Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA. 2021 Aug 17;326(7):637-648. doi: 10.1001/jama.2021.9907.
The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades.
To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US.
DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults.
Self-reported race, ethnicity, and income level.
Rates and racial and ethnic differences in self-reported health status and health care access and affordability.
The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification.
In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
消除健康状况和获得医疗保健方面的种族和民族差异是美国的一个目标，但不清楚在过去 20 年里，美国是否取得了进展。
确定美国成年人自我报告的健康状况和获得医疗保健的种族和民族差异的 20 年趋势，以及医疗保健的可负担性。
设计、地点和参与者：1999 年至 2018 年进行的国家健康访谈调查数据的系列横断面研究，纳入了 596355 名成年人。
自我报告的种族、族裔和收入水平。
自我报告的健康状况以及获得和负担得起医疗保健的比率和种族和民族差异。
该研究纳入了 596355 名成年人（平均[SE]年龄 46.2[0.07]岁，51.8%[SE，0.10%]为女性），其中 4.7%为亚洲人，11.8%为黑人，13.8%为拉丁裔/西班牙裔，69.7%为白人。低收入人群的估计百分比分别为亚洲人 28.2%、黑人 46.1%、拉丁裔/西班牙裔 51.5%和白人 23.9%。收入较低的黑人的不良或一般健康状况的估计患病率最高（1999 年为 29.1%[95%CI，26.5%-31.7%]，2018 年为 24.9%[95%CI，21.8%-28.3%]），而收入中等和较高的白人则最低（1999 年为 6.4%[95%CI，5.9%-6.8%]，2018 年为 6.3%[95%CI，5.8%-6.7%]）。1999 年，无论收入阶层如何，黑人的不良或一般健康状况的估计患病率均显著高于白人（整体和低收入人群中 P<0.001；中高收入人群 P=0.03）。从 1999 年到 2018 年，种族和民族之间不良或一般健康状况的差距没有明显变化，无论是否进行收入分层，除了低收入的白人和黑人之间的差异显著缩小（-6.7 个百分点[95%CI，-11.3 至-2.0]；P=0.005）；2018 年的差异不再具有统计学意义（P=0.13）。黑人和白人的自我报告功能障碍水平最高，随着时间的推移，所有群体的功能障碍水平都显著增加。在一些自我报告的医疗保健获取措施方面，种族和民族差异有了显著减少，但在可负担性方面没有显著减少，无论是否进行收入分层。
在对 1999 年至 2018 年美国成年人进行的一系列横断面调查研究中，自我报告的健康状况、获取和可负担性方面的种族和民族差异在一些亚组中有所改善，但总体上仍持续存在。
