U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, 5600 Fishers Lane, Rockville, MD 20850, USA.
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, 5600 Fishers Lane, Rockville, MD 20850, USA.
Prev Med. 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996. Epub 2022 Feb 19.
Use of recommended preventive care services in the United States is not universal and varies considerably by socio-economic status. We examine whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using data across 12 cycles of the Household Component of the Medical Expenditure Panel Survey (2005-2016), we employ a regression discontinuity design to assess changes in the use of preventive services. Our sample included: 8847 Hispanic respondents, 9908 non-Hispanic Black respondents, and 29,527 non-Hispanic White respondents. We examined six preventive services: routine check-ups, blood cholesterol screenings, receipt of the influenza vaccine, blood pressure screenings, mammograms, and colorectal cancer screenings. For non-Hispanic Black adults, we found that preventive service use increased after age 65 across a range of measures including a 4.8 percentage-point (95% confidence interval (CI)1.4, 8.2) increase in blood cholesterol screening, and a 9.1 percentage-point (95% CI 2.1, 15.9) increase in mammograms for Black women. For all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable (p > 0.10) between these groups after reaching the Medicare eligibility age. Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
在美国，推荐的预防保健服务的使用并非普及，而且因社会经济地位而有很大差异。我们研究了广泛的医疗保险在 65 岁时获得资格是否会缩小种族和族裔之间在预防服务使用方面的差异。我们使用了 12 个医疗支出面板调查家庭部分的周期（2005-2016 年）的数据，采用回归不连续性设计来评估预防服务使用的变化。我们的样本包括：8847 名西班牙裔受访者、9908 名非西班牙裔黑人受访者和 29527 名非西班牙裔白人受访者。我们检查了六项预防服务：常规检查、血液胆固醇筛查、流感疫苗接种、血压筛查、乳房 X 光检查和结肠癌筛查。对于非西班牙裔黑人成年人，我们发现，在 65 岁之后，一系列措施中的预防服务使用增加，包括血液胆固醇筛查增加了 4.8 个百分点（95%置信区间（CI）1.4，8.2），黑人女性的乳房 X 光检查增加了 9.1 个百分点（95% CI 2.1，15.9）。对于在 65 岁之前非西班牙裔黑人成年人的所有四项预防健康措施都低于非西班牙裔白人成年人的情况，在达到医疗保险资格年龄后，这些群体之间的服务使用没有区别（p>0.10）。医疗保险资格似乎减少了预防服务使用方面的大多数种族和族裔差异。
