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探讨医疗保健可及性在不同种族/族裔之间接受医患吸烟讨论方面的差异中的作用:潜在类别分析。

Examining the role of healthcare access in racial/ethnic disparities in receipt of provider-patient discussions about smoking: A latent class analysis.

机构信息

Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, New York, NY, United States of America.

Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, New York, NY, United States of America.

出版信息

Prev Med. 2021 Jul;148:106584. doi: 10.1016/j.ypmed.2021.106584. Epub 2021 Apr 27.

Abstract

Using insurance as a single indicator of healthcare access in examining the association between race/ethnicity and healthcare encounter-based interventions for smoking may not be adequate. In this study, we assessed the role of healthcare access using multifactorial measures in accounting for racial/ethnic disparities in the receipt of provider-patient discussions, defined as either being asked about smoking or advised to quit smoking by providers. We identified adult current smokers from the 2015 National Health Interview Survey. We first conducted a latent class analysis (LCA) to identify the underlying patterns of healthcare access measured by 13 indicators of healthcare access and utilization. We then used a propensity score - based weighting approach to examine racial/ethnic disparities in receiving provider-patient discussions about smoking or quitting in stratified groups by the distinct healthcare access clusters. Out of the 4134 adult current smokers who visited a doctor or a healthcare provider during the past 12 months, 3265 (79.90%) participants were classified as having high healthcare access and 869 (20.10%) participants as having low healthcare access. Compared to non-Hispanic whites, Hispanics had significantly lower odds of being asked about smoking (OR 0.46, 95% CI (0.27-0.77)) and being advised to quit (OR 0.57, 95% CI (0.34-0.97)) in the low access group, but neither association was significant in the high access group. In addition to increasing health insurance coverage, reducing other healthcare access barriers for Hispanics will likely facilitate provider-patient discussion and promote tobacco cessation among Hispanic smokers.

摘要

使用保险作为衡量医疗保健可及性的单一指标,来考察种族/族裔与以医疗保健为基础的吸烟干预措施之间的关联可能并不充分。在这项研究中,我们使用多因素措施评估了医疗保健可及性的作用,以解释在接受提供者-患者讨论方面的种族/族裔差异,这些讨论被定义为提供者询问吸烟情况或建议患者戒烟。我们从 2015 年全国健康访谈调查中确定了成年当前吸烟者。我们首先进行了潜在类别分析(LCA),以确定由 13 项医疗保健可及性和利用指标衡量的潜在医疗保健可及性模式。然后,我们使用基于倾向评分的加权方法,根据不同的医疗保健可及性聚类,在分层组中检查接受关于吸烟或戒烟的提供者-患者讨论的种族/族裔差异。在过去 12 个月内就诊过医生或医疗保健提供者的 4134 名成年当前吸烟者中,3265 名(79.90%)参与者被归类为具有高医疗保健可及性,869 名(20.10%)参与者被归类为具有低医疗保健可及性。与非西班牙裔白人相比,在低可及性组中,西班牙裔被问及吸烟的可能性显著降低(OR 0.46,95%CI(0.27-0.77))和被建议戒烟(OR 0.57,95%CI(0.34-0.97)),但在高可及性组中,这两种关联均不显著。除了增加健康保险覆盖范围外,减少西班牙裔的其他医疗保健可及性障碍可能有助于促进提供者-患者讨论并促进西班牙裔吸烟者戒烟。

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