Escarce J J, Epstein K R, Colby D C, Schwartz J S
Department of Medicine, University of Pennsylvania, Philadelphia.
Am J Public Health. 1993 Jul;83(7):948-54. doi: 10.2105/ajph.83.7.948.
This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans.
We used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, we calculated the age- and sex-adjusted rate of use by race and the corresponding White-Black relative risk.
Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. Whites had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders.
There are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access.
本研究旨在探讨美国老年人在医疗程序和诊断测试使用方面的种族差异。
我们使用了1986年针对全国5%的65岁及以上医疗保险参保者的医生索赔数据，研究32种程序和测试。对于每项服务，我们计算了按种族调整年龄和性别的使用率以及相应的白人-黑人相对风险。
白人比黑人更有可能接受23种服务，而且对于其中许多服务，使用差异很大。相比之下，黑人比白人更有可能接受7种服务。白人在获得高科技或更新服务方面具有特别优势。在除医疗保险覆盖外还拥有医疗补助的老年人中，使用方面的种族差异依然存在，且在农村老年人中有所增加。
美国老年人在医疗服务使用方面存在普遍的种族差异，这些差异无法用特定临床病症患病率的差异来解释。医疗护理的经济障碍并不能完全解释这些发现。种族可能会加剧其他获得医疗服务障碍的影响。
