Mahajan Shiwani, Caraballo César, Lu Yuan, Massey Dorothy, Murugiah Karthik, Annapureddy Amarnath R, Roy Brita, Riley Carley, Onuma Oyere, Nunez-Smith Marcella, Valero-Elizondo Javier, Forman Howard P, Nasir Khurram, Herrin Jeph, Krumholz Harlan M
Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
medRxiv. 2020 Nov 4:2020.10.30.20223487. doi: 10.1101/2020.10.30.20223487.
Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking.
To evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades.
Cross-sectional.
National Health Interview Survey data, years 1999-2018.
Adults aged 18-85 years.
Race/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic).
Proportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes.
We included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1-20.4) and 41.1% (95% CI 38.7-43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5- 11.7) and 31.2% (95% CI 30.3-32.1) among White individuals. Notably, between 1999-2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (-0.07% per year, 95% CI -0.16-0.01) and Hispanic (-0.03% per year, 95% CI -0.07- 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1-0.4) and Hispanic (+0.3% per year, 95% CI 0.1-0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep.
The marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.
35年前，《赫克勒报告》描述了美国少数族裔人群中的健康差异。自那时以来，已实施了多项政策来解决这些差异。然而，最近缺乏对美国成年人在改善健康和健康公平方面进展情况的评估。
评估过去20年美国成年人在身心健康方面的种族/族裔差异。
横断面研究。
1999 - 2018年的国家健康访谈调查数据。
18 - 85岁的成年人。
种族/族裔亚组（非西班牙裔白人、非西班牙裔黑人、非西班牙裔亚裔、西班牙裔）。
报告健康状况差/一般、严重心理困扰、功能受限和睡眠不足的成年人比例。我们还估计了非西班牙裔白人与其他亚组在这四个结局方面的差距。
我们纳入了596,355名成年人（平均年龄46岁，51.8%为女性），其中分别有69.7%、13.8%、11.8%和4.7%的人分别认定为非西班牙裔白人、西班牙裔、非西班牙裔黑人、非西班牙裔亚裔。在1999年至2018年期间，黑人在大多数健康指标上表现更差，2018年有18.7%（95%可信区间17.1 - 20.4）和41.1%（95%可信区间38.7 - 43.5）的人报告健康状况差/一般和睡眠不足，而白人中这一比例分别为11.1%（95%可信区间10.5 - 11.7）和31.2%（95%可信区间30.3 - 32.1）。值得注意的是，在1999 - 2018年期间，白人与黑人（每年 - 0.07%，95%可信区间 - 0.16 - 0.01）和西班牙裔（每年 - 0.03%，95%可信区间 - 0.07 - 0.02）在健康状况差/一般方面的差距没有显著缩小，白人与黑人（每年 + 0.2%，95%可信区间0.1 - 0.4）和西班牙裔（每年 + 0.3%，95%可信区间0.1 - 0.4）在睡眠方面的差距有所扩大。此外，报告健康状况差/一般的成年人没有显著减少，而报告严重心理困扰、功能受限和睡眠不足的成年人有所增加。
过去20年美国成年人在健康方面存在的显著种族/族裔差异并未得到改善。此外，在此期间美国成年人自我感知的健康状况恶化。这些发现凸显了重新审视旨在促进健康公平和改善健康的举措的必要性。
