Haas Jennifer S, Phillips Kathryn A, Sonneborn Dean, McCulloch Charles E, Baker Laurence C, Kaplan Celia P, Pérez-Stable Eliseo J, Liang Su-Ying
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusett 02160, USA.
Med Care. 2004 Jul;42(7):707-14. doi: 10.1097/01.mlr.0000129906.95881.83.
Although the majority of studies examining racial/ethnic disparities in health care have focused on the characteristics of the individual, more recently there has been growing attention to the notion that an individual's health practices could be influenced by the characteristics of the place where they reside.
The objective of this study was to examine whether access to care for individuals of different racial/ethnic groups varies by the prevalence of blacks and the prevalence of Latinos in their county of residence.
We conducted a cross-sectional cohort.
Individuals from the 1996 Medical Expenditure Panel Survey, a nationally representative sample of U.S. households, who described their race/ethnicity as white, black, or Latino, and who resided in 1 of 677 counties (n = 14740) were studied.
Counties were assigned to 6 groups based on the prevalence of blacks and Latinos who resided there (<6% referred to as "low prevalence," 6-39% referred to as "midprevalence," >or=40% referred to as "high prevalence" separately for both blacks and Latinos). Outcomes included whether during the past year any family members: 1). experienced difficulty obtaining any type of health care, delayed obtaining care, or did not receive health care they thought they needed (referred to as "difficulty obtaining care"); or (2). did not receive a doctor's care or a prescription medication because the family needed money to buy food, clothing, or pay for housing (referred to as "financial barriers").
After controlling for other individual and area-level covariates, blacks reported lower rates of both outcome variables when they lived in a county with a high prevalence of blacks compared with blacks who lived in a county with a low prevalence of blacks (difficulty obtaining care: 4.3% vs. 18.8%, P <0.005; financial barriers: 1.6% vs. 10.5%, P <0.005). There was a similar association for Latinos by the prevalence of Latinos in the county for difficulty obtaining care (high: 5.0% vs. low: 13.4%, P <0.05), but not the financial barriers outcome (high: 2.2% vs. low: 2.4%, P = 0.90). Whites who lived in an area with a high prevalence of Latinos were more likely to report both outcomes compared with whites who lived in a county with a low prevalence of Latinos (difficulty obtaining care: 17.7% vs. 9.4%, P <0.05; financial barriers: 8.5% vs. 3.2%, P <0.005) .
Blacks and Latinos may perceive fewer barriers to care when they live in a county with a high prevalence of people of similar race/ethnicity. Conversely, whites may perceive more difficulty receiving care when they live in an area with a high prevalence of Latinos. Diminishing disparities in access to health care may require interventions that extend beyond the individual.
尽管大多数研究医疗保健中种族/民族差异的研究都集中在个体特征上，但最近人们越来越关注个人的健康行为可能会受到其居住地区特征影响这一观点。
本研究的目的是检验不同种族/民族群体获得医疗服务的机会是否因居住县的黑人患病率和拉丁裔患病率而异。
我们进行了一项横断面队列研究。
来自1996年医疗支出面板调查的个体，该调查是美国家庭的全国代表性样本，他们将自己的种族/民族描述为白人、黑人或拉丁裔，并且居住在677个县中的1个（n = 14740），对其进行了研究。
根据居住在那里的黑人和拉丁裔的患病率，将县分为6组（<6%称为“低患病率”，6 - 39%称为“中等患病率”，黑人及拉丁裔的患病率均≥40%分别称为“高患病率”）。结果包括在过去一年中是否有家庭成员：1）。在获得任何类型的医疗服务方面遇到困难、延迟获得医疗服务或未获得他们认为需要的医疗服务（称为“获得医疗服务困难”）；或（2）。因为家庭需要钱购买食物、衣服或支付住房费用而未接受医生诊疗或未获得处方药（称为“经济障碍”）。
在控制了其他个体和地区层面的协变量后，与居住在黑人患病率低的县的黑人相比，居住在黑人患病率高的县的黑人报告这两个结果变量的发生率较低（获得医疗服务困难：4.3%对18.8%，P <0.005；经济障碍：1.6%对10.5%，P <0.005）。对于拉丁裔，在获得医疗服务困难方面，根据县内拉丁裔的患病率也有类似的关联（高患病率：5.0%对低患病率：13.4%，P <0.05），但在经济障碍结果方面没有（高患病率：2.2%对低患病率：2.4%，P = 0.90）。与居住在拉丁裔患病率低的县的白人相比，居住在拉丁裔患病率高的地区 的白人更有可能报告这两个结果（获得医疗服务困难：17.7%对9.4%，P <0.05；经济障碍：8.5%对3.2%，P <0.005）。
黑人和拉丁裔居住在同种族/民族患病率高的县时，可能会感觉到获得医疗服务的障碍较少。相反，白人居住在拉丁裔患病率高的地区时，可能会感觉到接受医疗服务更困难。减少获得医疗服务方面的差异可能需要超越个体层面的干预措施。
