Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
Am J Prev Med. 2015 Jan;48(1):13-21. doi: 10.1016/j.amepre.2014.08.029. Epub 2014 Oct 30.
Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives.
To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income.
Using pooled 2004-2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013.
Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant.
Generally, uninsured African American and Hispanic populations fare better than uninsured whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.
健康保险状况会影响获得预防服务的机会。有效利用预防服务是减少重要健康问题的关键因素，并有潜力使成年人过上更长寿、更健康的生活。
分析未参保成年人中美国预防服务工作组（USPSTF）推荐的预防服务的使用情况，重点关注种族、族裔和家庭收入的差异。
本研究使用 2004-2011 年医疗支出调查（MEPS）汇总数据，采用多元逻辑回归估计前一年未参保的 18 岁及以上成年人中，根据种族/族裔接受八项 USPSTF 推荐的预防服务的情况存在差异。对家庭收入进行分层分析。数据分析于 2013 年进行。
未参保成年人接受预防服务的比例远低于《2020 年健康人》目标。在未参保人群中，非裔美国人根据指南接受巴氏涂片检查、乳房 X 光检查、常规体检和血压检查的可能性高于白人。此外，与白人相比，西班牙裔接受巴氏涂片检查、乳房 X 光检查、流感疫苗接种和常规体检的可能性更高，而接受血压筛查和戒烟建议的可能性更低。按家庭收入分层时，除了最高收入水平（≥400%联邦贫困线）外，种族/族裔差异仍然存在，但差异基本不显著。
总体而言，未参保的非裔美国人和西班牙裔人群在预防服务利用方面的表现优于未参保的白人。未来的研究应研究这些种族/族裔差异背后的原因，为旨在提高未参保人群预防服务利用率的政策干预提供信息。
