Center on Aging and Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
Int J Geriatr Psychiatry. 2017 Aug;32(8):909-921. doi: 10.1002/gps.4546. Epub 2016 Jul 1.
The objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need.
Data were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+ years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need.
Racial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos.
Expenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright © 2016 John Wiley & Sons, Ltd.
运用美国医学研究所（Institute of Medicine）的医疗保健差异定义，比较（1）有和无共病精神健康需求的老年成年人在一般医疗保健使用方面的种族/民族差异，以及（2）有共病精神健康需求的群体中一般医疗保健使用的种族/民族差异。
数据来自医疗支出调查（Medical Expenditure Panel Survey，2004-2012 年）。样本包括 21263 名 65 岁及以上的参与者（14973 名非拉丁裔白种人、3530 名非裔美国人、2760 名拉丁裔人）。身体疾病通过患有 11 种优先慢性疾病之一来确定。共病精神健康需求的定义为患有慢性疾病之一且 Kessler-6 量表>12，或两项目患者健康问卷>2。一般医疗保健使用是指接受非精神健康专科护理。使用两部分广义线性模型来估计和比较有和无共病精神健康需求的老年成年人的一般医疗保健使用和支出。
与没有共病精神健康需求的成年人相比，有共病精神健康需求的成年人在一般医疗保健支出方面的种族/民族差异更大。在有共病精神健康需求的成年人中，非拉丁裔白种人在处方药使用方面的支出明显高于非裔美国人和拉丁裔人。
支出差异反映了与非拉丁裔白种人相比，向非裔美国人和拉丁裔人提供的资源数量存在差异。这与医疗质量的差异并不等同。需要采取干预措施和政策，以确保少数民族老年成年人获得公平的服务，使他们能够有效地管理其共病精神和身体健康需求。
