Heller T A, Larson E B, LoGerfo J P
J Am Geriatr Soc. 1984 Nov;32(11):782-8. doi: 10.1111/j.1532-5415.1984.tb06297.x.
Twelve hundred twenty-six (1,226) persons representative of the noninstitutionalized United States population aged 65-74 years were interviewed and examined as part of the 1971-1975 Health and Nutrition Examination Survey (HANES). Using information available in the HANES data base, standards for what could be considered minimally acceptable care were developed for five tracer conditions. Rates of "deficient" care were: angina, 46 percent; dyspnea on exertion, 78 per cent; hypertension, 26 per cent; hearing impairment, 61 per cent; depression, 80 per cent. Deficient care was analyzed by gender, race, income, locale, and self-rated health status. Only low income emerged as a consistent risk factor for deficient care, with the relative odds for deficient care for poor patients as compared with non-poor patients ranging from 2.7 to 5.6 (P less than 0.05) for four of five conditions. A subgroup analysis attempted to determine whether deficiencies were caused by limited access to physicians, underreporting of symptoms, or barriers that occurred after presenting complaints to a physician. The analysis revealed that for three of four symptomatic conditions, the poor and non-poor patients were equally likely to report their symptoms, whereas the poor were more likely to receive "deficient" care after presenting complaints to physicians. The ramifications of these findings as they pertain to the present situation are discussed.
作为1971 - 1975年健康与营养检查调查（HANES）的一部分，对1226名年龄在65 - 74岁、代表美国非机构化人口的人员进行了访谈和检查。利用HANES数据库中的现有信息，针对五种追踪疾病制定了可被视为最低可接受护理的标准。“护理不足”的比例分别为：心绞痛46%；劳力性呼吸困难78%；高血压26%；听力障碍61%；抑郁症80%。对护理不足情况按性别、种族、收入、地区和自我评定的健康状况进行了分析。只有低收入被确定为护理不足的一个持续风险因素，在五种情况中的四种情况下，贫困患者与非贫困患者相比护理不足的相对比值在2.7至5.6之间（P小于0.05）。一项亚组分析试图确定护理不足是由就医机会有限、症状报告不足还是在向医生投诉后出现的障碍所致。分析显示，在四种有症状的情况中的三种情况下，贫困患者和非贫困患者报告症状的可能性相同，然而贫困患者在向医生投诉后更有可能接受“护理不足”的治疗。讨论了这些发现与当前情况相关的影响。
