西班牙裔人群在就医行为和决策偏好方面的差异：跨种族/族裔、社会经济地位和医疗服务提供者类型的比较研究。
Disparities in Healthcare-Seeking Behavior and Decision Preference Among Hispanics: A Comparative Study Across Races/Ethnicities, SES, and Provider Types.
作者信息
Lin Cheryl, Mella-Velazquez Alejandra, Braund Wendy E, Tu Pikuei
机构信息
Policy and Organizational Management Program, Duke University, Durham, NC, USA.
Pennsylvania Department of Health, Harrisburg, PA, USA.
出版信息
J Multidiscip Healthc. 2024 Aug 8;17:3849-3862. doi: 10.2147/JMDH.S476285. eCollection 2024.
PURPOSE
Hispanics, the largest minority in America, have increased risk of several medical issues and face noteworthy health disparities. This study compares care-seeking behaviors and choice experience among Hispanics, Asians, Blacks, and Whites, considering SES (income, education, and insurance status) and across five healthcare provider (HCP) types. Concurrent analysis provides a comprehensive view of how and where inequity manifests in healthcare.
METHODS
A cross-sectional online survey assessed 1485 adults (Hispanic=314, Asian=313, Black=316, White=542, recruited through a panel agency) of the frequency of visiting primary care providers, dentists, optometrists, gynecologists, and specialists for chronic conditions. Participants also rated the importance of self-selecting a HCP and difficulty in finding one.
RESULTS
Whites visited each HCP most regularly. Compared to Asians, more Hispanics saw specialists regularly (45.1% vs 56.5%, p=0.042), and Blacks saw dentists less (47.0% vs 38.3%, p=0.028) and gynecologists more often (21.2% vs 33.1%, p=0.024). No other frequency differences were observed among minorities. Low-income participants across four races saw dentists and gynecologists with comparable infrequency. Hispanics and Asians assigned similarly significantly lower self-choice importance and experienced more difficulty relative to Whites or Blacks. Participants with lower income or education visited HCPs less regularly yet perceived the same choice importance as higher-SES peers (p>0.05). Notably, discrepancies in visit frequency between Whites and minorities were more pronounced in higher-SES than lower-SES group. Differences in experiencing care-seeking difficulty were associated with income (p=0.029) and insurance type (p=0.009) but not education (p>0.05).
CONCLUSION
Higher income and education increase healthcare utilization; however, racial disparities persist, particularly among higher-SES groups. Despite similarities among minorities, the extent of disparities varied by SES and provider type. The findings help explain evident inequity in healthcare access and health outcomes. Tailored patient education, culturally-specific navigation support, and more inclusive services are needed to address barriers faced by minorities and disadvantaged populations.
目的
西班牙裔是美国最大的少数族裔，面临多种健康问题的风险增加，且存在显著的健康差距。本研究比较了西班牙裔、亚裔、黑人和白人在考虑社会经济地位（收入、教育和保险状况）以及五种医疗服务提供者（HCP）类型时的就医行为和选择体验。同时进行的分析全面呈现了医疗保健中不公平现象的表现方式和地点。
方法
一项横断面在线调查评估了1485名成年人（通过一个专门机构招募，西班牙裔=314人，亚裔=313人，黑人=316人，白人=542人）看初级保健医生、牙医、验光师、妇科医生以及因慢性病看专科医生的频率。参与者还对自主选择医疗服务提供者的重要性以及寻找医疗服务提供者的难度进行了评分。
结果
白人看各类医疗服务提供者的频率最高。与亚裔相比，更多西班牙裔经常看专科医生（45.1%对56.5%，p = 0.042），黑人看牙医的频率较低（47.0%对38.3%，p = 0.028），看妇科医生的频率较高（21.2%对33.1%，p = 0.024）。在少数族裔之间未观察到其他频率差异。四个种族的低收入参与者看牙医和妇科医生的频率相当低。西班牙裔和亚裔相对于白人和黑人，自主选择的重要性显著较低，且遇到的困难更多。收入或教育程度较低的参与者看医疗服务提供者的频率较低，但他们认为选择的重要性与社会经济地位较高的同龄人相同（p > 0.05）。值得注意的是，白人和少数族裔在就诊频率上的差异在社会经济地位较高的群体中比在社会经济地位较低的群体中更为明显。寻求医疗服务困难程度的差异与收入（p = 0.029）和保险类型（p = 对于西班牙裔、亚裔、黑人和白人，考虑社会经济地位（收入、教育和保险状况）以及五种医疗服务提供者（HCP）类型时的就医行为和选择体验。同时进行的分析全面呈现了医疗保健中不公平现象的表现方式和地点。
方法
一项横断面在线调查评估了1485名成年人（通过一个专门机构招募，西班牙裔=314人，亚裔=313人，黑人=316人，白人=542人）看初级保健医生、牙医、验光师、妇科医生以及因慢性病看专科医生的频率。参与者还对自主选择医疗服务提供者的重要性以及寻找医疗服务提供者的难度进行了评分。
结果
白人看各类医疗服务提供者的频率最高。与亚裔相比，更多西班牙裔经常看专科医生（45.1%对56.5%，p = 0.042），黑人看牙医的频率较低（47.0%对38.3%，p = 0.028），看妇科医生的频率较高（21.2%对33.1%，p = 0.024）。在少数族裔之间未观察到其他频率差异。四个种族的低收入参与者看牙医和妇科医生的频率相当低。西班牙裔和亚裔相对于白人和黑人，自主选择的重要性显著较低，且遇到的困难更多。收入或教育程度较低的参与者看医疗服务提供者的频率较低，但他们认为选择的重要性与社会经济地位较高的同龄人相同（p > 0.05）。值得注意的是，白人和少数族裔在就诊频率上的差异在社会经济地位较高的群体中比在社会经济地位较低的群体中更为明显。寻求医疗服务困难程度的差异与收入（p = 0.029）和保险类型（p = 0.009）相关，但与教育程度无关（p > 0.05）。
结论
较高的收入和教育水平会增加医疗保健利用率；然而，种族差异仍然存在，尤其是在社会经济地位较高的群体中。尽管少数族裔之间存在相似之处，但差异程度因社会经济地位和医疗服务提供者类型而异。这些发现有助于解释医疗保健获取和健康结果方面明显的不公平现象。需要针对性的患者教育、特定文化的就医指导支持以及更具包容性的服务，以解决少数族裔和弱势群体面临的障碍。 0.009）相关，但与教育程度无关（p > 0.05）。
结论
较高的收入和教育水平会增加医疗保健利用率；然而，种族差异仍然存在，尤其是在社会经济地位较高的群体中。尽管少数族裔之间存在相似之处，但差异程度因社会经济地位和医疗服务提供者类型而异。这些发现有助于解释医疗保健获取和健康结果方面明显的不公平现象。需要针对性的患者教育、特定文化的就医指导支持以及更具包容性的服务，以解决少数族裔和弱势群体面临的障碍。
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