芝加哥高质量透析治疗获取中的种族/民族不平等：邻里的种族/民族构成是否重要？
Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?
机构信息
Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue Room 221, Los Angeles, CA, 90089-0191, USA.
General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
出版信息
J Racial Ethn Health Disparities. 2020 Oct;7(5):854-864. doi: 10.1007/s40615-020-00708-8. Epub 2020 Feb 5.
OBJECTIVES
Blacks and Hispanics face a higher incidence rate of end-stage renal disease (ESRD) and tend to experience poorer access to quality health care compared with Whites. Income, education, and insurance coverage differentials are typically identified as risk factors, but neighborhood-level analyses may provide additional insights. We examine whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago.
METHODS
Data are drawn from the United States Renal Data System merged to the ESRD Quality Incentive Program file and the American Community Survey (2005-2009) for facility and neighborhood characteristics (N = 2797). Outcomes included (1) spatial access (travel time to dialysis facilities) and (2) realized access (actual use of quality care). Neighborhood racial/ethnic composition was categorized into four types: predominantly White, Black, and Hispanic neighborhoods, and racially integrated neighborhoods.
RESULTS
Blacks lived closer to a dialysis facility but traveled the same distance to their own dialysis compared with Whites. Hispanics had longer travel time to any dialysis than Whites, and the difference between Hispanics and Whites became no longer significant after adjusting for neighborhood racial/ethnic composition. Blacks and Hispanics had better access to a high-quality facility if they lived in integrated neighborhoods (OR = 1.85 and 3.77, respectively, p < 0.01) or in neighborhoods with higher concentrations of their own race/ethnicity (OR = 1.68 for Blacks in Black neighborhoods and 1.92 for Hispanics in Hispanic neighborhoods, p < 0.05) compared with Whites in predominantly White neighborhoods.
CONCLUSION
Expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.
目的
与白人相比，黑人和西班牙裔面临更高的终末期肾病（ESRD）发病率，并且往往获得优质医疗保健的机会较差。收入、教育和保险覆盖范围的差异通常被认为是风险因素，但邻里层面的分析可能提供更多的见解。我们研究了邻里种族构成是否会导致芝加哥接受高质量透析护理的种族/族裔不平等。
方法
数据来自美国肾脏数据系统与 ESRD 质量激励计划文件和美国社区调查（2005-2009 年）的合并，用于设施和社区特征（N=2797）。结果包括（1）空间可达性（到透析设施的旅行时间）和（2）实现可达性（实际使用高质量护理）。邻里种族/族裔构成分为四种类型：主要是白人、黑人、西班牙裔和种族融合的邻里。
结果
与白人相比，黑人居住的地方离透析设施更近，但到自己的透析设施的距离相同。与白人相比，西班牙裔的透析旅行时间更长，而在调整邻里种族/族裔构成后，西班牙裔与白人之间的差异不再显著。如果黑人和西班牙裔居住在融合的邻里（OR=1.85 和 3.77，分别为 p<0.01）或自己种族/族裔浓度较高的邻里（黑人在黑人邻里的 OR=1.68，西班牙裔在西班牙裔邻里的 OR=1.92，均为 p<0.05），则他们获得高质量设施的机会更好与主要是白人的邻里中的白人相比。
结论
扩大黑人和西班牙裔获得融合和少数民族邻里的机会，可能有助于缓解肾脏病患者获得优质护理的种族/族裔不平等。
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