Healthcare access barriers among older refugee newcomers in the United States

BACKGROUND AND OBJECTIVES: Older refugees in the United States face substantial healthcare access barriers shaped by displacement, trauma, and systemic challenges. Despite growing recognition of these barriers, research remains limited. This study examined multilevel predictors of healthcare access barriers among older refugees using the Older Adult Immigrant Adapted Model for Health Promotion, an ecological framework integrating individual, interpersonal, community, and structural factors. RESEARCH DESIGN AND METHODS: Data were drawn from the Annual Survey of Refugees (2020-2022), yielding a nationally representative sample of 840 refugees aged 50 and older. Healthcare access barriers were measured as cumulative difficulties across cost, transportation, language, knowledge, and appointment access. Using Poisson regression with LASSO regularization and multiple imputation, we identified salient predictors across ecological levels while accounting for missing data and overfitting. RESULTS: The final model explained 65 percent of variance in barrier counts. Structural and social conditions were dominant: cumulative resettlement challenges showed the strongest association with barriers (Incidence Rate Ratio [IRR] = 1.60, p < .001), followed by perceived discrimination (IRR = 1.49-1.52, p < .001) and neighborhood unsafety (IRR = 1.34, p < .01). Poorer physical health modestly increased barriers (IRR = 1.14, p < .05), while residing in the United States for 2-3 years was protective (IRR = 0.81, p < .05). The model demonstrated excellent classification performance (AUC = 0.858). DISCUSSION AND IMPLICATIONS: Healthcare access barriers among older refugees reflect structural adversity and social exclusion rather than individual characteristics alone. Findings support an ecological perspective that emphasizes multilevel determinants and suggest that interventions should address resettlement coordination, discrimination reduction, and community welcoming alongside healthcare system improvements to achieve equity for aging refugee populations.