Elucidating the Role of Place in Health Care Disparities: The Example of Racial/Ethnic Residential Segregation

OBJECTIVE: To develop a conceptual framework for investigating the role of racial/ethnic residential segregation on health care disparities. DATA SOURCES AND SETTINGS: Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011. STUDY DESIGN: The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course. PRINCIPAL FINDINGS: The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified. CONCLUSIONS: Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions.