保险不稳定是否与高血压结果相关，且这种相关性是否因种族/民族而异？
Is insurance instability associated with hypertension outcomes and does this vary by race/ethnicity?
机构信息
VA Boston Healthcare System, Boston University School of Medicine, 801 Massachusetts Ave, Crosstown Center, Boston, MA, 02118, USA.
Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington St, Boston, MA, 02111, USA.
出版信息
BMC Health Serv Res. 2020 Mar 16;20(1):216. doi: 10.1186/s12913-020-05095-8.
BACKGROUND
Stable health insurance is often associated with better chronic disease care and outcomes. Racial/ethnic health disparities in outcomes are prevalent and may be associated with insurance instability, particularly in the context of health insurance reform.
METHODS
We examined whether insurance instability was associated with uncontrolled blood pressure (UBP) and whether this association varied by race/ethnicity. We used a retrospective longitudinal observational cohort study of patients diagnosed with hypertension who obtained care within two health systems in Massachusetts. We measured the UBP, insurance instability, and race of 43,785 adult primary care patients, age 21-64 with visits from 1/2005-12/2013.
RESULTS
We found higher rates of UBP for blacks and Hispanics at each time point over the entire 9 years. Insurance instability was associated with greater rates of UBP. Always uninsured black patients fared worst, while white and Hispanic patients with consistent public insurance fared best.
CONCLUSIONS
Stable insurance of any type was associated with better hypertension control than no or unstable insurance.
背景
稳定的健康保险通常与更好的慢性病护理和结果相关。在健康保险改革的背景下，不同种族/民族在结果方面存在健康差距，这很常见，并且可能与保险不稳定有关。
方法
我们研究了保险不稳定是否与未控制的血压（UBP）有关，以及这种关联是否因种族/民族而异。我们使用了一项回顾性纵向观察队列研究，研究对象为在马萨诸塞州两个医疗系统中就诊的被诊断患有高血压的成年初级保健患者。我们测量了 43785 名年龄在 21-64 岁之间、2005 年 1 月至 2013 年 12 月期间就诊的患者的 UBP、保险不稳定情况和种族。
结果
我们发现，在整个 9 年期间，每个时间点的黑人及西班牙裔患者的 UBP 发生率都更高。保险不稳定与更高的 UBP 发生率相关。一直没有保险的黑人患者情况最差，而白人患者和一直拥有公共保险的西班牙裔患者情况最好。
结论
任何类型的稳定保险都与更好的高血压控制相关，而非没有保险或保险不稳定。
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