{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:37Z","timestamp":1777859017092,"version":"3.51.4"},"reference-count":8,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32-HL160522"],"award-info":[{"award-number":["T32-HL160522"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>The Cape Verdean diaspora in the United States is growing, yet Cape Verdean adults remain underrepresented in health services research. We retrospectively analyzed 583 hospitalized Cape Verdean adults admitted to a tertiary care center from 2017 to 2023, and compared their post-discharge outcomes and healthcare utilization with other racial and ethnic groups. Sequential nested regression models using inverse-probability weighting assessed how demographic, clinical, and community-level characteristics using the Environmental Justice Index (EJI) mediated the observed differences. We found that Cape Verdean adults had uniquely high primary care engagement, a difference which was magnified after EJI adjustment. They also had lower rates of specialist visits and higher emergency department use, but these associations attenuated or reversed after adjustment for clinical factors and EJI. These findings suggest that care continuity is strong within this population, potentially due to robust Community Health Center engagement, but socioeconomic and structural factors may hinder specialist access and drive emergency care use.<\/jats:p>","DOI":"10.1177\/21501319251383427","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T09:54:52Z","timestamp":1761126892000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Primary Care Engagement and Post-Hospitalization Outcomes Among Cape Verdean Adults"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4443-2441","authenticated-orcid":false,"given":"Lucas X.","family":"Marinacci","sequence":"first","affiliation":[{"name":"Richard A. and Susan F. 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Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Northwell Health, Phelps Memorial Hospital Center, Sleepy Hollow, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Jacques","family":"Alves","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Djanira","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azariah","family":"Boyd","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishi K.","family":"Wadhera","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Stevens","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"35","volume-title":"Transnational Archipelago: Perspectives on Cape Verdean Migration and Diaspora","author":"Halter M.","unstructured":"Halter M. Chapter 2 Cape Verdeans in the U.S. In: Batalha L, Carling J eds. Transnational Archipelago: Perspectives on Cape Verdean Migration and Diaspora, Amsterdam University Press; 2008:35-46."},{"key":"e_1_3_3_3_2","unstructured":"The Immigrant Learning Center Public Education Institute. Greater Boston\u2019s Immigrants from Cape Verde. The Immigrant Learning Center. 2020. Accessed May 30 2024. https:\/\/www.ilctr.org\/wp-content\/uploads\/2020\/11\/Cape-Verde-Greater-Boston-factsheet.pdf"},{"key":"e_1_3_3_4_2","unstructured":"Boston Planning and Development Agency Research Division. Race and Ethnicity in the 2020 Census: Self-Identification or Classification? The Boston Planning & Development Agency. 2023. Accessed July 23 2024. https:\/\/www.bostonplans.org\/getattachment\/7f8a7f96-e7f1-4d9c-b5bf-e353c1bc277d"},{"key":"e_1_3_3_5_2","unstructured":"U.S. Census Bureau. American Community Survey 5 Year Estimates: People Reporting Ancestry; 2023. Accessed September 1 2025. https:\/\/data.census.gov\/table\/ACSDT5Y2023.B04006?t=Ancestry&g=010XX00U$S0400000&moe=false&tp=true&tableFilters=ag-Grid-AutoColumn~(Margin+of+Errorundefined)"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-017-0353-1"},{"key":"e_1_3_3_7_2","unstructured":"Massachusetts Alliance of Portuguese Speakers. The Health of Portuguese Speakers in Massachusetts. 2012. Accessed September 1 2025. https:\/\/www.maps-inc.org\/wp-content\/uploads\/2012\/05\/Community-Health-Profile.pdf"},{"key":"e_1_3_3_8_2","unstructured":"McKenzie B Berens A Bogovic S et al Technical Documentation for the Environmental Justice Index 2022. Centers for Disease Control and Prevention Agency for Toxic Substance and Disease Registry. 2022. 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