Richter Nancy L, Gorey Kevin M, Haji-Jama Sundus, Luginaah Isaac N
School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada,
J Immigr Minor Health. 2015 Jun;17(3):652-9. doi: 10.1007/s10903-013-9941-2.
We hypothesized 3-way ethnicity by barrio by health insurance interactions such that the advantages of having adequate health insurance were greatest among Mexican American (MA) women who lived in barrios. Barrios were neighborhoods with relatively high concentrations of MAs (60% or more). Data were analyzed for 194 MA and 2,846 non-Hispanic white women diagnosed with, very treatable, node negative breast cancer in California between 1996 and 2000 and followed until 2011. Significant interactions were observed such that the protective effects of Medicare or private health insurance on radiation therapy access and long term survival were largest for MA women who resided in MA barrios, neighborhoods that also tended to be extremely poor. These paradoxical findings are consistent with the theory that more facilitative social and economic capital available to MA women in barrios enables them to better absorb the indirect and direct, but uncovered, costs of breast cancer care.
我们假设存在种族、社区和医疗保险的三方交互作用，即对于居住在社区中的墨西哥裔美国（MA）女性而言，拥有足够医疗保险的优势最为显著。社区是指墨西哥裔美国人聚居程度相对较高（60%或更高）的街区。对1996年至2000年间在加利福尼亚州被诊断患有极易治疗的淋巴结阴性乳腺癌的194名墨西哥裔美国女性和2846名非西班牙裔白人女性的数据进行了分析，并随访至2011年。观察到显著的交互作用，即医疗保险或私人健康保险对放疗可及性和长期生存的保护作用，对于居住在墨西哥裔美国人社区（这些社区往往也极其贫困）的墨西哥裔美国女性最为显著。这些矛盾的发现与以下理论一致：社区中的墨西哥裔美国女性可获得更多便利的社会和经济资本，这使她们能够更好地承担乳腺癌护理的间接和直接但未涵盖的费用。
