), and poorer self-rated health (AOR, 4.09; 95% CI, 3.05-5.48) had higher odds of at least 1 ED visit. Compared with US-born individuals, those born outside the US had lower odds of having at least 1 ED visit (AOR, 0.75; 95% CI, 0.65-0.86). All estimates were adjusted for delayed or forgone care.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study including Latino US adults, cost-related delays and forgone care were associated with increased ED use, underscoring the need for policies that reduce financial barriers to timely health care.
PMID:41817528 | DOI:10.1001/jamanetworkopen.2026.0237
