Callahan S Todd, Hickson Gerald B, Cooper William O
Child and Adolescent Health Research Unit, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee 37212-3100, USA.
J Adolesc Health. 2006 Nov;39(5):627-33. doi: 10.1016/j.jadohealth.2006.04.012. Epub 2006 Jul 10.
Hispanic persons in the United States experience higher rates of many chronic conditions than non-Hispanic whites. Access to care, especially during young adulthood, may afford opportunities for prevention or early management of these conditions. Given the heterogeneity of the Hispanic population, the specific aims of this study were to assess health insurance coverage and health care access and utilization for different Hispanic subgroups young adults in the U.S.
We analyzed data from 5189 Hispanic and 13,214 white young adults (19-29 years old) completing the National Health Interview Survey (NHIS) from 1999-2002. Health care access/utilization measures included reports of 1) uninsurance, 2) lacking a usual source of care, 3) no health professional contact, and 4) delaying needed care because of cost. Multivariate analyses were used to estimate the risk of access barriers after adjusting for sociodemographic variables and citizenship.
Young adults of Central/South American, Mexican, or Puerto Rican origins were more likely than whites to be uninsured (28%-64% vs. 22%; p < .01) and this was especially true for noncitizens. Central/South American and Mexican young adults without U.S. citizenship were most likely to be uninsured (63% and 73%, respectively). The majority of noncitizens also lacked a usual source of care and had no health professional contact in the prior year. After adjustment, the risk of uninsurance was 60% higher for Mexican and Central/South American young adults relative to white peers. Mexican young adults also had higher risk of lacking a usual source of care and having no health professional contact.
Substantial variability in rates of uninsurance and health care access/utilization measures exist among subgroups of Hispanic young adults participating in the NHIS. U.S. citizenship and sociodemographic factors explain much, but not all of the differences.
在美国，西班牙裔人群患多种慢性病的几率高于非西班牙裔白人。获得医疗服务，尤其是在青年时期，可能为预防或早期管理这些疾病提供机会。鉴于西班牙裔人口的异质性，本研究的具体目的是评估美国不同西班牙裔亚组青年成年人的医疗保险覆盖情况以及医疗服务的可及性和利用情况。
我们分析了1999 - 2002年完成国家健康访谈调查（NHIS）的5189名西班牙裔和13214名白人青年成年人（19 - 29岁）的数据。医疗服务可及性/利用情况的衡量指标包括：1）未参保；2）缺乏固定的医疗服务来源；3）未与医疗专业人员接触；4）因费用问题推迟所需医疗服务。在对社会人口统计学变量和公民身份进行调整后，采用多变量分析来估计获得医疗服务障碍的风险。
来自中美洲/南美洲、墨西哥或波多黎各的青年成年人比白人更有可能未参保（28% - 64%对22%；p < 0.01），非公民尤其如此。没有美国公民身份的中美洲/南美洲和墨西哥青年成年人最有可能未参保（分别为63%和73%）。大多数非公民在前一年也缺乏固定的医疗服务来源且未与医疗专业人员接触。调整后，墨西哥和中美洲/南美洲青年成年人未参保的风险比白人同龄人高60%。墨西哥青年成年人缺乏固定医疗服务来源和未与医疗专业人员接触的风险也更高。
参与NHIS的西班牙裔青年成年人亚组在未参保率以及医疗服务可及性/利用情况衡量指标方面存在很大差异。美国公民身份和社会人口统计学因素解释了大部分但并非全部差异。
