Structural Determinants of Cost‐Related Healthcare Delay Among Refugee Newcomers in the United States: Evidence From the Annual Survey of Refugees, 2020–2022

Objective To examine multilevel correlates of cost‐related healthcare delay among refugee newcomers and their families in the United States. Study Setting and Design We analyzed pooled cross‐sectional data from the 2020 to 2022 Annual Survey of Refugees, guided by an integrated Andersen‐Hynie framework. Survey‐weighted least absolute shrinkage and selection operator (LASSO) regression selected variables for weighted logistic regression, with region, and survey cycle retained throughout. Data Sources and Analytic Sample Public‐use data comprised 4333 adult household respondents with an observed outcome; 3129 had complete candidate‐variable data. Multilingual telephone interviews were conducted in 2021–2023. Principal Findings The weighted prevalence of reported cost‐related delay for oneself or a family member was 17.8%. Noncost healthcare barriers and discrimination were associated with increases of 12.7 percentage points (95% confidence interval, 8.8–16.7) and 9.4 percentage points (5.6–13.2), respectively, in adjusted delay probability. Each additional insured month was associated with a 1.1‐percentage‐point decrease (0.6–1.5). Regional differences were not clearly supported after adjustment. Key associations persisted in sensitivity analyses. Conclusions Noncost healthcare barriers, discrimination, and shorter insurance coverage were associated with cost‐related delays. The findings support attention to coverage continuity, navigation support, and equitable treatment in healthcare services.