Moreno Ruby, Buckelew Sara M, Accurso Erin C, Raymond-Flesch Marissa
Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, CA, USA.
J Eat Disord. 2023 Jan 24;11(1):10. doi: 10.1186/s40337-022-00730-7.
Eating disorders are associated with substantial morbidity and mortality that can be minimized by timely access to evidence-based treatment. However, disparate access to eating disorders treatment may contribute to significant health disparities amongst marginalized groups. This study examined the association between insurance type (public vs. private) and receipt of recommended mental health treatment in a sample of racially/ethnically diverse youth who presented to an adolescent medicine clinic with malnutrition secondary to disordered eating.
A retrospective chart review was conducted for youth ages 11-25 years (N = 1060) who presented to an urban adolescent medicine specialty program between June 1, 2012 and December 31, 2019 for malnutrition secondary to disordered eating. Bivariate and logistic regression analyses examined the association between insurance type (public vs. private) and other demographic/clinical factors on receipt of recommended treatment within six months of the initial evaluation.
Patients with public insurance were one third as likely to receive recommended treatment as patients with private insurance (AOR = 3.23; 95% CI = 1.99, 4.52), after adjusting for demographic and clinical factors. Latinx (AOR = 0.49; 95% CI = 0.31, 0.77) and Asian (AOR = 0.55; 95% CI = 0.32, 0.94) patients were half as likely to receive recommended treatment as White patients.
Access to evidence-based mental health treatment is a necessary first step towards health equity for individuals with eating disorders. Additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color and those with public insurance.
饮食失调与较高的发病率和死亡率相关，及时获得循证治疗可将这些风险降至最低。然而，饮食失调治疗的获取差异可能导致边缘化群体之间出现显著的健康差距。本研究在一个种族/民族多样化的青少年样本中，调查了保险类型（公共保险与私人保险）与接受推荐的心理健康治疗之间的关联，这些青少年因饮食紊乱继发营养不良而就诊于青少年医学诊所。
对2012年6月1日至2019年12月31日期间因饮食紊乱继发营养不良而就诊于城市青少年医学专科项目的11至25岁青少年（N = 1060）进行回顾性病历审查。双变量和逻辑回归分析研究了保险类型（公共保险与私人保险）以及其他人口统计学/临床因素与初次评估后六个月内接受推荐治疗之间的关联。
在调整人口统计学和临床因素后，参加公共保险的患者接受推荐治疗的可能性仅为参加私人保险患者的三分之一（调整后比值比[AOR]=3.23；95%置信区间[CI]=1.99，4.52）。拉丁裔（AOR = 0.49；95% CI = 0.31，0.77）和亚裔（AOR = 0.55；95% CI = 0.32，0.94）患者接受推荐治疗的可能性仅为白人患者 的一半。
获得循证心理健康治疗是饮食失调患者实现健康公平的必要第一步。需要开展更多工作来消除导致有色人种青少年和参加公共保险者在医疗保健方面存在差距的系统性不平等现象。
