Fiscella Kevin, Franks Peter, Doescher Mark P, Saver Barry G
Department of Family Medicine, University of Rochester School of Medicine, New York, USA.
Med Care. 2002 Jan;40(1):52-9. doi: 10.1097/00005650-200201000-00007.
Racial and ethnic disparities in health care have been well documented, but poorly explained.
To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care.
Cross-sectional analysis of the Community Tracking Survey (1996-1997).
Adults 18 to 64 years with private or Medicaid health insurance.
Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year.
The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55).
Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.
医疗保健中的种族和族裔差异已有充分记录，但原因却鲜为人知。
研究包括英语流利程度在内的就医障碍对医疗保健中种族和族裔差异的影响。
对社区追踪调查（1996 - 1997年）进行横断面分析。
年龄在18至64岁之间、拥有私人医疗保险或医疗补助保险的成年人。
自变量包括种族、族裔和英语流利程度。因变量包括在过去一年中是否看过医生或进行过心理健康咨询、是否接种流感疫苗或进行过乳房X光检查。
在粗模型或多变量模型中，讲英语的西班牙裔患者的医疗保健使用模式与非西班牙裔白人患者没有显著差异。相比之下，讲西班牙语的西班牙裔患者看医生（相对风险RR，0.77；95%置信区间CI，0.72 - 0.83）、进行心理健康咨询（RR，0.50；95% CI，0.32 - 0.76）或接种流感疫苗（RR，0.30；95% CI，0.15 - 0.52）的可能性明显低于非西班牙裔白人患者。在对 predisposing、需求和促成因素进行调整后，讲西班牙语的西班牙裔患者在所有四项测量指标上的使用量均显著低于非西班牙裔白人患者。黑人患者接种流感疫苗的粗相对风险显著较低（RR，0.73；95% CI，0.58 - 0.87）。对其他因素进行调整对这一效应影响不大，但导致黑人患者与心理健康专业人员就诊的可能性显著低于非西班牙裔白人患者（RR，0.46；95% CI，0.37 - 0.55）。
在有保险的非老年成年人中，按种族和西班牙裔族裔划分，医疗保健使用情况存在明显差异。护理方面的族裔差异在很大程度上可由英语流利程度的差异来解释，但护理方面的种族差异无法通过常用的就医因素来解释。
