Cook Benjamin L, Zuvekas Samuel H, Chen Jie, Progovac Ana, Lincoln Alisa K
1 Harvard Medical School, Boston, MA, USA.
2 Cambridge Health Alliance, Cambridge, MA, USA.
Med Care Res Rev. 2017 Aug;74(4):404-430. doi: 10.1177/1077558716646898. Epub 2016 May 4.
This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods with higher minority density, lower average education, and greater specialist mental health provider density, all of which predict lesser mental health care initiation. Neighborhood-level variables do not have differential effects on mental health care by race/ethnicity. Racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with Whites. Low rates of initiation in neighborhoods with a high density of specialists suggest that interventions to increase mental health care specialists, without a focus on treating racial/ethnic minorities, may not reduce access disparities.
本研究评估了患有精神疾病的成年人在心理健康护理事件中种族/族裔差异的个体层面和地区层面预测因素。使用与地区层面数据集相关联的医疗支出面板调查数据估计多层次回归模型。与白人相比，黑人和拉丁裔居住在少数族裔密度更高、平均教育水平更低且精神健康专科提供者密度更大的社区，所有这些因素都预示着心理健康护理开始的可能性较小。社区层面的变量对不同种族/族裔的心理健康护理没有差异影响。种族/族裔差异的出现是因为少数族裔更有可能居住在治疗开始率较低的社区，而不是因为与白人相比，社区劣势对少数族裔治疗开始的影响存在差异。专科医生密度高的社区治疗开始率低，这表明在不关注治疗种族/族裔少数群体的情况下增加心理健康护理专科医生的干预措施可能无法减少获得医疗服务的差距。
