1 Department of Public Health, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
Eur J Public Health. 2013 Dec;23(6):922-6. doi: 10.1093/eurpub/cks170. Epub 2012 Dec 7.
The increasing diversity of the Western-European population demands identification of potential ethnic healthcare inequities. We developed a framework that helps researchers in interpreting ethnic inequalities in healthcare consumption in equity terms. From this framework, we develop recommendations for the design of future studies.
The framework was developed by analysing three typical studies on ethnic inequalities in healthcare consumption with respect to the potential of interpreting their results as healthcare inequities.
Analysing the effects of ethnic variations in healthcare consumption on health outcomes provides important clues about the presence of potential ethnic healthcare inequities. Interpretation of ethnic variations in healthcare consumption as potentially inequitable requires appropriate adjustment for medical need for healthcare, patient preferences and treatment adherence. Because of the central position of medical need, studies need to be disease-specific and based on standardized assessment of risk factors and disease characteristics. A longitudinal study design is necessary to prevent reverse causation.
The framework shows that ethnic inequalities in healthcare consumption can be justified if healthcare received meets the need for healthcare in all groups and is in accordance with informed patient preferences. It also shows that ethnic equality in healthcare consumption may hide healthcare inequities. We recommend further research on ethnic healthcare inequities using multi-ethnic cohort designs combined with linkage to healthcare registries. We also recommend research to identify clinically relevant ethnic differences in disease profiles and optimization of treatment regimens.
西欧人口日益多样化，需要确定潜在的族裔医疗保健不公平现象。我们制定了一个框架，帮助研究人员从公平的角度解释医疗保健消费中的族裔不平等现象。根据这一框架，我们提出了未来研究设计的建议。
该框架是通过分析三项关于族裔间医疗保健消费不平等的典型研究而制定的，这些研究涉及到解释其结果是否为医疗保健不公平的潜力。
分析医疗保健消费的族裔差异对健康结果的影响，可以为潜在的族裔医疗保健不公平现象的存在提供重要线索。将医疗保健消费的族裔差异解释为潜在的不公平现象，需要对医疗保健的医疗需求、患者偏好和治疗依从性进行适当调整。由于医疗需求处于核心地位，研究需要针对具体疾病，并基于对风险因素和疾病特征的标准化评估。为了防止反向因果关系，需要采用纵向研究设计。
该框架表明，如果所有群体的医疗保健需求都能得到满足，并且符合知情患者的偏好，那么医疗保健消费中的族裔不平等是可以被证明合理的。它还表明，医疗保健消费中的族裔平等可能隐藏着医疗保健不公平现象。我们建议使用多族裔队列设计，并结合与医疗保健登记处的链接，进一步研究族裔医疗保健不公平问题。我们还建议开展研究，以确定疾病特征方面具有临床意义的族裔差异，并优化治疗方案。
