Internal Medicine/Hospital Medicine, Baptist Medical Center South, Prattville Baptist Hospital, Montgomery, AL.
Internal Medicine, Mclaren Regional Medical Center, Michigan State University, Flint, MI.
Medicine (Baltimore). 2022 Sep 23;101(38):e30539. doi: 10.1097/MD.0000000000030539.
Medical uninsurance (MU) is associated with cancer disparities, particularly among underprivileged and minority sections of the United States. In this cross-sectional study of National Health and Nutritional Examination Survey (NHANES) data from 2013 to 2018, we evaluated sociodemographic attributes of MU disparity in the US cancer population. Those aged ≥20 years with a history of cancer and disclosed MU status were included. We calculated the descriptive statistics of the population stratified by insurance type and performed bivariate and multivariate logistic regression models to assess the association of sociodemographic attributes and MU and reported unadjusted (UOR) and adjusted odds ratios (AOR). Among the 1681 participants (US estimated, 25,982,352), 4.3% ± 0.62 were uninsured. Uninsured individuals were 13.5-year younger, largely female, less educated, and non-US born compared to insured individuals. Age (UOR: 0.94, 95% CI: 0.93-0.96), female sex (UOR: 3.53, 95% CI: 1.73-7.19), Hispanics (UOR: 4.30, 95% CI: 2.45-7.54), <high school education (UOR: 7.41, 95% CI: 2.51-21.86), and non-US born with <20-years-stay in US (UOR: 7.69, 95% CI: 3.32-17.82) were associated with MU. In the multivariate model, age (AOR: 0.95, 95% CI: 0.93-0.96), female sex (AOR: 2.88, 95% CI: 1.25-6.62), <high school education (AOR: 4.02, 95% CI: 1.24-13.00), and non-US-born status with <20-years stay (AOR: 3.42, 95% CI: 1.44-8.11) were independent predictors of MU. Income was not a predictor of MU. The US cancer population has unique determinants of MU. Ethnicity alone is not a predictor of MU, whereas income is not correlated with MU. Public health interventions focusing on the attributes of MU are needed.
医疗保险不足（MU）与癌症的差异有关，尤其是在美国贫困和少数族裔中。在这项对 2013 年至 2018 年国家健康和营养检查调查（NHANES）数据的横断面研究中，我们评估了美国癌症人群中 MU 差异的社会人口属性。包括年龄≥20 岁、有癌症病史并披露 MU 状况的人群。我们按保险类型对人群进行了描述性统计，并进行了双变量和多变量逻辑回归模型，以评估社会人口属性和 MU 的关联，并报告了未经调整的（UOR）和调整后的比值比（AOR）。在 1681 名参与者（美国估计值为 25982352 人）中，有 4.3%±0.62 人没有保险。与有保险的人相比，没有保险的人年龄小 13.5 岁，主要是女性，受教育程度较低，并且不是美国出生。年龄（UOR：0.94，95%CI：0.93-0.96）、女性（UOR：3.53，95%CI：1.73-7.19）、西班牙裔（UOR：4.30，95%CI：2.45-7.54）、<高中学历（UOR：7.41，95%CI：2.51-21.86）和非美国出生且在美国居住时间<20 年（UOR：7.69，95%CI：3.32-17.82）与 MU 相关。在多变量模型中，年龄（AOR：0.95，95%CI：0.93-0.96）、女性（AOR：2.88，95%CI：1.25-6.62）、<高中学历（AOR：4.02，95%CI：1.24-13.00）和非美国出生且在美国居住时间<20 年（AOR：3.42，95%CI：1.44-8.11）是 MU 的独立预测因素。收入不是 MU 的预测因素。美国癌症人群有独特的 MU 决定因素。种族本身不是 MU 的预测因素，而收入与 MU 无关。需要关注 MU 特征的公共卫生干预措施。
