青少年和青年肌营养不良症患者的种族间医疗保健利用差异。
Disparities in health care utilization by race among teenagers and young adults with muscular dystrophy.
机构信息
*Department of Economics, Moore School of Business †Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina ‡Department of Family and Preventive Medicine, University of South Carolina School of Medicine §Division of Research and Statistics, South Carolina Budget and Control Board, Columbia, SC ∥Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA.
出版信息
Med Care. 2014 Oct;52(10 Suppl 3):S32-9. doi: 10.1097/MLR.0000000000000194.
BACKGROUND
For people with muscular dystrophy (MD) health care access is crucial and utilization is expected to be high. A multidisciplinary approach is needed for optimal management of symptoms of this rare condition. Regular primary care, specialty care, therapy, and medicine use can improve quality of care and reduce need for emergency treatment and hospitalization. We analyzed health insurance and administrative data to test for racial disparities in regular care use among teenagers and young adults with MD.
METHODS
We used South Carolina Medicaid and other administrative data for individuals aged 15-24 years to determine annual health care utilization patterns for individuals with MD by race. We studied adolescents and young adults with MD because this age group represents a time when the condition is typically intensifying and the transition from pediatric to adult care is expected. We used Generalized Estimating Equation models to analyze longitudinal utilization data conditional on other factors that may lead to utilization differences.
RESULTS
Race is correlated with health care utilization among adolescents and young adults with MD. Blacks have lower overall utilization, and less primary care, therapy, and specialist care use but higher incidence of hospitalization and emergency treatment use compared with whites and also to other races. The most striking disparity was the use of outpatient services. Blacks utilized these services 50% less compared with whites and 70% less compared with others. Even in regression analysis, where we take into account individual unobserved factors and allow clustering at the individual level, these differences remained and were in most cases statistically significant.
CONCLUSIONS
Our results indicate that there are differences in health care utilization by race even when individuals have access to the same health care benefits. This means simply offering coverage to individuals with MD may not be sufficient in eliminating health disparities. Future studies will be needed to examine other possible sources of these racial disparities, such as resource awareness, health knowledge, or access barriers such as transportation.
背景
对于肌肉萎缩症 (MD) 患者来说，获得医疗保健至关重要，预计他们的利用率会很高。为了对这种罕见疾病的症状进行最佳管理，需要采取多学科方法。定期的初级保健、专科护理、治疗和药物使用可以改善护理质量，并减少对急诊治疗和住院的需求。我们分析了医疗保险和管理数据，以检验 MD 青少年和年轻人常规护理使用中的种族差异。
方法
我们使用南卡罗来纳州医疗补助计划和其他管理数据，针对 15-24 岁的个人，根据种族确定 MD 个人的年度医疗保健使用模式。我们研究了患有 MD 的青少年和年轻人，因为这个年龄段通常是病情加重的时候，预计他们将从儿科护理过渡到成人护理。我们使用广义估计方程模型，根据可能导致利用差异的其他因素，对纵向利用数据进行分析。
结果
种族与 MD 青少年和年轻人的医疗保健利用有关。与白人相比，黑人的整体利用率较低，初级保健、治疗和专科护理的利用率较低，但住院和急诊治疗的利用率较高，与其他种族相比也是如此。最引人注目的差异是门诊服务的使用。与白人相比，黑人使用这些服务的比例低 50%，与其他人相比低 70%。即使在回归分析中，我们考虑到个人未观察到的因素，并允许在个人层面进行聚类，这些差异仍然存在，而且在大多数情况下具有统计学意义。
结论
即使个人获得相同的医疗保健福利，我们的研究结果表明，医疗保健的利用存在种族差异。这意味着仅仅向 MD 患者提供覆盖范围可能不足以消除健康差距。未来的研究将需要研究其他可能导致这些种族差异的来源，例如资源意识、健康知识或交通等获取障碍。
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