Wang Yang, Wilson Fernando A, Chen Li-Wu
*Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI †Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
Med Care. 2017 Jun;55(6):629-635. doi: 10.1097/MLR.0000000000000697.
We examined differences in cancer-related office-based provider visits associated with immigration status in the United States.
Data from the 2007-2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups. We measured the relationships of immigrant status to number of visits and associated expenditure within the past 12 months, adjusting for age, sex, educational attainment, race/ethnicity, self-reported health status, time since cancer diagnosis, cancer remission status, marital status, poverty status, insurance status, and usual source of care. We finally performed sensitivity analyses for regression results by using the propensity score matching method to adjust for potential selection bias.
Noncitizens had about 2 fewer visits in a 12-month period in comparison to US-born citizens (4.0 vs. 5.9). Total expenditure per patient was higher for US-born citizens than immigrants (not statistically significant). Noncitizens (88.3%) were more likely than US-born citizens (76.6%) to be seen by a medical doctor during a visit. Multivariate regression results showed that noncitizens had 42% lower number of visiting medical providers at office-based settings for cancer care than US-born citizens, after adjusting for all the other covariates. There were no significant differences in expenditures across immigration groups. The propensity score matching results were largely consistent with those in multivariate-adjusted regressions.
Results suggest targeted interventions are needed to reduce disparities in utilization between immigrants and US-born citizen cancer patients.
我们研究了在美国与移民身份相关的基于办公室的癌症医疗服务提供者就诊差异。
2007 - 2012年医疗支出小组调查和国民健康访谈调查的数据纳入了被诊断患有癌症的成年患者。单因素分析描述了各移民群体接受的基于办公室的癌症相关医疗服务提供者就诊分布、支出、就诊特征以及人口统计学、社会经济和健康协变量。我们测量了移民身份与过去12个月内就诊次数和相关支出之间的关系，并对年龄、性别、教育程度、种族/族裔、自我报告的健康状况、癌症诊断后的时间、癌症缓解状态、婚姻状况、贫困状况、保险状况和通常的医疗服务来源进行了调整。我们最后使用倾向得分匹配方法对回归结果进行敏感性分析，以调整潜在的选择偏倚。
与美国出生的公民相比，非公民在12个月内的就诊次数大约少2次（4.0次对5.9次）。美国出生的公民的每位患者总支出高于移民（无统计学意义）。非公民（88.3%）在就诊时比美国出生的公民（76.6%）更有可能看医生。多变量回归结果显示，在调整所有其他协变量后，非公民在基于办公室的癌症护理环境中看医疗服务提供者的次数比美国出生的公民少42%。各移民群体之间的支出没有显著差异。倾向得分匹配结果与多变量调整回归结果基本一致。
结果表明需要有针对性的干预措施来减少移民和美国出生的公民癌症患者在医疗服务利用方面的差异。
