Wu Zhiyuan, Qian Frank, Zou Siyu, Zou Xinye, Zhang Ruolin, Guo Xiuhua, Li Haibin
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
BMC Med. 2025 Aug 15;23(1):478. doi: 10.1186/s12916-025-04315-4.
Concerns exist over a possible worsening of disparities in health status and health care access across racial/ethnic and income groups during the COVID-19 pandemic. We aimed to characterize trends in racial/ethnic and income differences in self-reported measures of health status and health care access among US adults.
This serial cross-sectional nationally representative study included adults (age ≥ 18 years) participating in the National Health Interview Survey (NHIS) from 2019 to 2022. Self-reported health status (poor or fair health status, functional limitation, clinician-diagnosed depression or anxiety disorders) and health care access and affordability were collected.
Our analysis included 107,230 adults (mean [SE] age, 48.1 [0.1] years, 51.6% women), of whom 6.1% were Asian, 12.1% were Black, 17.3% were Latino/Hispanic, and 64.5% were White. Black individuals with low income had the highest prevalence of poor or fair health status (30.9% [95% CI, 27.8%-34.3%] in 2019 and 28.4% [95% CI, 25.1% to 32.0%] in 2022), and these racial/ethnic gaps did not change significantly, irrespective of income levels. The prevalence of clinician-diagnosed depression or anxiety disorders increased from 2019 to 2022 for all racial/ethnic groups, especially for Whites (from 32.6% [95% CI, 30.8%-34.4%] to 38.2% [95% CI, 36.4% to 40.1%], P < 0.001). There was no significant change in functional limitations during the pandemic. Latino/Hispanic individuals with low income had the highest estimated prevalence of limited health care access from 2019 to 2022. Health insurance access and affordability significantly improved for White individuals with low income from 2019 to 2022 (P < 0.001), but not for other racial/ethnic groups. Racial/ethnic gaps in health care access and affordability did not change significantly, irrespective of income levels.
In a serial cross-sectional survey study of US adults during the COVID-19 pandemic, prevalence of clinician-diagnosed depression or anxiety disorders significantly increased. Racial and ethnic differences in health status and health care access either persisted or widened over time.
人们担心在新冠疫情期间，不同种族/族裔和收入群体在健康状况和医疗保健可及性方面的差距可能会进一步扩大。我们旨在描述美国成年人自我报告的健康状况和医疗保健可及性方面的种族/族裔和收入差异趋势。
这项具有全国代表性的系列横断面研究纳入了2019年至2022年参加美国国家健康访谈调查（NHIS）的成年人（年龄≥18岁）。收集了自我报告的健康状况（健康状况差或一般、功能受限、临床诊断的抑郁症或焦虑症）以及医疗保健可及性和可负担性。
我们的分析包括107,230名成年人（平均[标准误]年龄为48.1[0.1]岁，女性占51.6%），其中6.1%为亚裔，12.1%为黑人，17.3%为拉丁裔/西班牙裔，64.5%为白人。低收入黑人的健康状况差或一般的患病率最高（2019年为30.9%[95%置信区间，27.8%-34.3%]，2022年为28.4%[95%置信区间，25.1%至32.0%]），并且这些种族/族裔差距没有显著变化，无论收入水平如何。从2019年到2022年，所有种族/族裔群体临床诊断的抑郁症或焦虑症患病率均有所上升，尤其是白人（从32.6%[95%置信区间，30.8%-34.4%]升至38.2%[95%置信区间，36.4%至40.1%]，P<0.001）。疫情期间功能受限情况没有显著变化。2019年至2022年，低收入拉丁裔/西班牙裔个体的医疗保健可及性受限估计患病率最高。2019年至2022年，低收入白人的医疗保险可及性和可负担性显著改善（P<0.001），但其他种族/族裔群体并非如此。无论收入水平如何，医疗保健可及性和可负担性方面的种族/族裔差距没有显著变化。
在一项针对新冠疫情期间美国成年人的系列横断面调查研究中，临床诊断的抑郁症或焦虑症患病率显著上升。健康状况和医疗保健可及性方面的种族和族裔差异要么持续存在，要么随着时间推移而扩大。
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