University of Maryland, School of Pharmacy, Baltimore, MD.
Ethn Dis. 2020 Jul 9;30(3):399-410. doi: 10.18865/ed.30.3.399. eCollection 2020 Summer.
There is limited information regarding the prevalence and predictors of cost-related non-utilization (CRNU), while there is increasing attention to the rising out-of-pocket cost of health services including prescription medications. Prior studies have not quantified the role of perceived racism despite its documented relationship with health services utilization. We examine perceptions of reactions to race and quantify their relationship with CRNU.
This retrospective cross-sectional study utilized data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) public use file, an annual, state-based telephone survey of US adults aged 18 and older. We utilized data for four states that provided responses to five Reactions to Race items, including information about the self-perceived quality of the respondent's health care experience compared with people of other races (worse vs same or better) and whether the respondent experienced physical symptoms because of treatment due to their race. The three binary outcomes were: 1) did not visit a physician; 2) did not visit a physician due to cost; 3) did not fill a prescription due to cost. We estimated covariate-adjusted odds ratios associated with each outcome using logistic regression models.
The BRFSS sample consisted of 20,366 respondents of whom 8% were African American non-Hispanic, 12% were Hispanic and 73% were White. Three percent of respondents considered their experience to be worse than people of other races. Three percent of individuals reported physical symptoms because of treatment due to their race while 5% of respondents reported becoming emotionally upset because of treatment due to their race. The proportions for the three study outcomes were 11%, 13% and 7%, respectively. In covariate-adjusted models, a worse experience with the health care system was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.6 - 4.3]). The experience of physical symptoms because of treatment due to race was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.7 - 4]; prescription fills: 2.1 [1.2 - 3.6]). No Reactions to Race items were associated with general non-utilization.
Negative perceptions of reactions to race during the time of health services utilization is positively associated with CRNU, ie, foregoing physician visits and prescription fills due to cost.
有关经济相关非利用（CRNU）的发生率和预测因素的信息有限，而人们对包括处方药物在内的医疗服务不断上涨的自付费用的关注日益增加。尽管先前的研究已经证明了种族观念与卫生服务利用之间存在关系，但它们并未量化种族观念的作用。我们检查了对种族的反应的看法，并量化了它们与 CRNU 的关系。
本回顾性横断面研究利用了 2014 年行为风险因素监测系统（BRFSS）公共使用文件的数据，该系统是一项针对美国 18 岁及以上成年人的年度州际电话调查。我们使用了四个提供五个种族反应项目答复的州的数据，这些数据包括受访者对自己的医疗保健体验与其他种族的人相比的看法（较差与相同或更好）以及由于种族原因接受治疗时受访者是否出现身体症状。三个二进制结果为：1）未看医生；2）由于费用而未看医生；3）由于费用而未开处方。我们使用逻辑回归模型估计了与每个结果相关的调整后的协变量比值。
BRFSS 样本由 20366 名受访者组成，其中 8％是非西班牙裔的非洲裔美国人，12％是西班牙裔，73％是白人。3％的受访者认为自己的经历比其他人差。有 3％的人因种族原因接受治疗而出现身体症状，而 5％的人因种族原因接受治疗而感到情绪激动。这三个研究结果的比例分别为 11％，13％和 7％。在调整后的协变量模型中，对医疗保健系统的体验较差与 CRNU 具有统计学显着相关性（医生就诊：2.6 [95％CI：1.6-4.3]）。由于种族原因接受治疗而出现身体症状与 CRNU 具有统计学显着相关性（医生就诊：2.6 [95％CI：1.7-4]；处方填写：2.1 [1.2-3.6]）。种族反应的任何项目都与一般非利用无关。
在卫生服务利用过程中对种族反应的负面看法与 CRNU 呈正相关，即由于费用而放弃医生就诊和处方填写。
