Wiltshire Jacqueline C, Elder Keith, Kiefe Catarina, Allison Jeroan J
Jacqueline C. Wiltshire is with the Department of Health Policy and Management, University of South Florida College of Public Health, Tampa. Keith Elder is with the Department of Health Management and Policy, Saint Louis University School of Public Health, St Louis, MO. Jeroan J. Allison and Catarina Kiefe are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
Am J Public Health. 2016 Jun;106(6):1086-91. doi: 10.2105/AJPH.2016.303137. Epub 2016 Apr 14.
To evaluate African American-White differences in medical debt among older adults and the extent to which economic and health factors explained these.
We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education.
African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings.
African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status, income, and insurance disparities. Public health implications. In Medicare, low-income beneficiaries, especially low-income African Americans with poor health status, should be protected from the unintended financial consequences of cost-reduction strategies.
评估老年非裔美国人和白人在医疗债务方面的差异，以及经济和健康因素对这些差异的解释程度。
我们使用了来自2007年和2010年美国健康跟踪家庭调查的全国代表性数据（n = 5838），并计算了基于人口的、归因于经济和健康因素的医疗债务估计值，同时对年龄、性别、婚姻状况和教育程度进行了调整。
非裔美国人有医疗债务的几率是白人的2.6倍（优势比 = 2.62；95%置信区间 = 1.85, 3.72）。健康状况解释了观察到的差异的22.8%，收入和保险解释了19.4%。这些因素综合起来解释了观察到的差异的42.4%。此外，非裔美国人更有可能被追债机构联系，并且因为医疗债务而借钱，而白人更有可能动用储蓄。
与白人相比，非裔美国人背负着大量医疗债务，其中超过40%是由健康状况、收入和保险差异所介导的。公共卫生影响。在医疗保险中，低收入受益人，尤其是健康状况不佳的低收入非裔美国人，应免受成本削减策略带来的意外财务后果的影响。
