Asch David A, Armstrong Katrina
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
J Clin Oncol. 2007 May 20;25(15):2117-21. doi: 10.1200/JCO.2006.09.3336.
Health and health care are distributed unevenly across individuals and populations, and identifying these disparities is the first step toward remedying them. We reveal how conceptual and statistical challenges make even the identification of disparities difficult. These difficulties arise because the social, biologic, and environmental causes of disparities are intertwined, leading to statistical confounding. These difficulties arise also because the same data can be analyzed to examine care from the perspective of the patient, or from the perspective of organizations such as health systems or jurisdictions, and these alternative perspectives can yield contradictory results. The result is that health care disparities can be challenging to interpret unless the analytic and policy perspective is clear.
健康和医疗保健在个体和人群中分布不均，识别这些差异是纠正差异的第一步。我们揭示了概念和统计方面的挑战如何使差异的识别变得困难。这些困难之所以出现，是因为差异的社会、生物和环境原因相互交织，导致统计上的混杂。这些困难的出现还因为可以对相同的数据进行分析，从患者的角度，或从卫生系统或司法管辖区等组织的角度来审视医疗服务，而这些不同的视角可能会产生相互矛盾的结果。结果是，除非分析和政策视角明确，否则医疗保健差异可能难以解释。
