Kenik Jordan, Jean-Jacques Muriel, Feinglass Joe
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Prev Med. 2014 Aug;65:65-9. doi: 10.1016/j.ypmed.2014.04.026. Epub 2014 May 5.
To determine whether racial and ethnic disparities in cholesterol screening persist after controlling for socioeconomic status, access to care and language.
Data were obtained from the 2011 Behavioral Risk Factor Surveillance System for men aged 35 and older and women aged 45 and older in accordance with the United States Preventive Services Task Force guidelines. Self-reported cholesterol screening data are presented for 389,039 respondents reflecting over 141million people. Sequential logistic regression models of the likelihood of never having been screened are presented adjusted for demographic characteristics, health status, behavioral risk factors, socioeconomic status, health care access, and questionnaire language.
A total of 9.1% of respondents, reflecting almost 13million individuals, reported never having been screened. After adjustment for socioeconomic status, health care access and Spanish language, disparities between whites and Blacks and Hispanics, but not Asians and Pacific Islanders, were eliminated.
Lower socioeconomic status, lack of healthcare access and language barriers explained most of the racial and ethnic disparities in cholesterol screening. Expanding insurance coverage, simplifying cardiac risk assessment and improving access to culturally and linguistically appropriate care hold the greatest promise for improving cardiovascular disease screening and treatment for vulnerable populations.
在控制社会经济地位、医疗服务可及性和语言因素后，确定胆固醇筛查中的种族和族裔差异是否依然存在。
根据美国预防服务工作组指南，从2011年行为危险因素监测系统中获取35岁及以上男性和45岁及以上女性的数据。呈现了389,039名受访者的自我报告胆固醇筛查数据，这些受访者代表了超过1.41亿人。针对从未接受过筛查的可能性建立了序贯逻辑回归模型，并根据人口统计学特征、健康状况、行为危险因素、社会经济地位、医疗服务可及性和问卷语言进行了调整。
共有9.1%的受访者（代表近1300万人）报告从未接受过筛查。在调整社会经济地位、医疗服务可及性和西班牙语因素后，白人与黑人和西班牙裔之间的差异消除，但亚洲人和太平洋岛民之间的差异未消除。
较低的社会经济地位、缺乏医疗服务可及性和语言障碍解释了胆固醇筛查中大部分的种族和族裔差异。扩大保险覆盖范围、简化心脏风险评估以及改善获得文化和语言适宜的医疗服务的机会，对于改善弱势群体的心血管疾病筛查和治疗最具前景。
