Oronce Carlos Irwin A, Pablo Ray, Shapiro Susi Rodriguez, Willis Phyllis, Ponce Ninez, Mafi John N, Sarkisian Catherine
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
J Am Geriatr Soc. 2025 Mar;73(3):900-909. doi: 10.1111/jgs.19369. Epub 2025 Feb 3.
As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.
We conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.
Among 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (-4.9 percentage points [pp]; 95% CI -5.9, -3.8 pp), Black (-5.4 pp; 95% CI -8.0, -2.7 pp), and Latino (-2.5 pp; 95% CI -4.6, -0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.
These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.
由于基于价值的支付模式同时纳入了健康公平性和低价值医疗（LVC）的衡量指标，了解LVC如何因种族而异对于干预措施至关重要。因此，我们在一个当代样本中测量了LVC的种族差异。
我们对2019年至2021年在加利福尼亚州五家学术医疗中心接受治疗的年龄≥55岁成年人的索赔数据进行了横断面分析。我们的样本包括接受了可归类为LVC服务的患者。主要结局是一项服务是否被归类为LVC。次要结局包括LVC的临床类别（预防性筛查、诊断测试、处方药和术前测试）。我们使用针对患者特征和医疗中心进行调整的多变量回归模型来研究种族/族裔与结局之间的关联。
在15720名接受了潜在LVC的成员中，非西班牙裔白人老年人占样本的59%，其次是亚洲人（17%）、种族未知者（8%）、拉丁裔（8%）、非西班牙裔黑人（5%）、其他种族（2%）。在调整后的模型中，与白人老年人相比，亚洲（-4.9个百分点[pp]；95%置信区间-5.9，-3.8 pp）、黑人（-5.4 pp；95%置信区间-8.0，-2.7 pp）和拉丁裔（-2.5 pp；95%置信区间-4.6，-0.4 pp）老年人接受LVC的可能性较小，特别是预防性和术前服务。然而，亚洲、黑人和拉丁裔老年人更有可能接受低价值处方。
LVC在不同衡量指标上的这些不同种族模式可能反映了不同的机制，强调需要使用临床特定指标而非综合指标，因为综合指标会掩盖潜在的异质性，并可能导致潜在有害和产生不公平的干预措施。
