Chen Judy Y, Diamant Allison, Pourat Nadereh, Kagawa-Singer Marjorie
Department of Medicine, University of California-Los Angeles, Los Angeles, California 90024, USA.
Am J Prev Med. 2005 Dec;29(5):388-95. doi: 10.1016/j.amepre.2005.08.006.
Minorities have worse health outcomes compared to whites, which are partially explained by racial/ethnic disparities in use of health services. Less well known, however, are whether these disparities persist among the elderly, the only group that possesses near universal health insurance coverage by Medicare, and how variation in Medicare coverage affects the receipt of preventive services. The scope of racial/ethnic disparities in the use of preventive services in the elderly was assessed, and the impact of the type of health insurance coverage on the use of preventive services was measured.
Data were derived from the 2001 California Health Interview Survey, a random-digit-dial population-based survey, collected between November 2000 and October 2001. Analysis for this project was conducted in 2004. The association of race/ethnicity and type of health insurance with receipt of preventive services was assessed using bivariate and multivariate logistic regression models.
African Americans and Latinos were significantly less likely to be vaccinated for influenza, and Asian Americans were significantly less likely to obtain a mammogram compared to whites, while controlling for other explanatory factors. Moreover, those with Medicare plus Medicaid coverage were significantly less likely to use all four preventive services compared to those with Medicare plus private supplemental insurance.
Despite near-universal coverage by Medicare, racial/ethnic disparities in the use of some preventive services among the elderly persist. Further research should focus on identifying potential cultural and structural barriers to receipt of preventive services aimed at designing effective intervention among high-risk groups.
与白人相比，少数族裔的健康状况更差，部分原因是医疗服务使用方面的种族/族裔差异。然而，鲜为人知的是，这些差异在老年人（唯一通过医疗保险享有近乎全民医保覆盖的群体）中是否依然存在，以及医疗保险覆盖范围的差异如何影响预防性服务的获得。评估了老年人在预防性服务使用方面的种族/族裔差异范围，并衡量了医疗保险覆盖类型对预防性服务使用的影响。
数据来源于2001年加利福尼亚健康访谈调查，这是一项基于随机数字拨号的人群调查，于2000年11月至2001年10月期间收集。该项目的分析于2004年进行。使用双变量和多变量逻辑回归模型评估种族/族裔与医疗保险类型与预防性服务获得之间的关联。
在控制其他解释因素的情况下，与白人相比，非裔美国人和拉丁裔接种流感疫苗的可能性显著降低，亚裔美国人进行乳房X光检查的可能性显著降低。此外，与拥有医疗保险加私人补充保险的人相比，拥有医疗保险加医疗补助的人使用所有四项预防性服务的可能性显著降低。
尽管医疗保险覆盖率近乎全民，但老年人在某些预防性服务使用方面的种族/族裔差异依然存在。进一步的研究应侧重于确定获得预防性服务的潜在文化和结构障碍，以便针对高危群体设计有效的干预措施。
