Healthcare access is a key determinant of population health and health equity in the United States. The structural and socioeconomic determinants of access to ongoing, timely care include health insurance coverage, income level, and the presence of a usual source of care, which in turn affect whether individuals receive continuous, timely care or primarily use acute and hospital-based services. Non-Hispanic Black women of reproductive age have been found to have limited access to healthcare, which has been associated with delayed access to healthcare, poorly controlled chronic conditions, and poor health outcomes. To characterize patterns of access to healthcare and overnight hospital use among reproductive-age non-Hispanic Black women in the United States, this capstone analyzed data from the National Health and Nutrition Examination Survey (NHANES) pre-pandemic cycle (2017–March 2020). The analytic sample consisted of 531 non-Hispanic Black women aged 18– 44 years with positive sampling weights, representing approximately 7.8 million women nationwide. The outcomes of interest were health insurance coverage, usual source of care, self- rated health, and overnight hospital stay in the last 12 months. The estimates were generated using PROC SURVEYFREQ in SAS, accounting for the complex NHANES sampling design. Most women (82.5%) reported good health or better. Nonetheless, 18.7% were uninsured, and 14.7% lacked a usual source of care, with both indicators being patterned by income. The lack of a usual source of care was strongly associated with being uninsured: 28.6% of uninsured women had no usual source of care, compared with 11.5% of insured women. Women with fair (22.2%) or poor (25.1%) self-rated health were more likely to be uninsured than the overall sample (18.7%). The 12-month prevalence of overnight hospital stay was 11.8% and did not differ meaningfully by insurance status (11.9% insured vs. 11.1% uninsured) or by self-rated 3 health, which supports the interpretation that this prevalence reflects obstetric and elective inpatient utilization rather than access-driven acute care. These findings characterize patterned disparities in structural access within a population with substantial healthcare needs. They can inform public health strategies to expand insurance coverage and connect reproductive-age Black women to continuous primary care.
Emmanuel Bassey (Tue,) studied this question.