Choi Sunha
College of Social Work, The University of Tennessee, Knoxville, Tennessee, USA
Int J Health Serv. 2016 Oct;46(4):693-711. doi: 10.1177/0020731416662610. Epub 2016 Aug 5.
Healthy People 2020 in the United States highlights timely access to necessary health care as a major factor that can reduce health-related disparities. This study examined the prevalence of delaying/missing necessary health care because of cost among foreign-born adults (26+ years old) in the United States by their region of origin, after controlling for geographic clustering at the county and state levels.
Using the pooled 2007-2011 National Health Interview Survey and linked state/county-level data, this study analyzed data on 61,732 foreign-born adults from nine regions of birth. Three-level multilevel modeling (state > county > individual) was conducted. The age-adjusted percentages of foreign-born adults who delayed/missed necessary health care because of cost varied by region of birth, ranging from 7.0% (Southeast Asia) and 11.9% (Europe) to 15.5% (Mexico/Central America/Caribbean) and 16.7% (the Middle East). However, after controlling for geographic clustering and other individual-level covariates (e.g., insurance), adults from Mexico/Central America/Caribbean were less likely to delay or not receive necessary care compared to their counterparts from all other parts of the world except for those from Asian regions. This study implies that disparities can be reduced if some known risk factors (e.g., insurance) are improved among foreign-born adults.
美国《健康人民2020》强调及时获得必要的医疗保健是减少与健康相关差异的一个主要因素。本研究在控制了县和州层面的地理聚集因素后，按原籍地区调查了美国外国出生的成年人（26岁及以上）中因费用问题推迟/错过必要医疗保健的情况。
利用2007 - 2011年合并的国家健康访谈调查以及州/县层面的关联数据，本研究分析了来自九个出生地区的61732名外国出生成年人的数据。进行了三级多水平建模（州>县>个体）。因费用问题推迟/错过必要医疗保健的外国出生成年人的年龄调整百分比因出生地区而异，范围从7.0%（东南亚）和11.9%（欧洲）到15.5%（墨西哥/中美洲/加勒比地区）和16.7%（中东）。然而，在控制了地理聚集和其他个体层面的协变量（如保险）后，与除亚洲地区以外世界其他地区的同龄人相比，来自墨西哥/中美洲/加勒比地区的成年人推迟或未接受必要护理的可能性较小。本研究表明，如果改善外国出生成年人中的一些已知风险因素（如保险），差异可能会减少。
