Persky Susan, de Heer Hendrik D, McBride Colleen M, Reid Robert J
Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA.
Obesity (Silver Spring). 2014 Apr;22(4):1194-200. doi: 10.1002/oby.20677. Epub 2013 Dec 19.
Increases in overweight and obesity (O/O)-related morbidities and health care costs raise questions about how weight influences patients' health care use and care experiences. Past research has been inconsistent; however, prior study designs and samples have limited exploration of how this association might be influenced by gender, race, and the joint impact of these factors.
This analysis of 1,036 young, relatively healthy, ethnically diverse, insured adults assessed the influence of O/O, gender, and race on, and the role of health care experiences in primary and preventive care use over a 12-month period.
The association of weight status with care use differed by gender. O/O men used more primary care visits; O/O women used fewer preventive care visits than their healthy weight counterparts. O/O men had poorer health care experiences than healthy weight men. African-American women reported poorer experiences, but those who were O/O reported greater trust in their provider. Care experience ratings did not explain the associations between BMI and care use.
Gender, race, and visit type together provide a context for O/O patient's care that may not be explained by care experiences. This context must be considered in efforts to encourage appropriate use of services.
超重和肥胖（O/O）相关疾病及医疗保健成本的增加引发了关于体重如何影响患者医疗保健利用和就医体验的问题。过去的研究结果并不一致；然而，以往的研究设计和样本对这种关联如何受到性别、种族以及这些因素的共同影响的探索有限。
对1036名年轻、相对健康、种族多样且参保的成年人进行分析，评估了O/O、性别和种族对12个月期间初级和预防性医疗保健利用的影响，以及就医体验在其中所起的作用。
体重状况与医疗保健利用之间的关联因性别而异。O/O男性进行的初级保健就诊更多；与体重正常的女性相比，O/O女性进行的预防性保健就诊更少。O/O男性的就医体验比体重正常的男性更差。非裔美国女性报告的就医体验较差，但那些O/O女性对其医疗服务提供者的信任度更高。就医体验评分并不能解释体重指数（BMI）与医疗保健利用之间的关联。
性别、种族和就诊类型共同为O/O患者的医疗保健提供了一个背景，而这可能无法通过就医体验来解释。在鼓励合理使用医疗服务的努力中，必须考虑到这一背景。
