MMWR Morb Mortal Wkly Rep. 2018 Jun 1;67(21):593-598. doi: 10.15585/mmwr.mm6721a1.
Lack of health insurance has been associated with poorer health status and with difficulties accessing preventive health services and obtaining medical care, especially for chronic diseases (1-3). Among workers, the prevalence of chronic conditions, risk behaviors, and having health insurance has been shown to vary by occupation (4,5). CDC used data from the 2013 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the prevalence of having no health care coverage (e.g., health insurance, prepaid plans such as health maintenance organizations, government plans such as Medicare, or Indian Health Service) by occupation. Among all workers aged 18-64 years, the prevalence of being uninsured declined significantly (21%) from 16.0% in 2013 to 12.7% in 2014. In both years there were large differences in the prevalence of being uninsured among occupational groups, ranging from 3.6% among the architecture and engineering occupations to 37.9% among the farming, fishing, and forestry occupations in 2013 and 2.7% among community and social services; and education, training, and library occupations to 37.0% among building and grounds cleaning and maintenance occupations in 2014 (p<0.001). In 2014, more than 25% of workers in four occupational groups reported having no health insurance (construction and extraction [29.1%]; farming, fishing, and forestry [34.6%]; food preparation and serving related [35.5%]; and building and grounds cleaning and maintenance [37.0%]). Identifying factors affecting differences in coverage by occupation might help to address health disparities among occupational groups.
缺乏健康保险与较差的健康状况以及获得预防保健服务和医疗保健的困难有关,尤其是对于慢性病而言(1-3)。在工人中,已经发现慢性病的流行率、风险行为以及是否有健康保险因职业而异(4,5)。疾病预防控制中心使用 2013 年和 2014 年行为风险因素监测系统(BRFSS)的数据,按职业估算了没有医疗保健覆盖(例如,健康保险、预付计划(如健康维护组织)、政府计划(如医疗保险)或印度卫生服务)的患病率。在所有 18-64 岁的工人中,未参保的比例从 2013 年的 16.0%显著下降到 2014 年的 12.7%。在这两年中,职业群体之间的未参保率存在很大差异,从 2013 年建筑和工程职业的 3.6%到农业、渔业和林业职业的 37.9%不等,而 2014 年社区和社会服务以及教育、培训和图书馆职业的 37.0%到建筑和场地清洁和维护职业的 3.7%(p<0.001)。2014 年,四个职业群体中有超过 25%的工人报告没有健康保险(建筑和采掘业[29.1%];农业、渔业和林业[34.6%];食品制备和相关服务[35.5%];以及建筑和场地清洁和维护[37.0%])。确定影响职业差异的因素可能有助于解决职业群体之间的健康差距。