Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD.
Med Care. 2021 Jun 1;59(6):528-536. doi: 10.1097/MLR.0000000000001538.
Asian Americans have lower cancer screening rates than non-Latino "Whites," suggesting inequities in cancer prevention among Asian Americans. Little is known about inequities in cancer treatment between Whites and Asian Americans with cancer.
Using the 2002-2017 Medical Expenditure Panel Survey, we examined inequities in access to care and health care spending between Whites and Asian Americans with and without cancer. Our outcomes included 3 measures of access to care and 3 measures of health care spending. We used multivariable regressions while adjusting for predisposing, enabling, and need factors and estimated the mean adjusted values of the outcomes for each group. We then examined the differences in these adjusted mean outcomes among Asian Americans relative to Whites.
We observed evidence of inequities that Asian Americans without cancer experienced limited access to care due to a lack of a usual source of care. The likelihood of having a usual source of care was lower among Asian Americans without cancer than Whites without cancer. Inequities were not observed among Asian Americans with cancer. Compared with Whites with cancer, Asian Americans with cancer had similar or better levels of access to care. No or marginal differences in health care spending were detected between Whites and Asian Americans with cancer. These findings were consistent in both nonelderly and elderly groups.
While Asian Americans without cancer have unmet medical needs due to limited access to care, access to care and spending are relatively equitable between Whites and Asian Americans with cancer.
亚洲裔美国人的癌症筛查率低于非拉丁裔“白人”,这表明亚洲裔美国人的癌症预防存在不平等现象。关于患有癌症的白人和亚洲裔美国人之间在癌症治疗方面的不平等现象,人们知之甚少。
利用 2002 年至 2017 年的医疗支出调查,我们研究了有和没有癌症的白人和亚洲裔美国人在获得医疗服务和医疗支出方面的不平等情况。我们的研究结果包括 3 项获得医疗服务的措施和 3 项医疗支出措施。我们使用多变量回归,同时调整了倾向因素、促成因素和需求因素,并估计了每个群体的这些结果的平均调整值。然后,我们观察了亚洲裔美国人相对于白人的这些调整后结果的差异。
我们观察到了证据表明,没有癌症的亚洲裔美国人由于缺乏常规医疗来源而面临有限的医疗服务获取机会,这导致了他们的医疗服务获取不平等。没有癌症的亚洲裔美国人获得常规医疗来源的可能性低于没有癌症的白人。而患有癌症的亚洲裔美国人则没有观察到这种不平等现象。与患有癌症的白人相比,患有癌症的亚洲裔美国人具有相似或更好的医疗服务获取水平。在患有癌症的白人和亚洲裔美国人之间,没有发现或仅发现了边际上的医疗支出差异。这些发现无论在非老年组还是老年组中都是一致的。
虽然没有癌症的亚洲裔美国人由于医疗服务获取有限而存在未满足的医疗需求,但在癌症患者中,白人与亚洲裔美国人之间在医疗服务获取和支出方面相对公平。