Machen Leah, Davenport Clemontina A, Oakes Megan, Bosworth Hayden B, Patel Uptal D, Diamantidis Clarissa
Ochsner Medical Center, New Orleans, LA.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
Kidney Med. 2021 Oct 26;4(1):100382. doi: 10.1016/j.xkme.2021.08.016. eCollection 2022 Jan.
RATIONALE & OBJECTIVE: Little is known about how socioeconomic status (SES) relates to the prioritization of medical care spending over personal expenditures in individuals with multiple comorbid conditions, and whether this relationship differs between Blacks and non-Blacks. We aimed to explore the relationship between SES, race, and medical spending among individuals with multiple comorbid conditions.
Cross-sectional evaluation of baseline data from a randomized controlled trial.
SETTING & PARTICIPANTS: The STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study is a completed randomized controlled trial of Duke University primary care patients with diabetes, hypertension, and chronic kidney disease. Participants underwent survey assessments inclusive of measures of socio-demographics and medication adherence.
Race (Black or non-Black) and socioeconomic status (income, education, and employment).
The primary outcomes were based on 4 questions related to spending, asking about reduced spending on basic/leisure needs or using savings to pay for medical care. Participants were also asked if they skipped medications to make them last longer.
Multivariable logistic regression stratified by race and adjusted for age, sex, and household chaos was used to determine the independent effects of SES components on spending.
Of 263 STOP-DKD participants, 144 (55%) were Black. Compared with non-Blacks, Black participants had lower incomes with similar levels of education and employment but were more likely to reduce spending on basic needs (29.2% vs 13.5%), leisure activities (35.4% vs 20.2%), and to skip medications (31.3% vs 15.1%), all < 0.05. After multivariable adjustment, Black race was associated with increased odds of reduced basic spending (OR, 2.29; 95% CI, 1.14-4.60), reduced leisure spending (OR, 1.94; 95% CI, 1.05-3.58), and skipping medications (OR, 2.12; 95% CI, 1.12-4.04).
This study was conducted at a single site in Durham, North Carolina, and nearly exclusively included insured patients. Further, the impact of the number of comorbid conditions, medication costs, or copayments was not assessed.
In primary care patients with multiple chronic diseases, Black patients are more likely to reduce spending on basic needs and leisure activities to afford their medical care than non-Black patients of equivalent SES.
NCT01829256.
对于患有多种合并症的个体，社会经济地位（SES）如何与医疗保健支出相对于个人支出的优先排序相关，以及这种关系在黑人和非黑人之间是否存在差异，我们知之甚少。我们旨在探讨患有多种合并症的个体的SES、种族与医疗支出之间的关系。
对一项随机对照试验的基线数据进行横断面评估。
STOP-DKD（使用远程医疗同时控制危险因素以减缓糖尿病肾病进展）研究是一项已完成的针对杜克大学患有糖尿病、高血压和慢性肾病的初级保健患者的随机对照试验。参与者接受了包括社会人口统计学和药物依从性测量在内的调查评估。
种族（黑人或非黑人）和社会经济地位（收入、教育程度和就业情况）。
主要结果基于4个与支出相关的问题，询问是否减少了基本/休闲需求支出或使用储蓄来支付医疗费用。还询问了参与者是否为了让药物维持更长时间而减少用药剂量。
采用按种族分层并对年龄、性别和家庭混乱情况进行调整的多变量逻辑回归，以确定SES各组成部分对支出的独立影响。
在263名STOP-DKD参与者中，144名（55%）为黑人。与非黑人相比，黑人参与者收入较低，教育程度和就业水平相近，但更有可能减少基本需求支出（29.2%对13.5%）、休闲活动支出（35.4%对20.2%）以及减少用药剂量（31.3%对15.1%），所有P值均<0.05。经过多变量调整后，黑人种族与减少基本支出的几率增加相关（比值比[OR]，2.29；95%置信区间[CI]，1.14 - 4.60）、减少休闲支出（OR，1.94；95% CI，1.05 - 3.58）以及减少用药剂量（OR，2.12；95% CI，1.12 - 4.04）。
本研究在北卡罗来纳州达勒姆的一个地点进行，且几乎只纳入了参保患者。此外，未评估合并症数量、药物成本或自付费用的影响。
在患有多种慢性病的初级保健患者中，与社会经济地位相当的非黑人患者相比，黑人患者更有可能减少基本需求和休闲活动支出以支付医疗费用。
NCT01829256。
