Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.
Neurology. 2011 Jan 4;76(1):53-61. doi: 10.1212/WNL.0b013e318203e952. Epub 2010 Nov 17.
Mexican Americans and non-Hispanic blacks have higher stroke recurrence rates and lower rates of secondary stroke prevention than non-Hispanic whites. As a potential explanation for this disparity, we assessed racial/ethnic differences in access to physician care and medications in a national sample of US stroke survivors.
Among all 4,864 stroke survivors aged≥45 years who responded to the National Health Interview Survey years 2000-2006, we compared access to care within the last 12 months by race/ethnicity before and after stratification by age (45-64 years vs ≥65 years). With logistic regression, we adjusted associations between access measures and race/ethnicity for sex, comorbidity, neurologic disability, health status, year, income, and health insurance.
Among stroke survivors aged 45-64 years, Mexican Americans, non-Hispanic blacks, and non-Hispanic whites reported similar rates of no generalist physician visit (approximately 15%) and inability to afford medications (approximately 20%). However, among stroke survivors aged≥65 years, Mexican Americans and blacks, compared with whites, reported greater frequency of no generalist visit (15%, 12%, 8%; p=0.02) and inability to afford medications (20%, 11%, 6%; p<0.001). Mexican Americans and blacks more frequently reported no medical specialist visit (54%, 49%, 40%; p<0.001) than did whites and rates did not differ by age. Full covariate adjustment did not fully explain these racial/ethnic differences.
Among US stroke survivors at least 65 years old, Mexican Americans and blacks reported worse access to physician care and medications than whites. This reduced access may lead to inadequate risk factor modification and recurrent stroke in these high-risk minority groups.
与非西班牙裔白人相比，墨西哥裔美国人和非西班牙裔黑人的中风复发率更高，二级中风预防率更低。作为这种差异的一个潜在解释，我们评估了美国中风幸存者中种族/民族在获得医生护理和药物方面的差异。
在对 2000 年至 2006 年全国健康访谈调查中回答问题的所有 4864 名年龄≥45 岁的中风幸存者中，我们比较了按年龄分层（45-64 岁与≥65 岁）前后种族/民族在过去 12 个月内获得医疗服务的情况。我们使用逻辑回归，调整了性别、合并症、神经功能障碍、健康状况、年份、收入和医疗保险等因素与种族/民族之间的关系。
在年龄为 45-64 岁的中风幸存者中，墨西哥裔美国人、非西班牙裔黑人和非西班牙裔白人报告的普通内科医生就诊率相似（约 15%），无法负担药物费用的比例相似（约 20%）。然而，在年龄≥65 岁的中风幸存者中，与白人相比，墨西哥裔美国人和黑人报告了更多的普通内科医生就诊（15%、12%、8%；p=0.02）和无法负担药物费用（20%、11%、6%；p<0.001）。与白人相比，墨西哥裔美国人和黑人更多地报告没有看医学专家（54%、49%、40%；p<0.001），且年龄之间没有差异。完全调整协变量并不能完全解释这些种族/民族差异。
在美国至少 65 岁的中风幸存者中，墨西哥裔美国人和黑人报告的医疗服务和药物获得情况比白人差。这种获取途径的减少可能导致这些高风险少数群体的危险因素控制不足和中风复发。
