种族和收入对医疗保险受益人的死亡率及服务使用情况的影响。

Effects of race and income on mortality and use of services among Medicare beneficiaries.

作者信息

Gornick M E, Eggers P W, Reilly T W, Mentnech R M, Fitterman L K, Kucken L E, Vladeck B C

机构信息

Health Care Financing Administration, Department of Health and Human Services, Baltimore, MD 21244-1850, USA.

出版信息

N Engl J Med. 1996 Sep 12;335(11):791-9. doi: 10.1056/NEJM199609123351106.

DOI:10.1056/NEJM199609123351106

PMID:8703185

Abstract

BACKGROUND

There are wide disparities between blacks and whites in the use of many Medicare services. We studied the effects of race and income on mortality and use of services.

METHODS

We linked 1990 census data on median income according to ZIP Code with 1993 Medicare administrative data for 26.3 million beneficiaries 65 years of age or older (24.2 million whites and 2.1 million blacks). We calculated age-adjusted mortality rates and age- and sex-adjusted rates of various diagnoses and procedures according to race and income and computed black:white ratios. The 1993 Medicare Current Beneficiary Survey was used to validate the results and determine rates of immunization against influenza.

RESULTS

For mortality, the black:white ratios were 1.19 for men and 1.16 for women (P<0.001 for both). For hospital discharges, the ratio was 1.14 (P<0.001), and for visits to physicians for ambulatory care it was 0.89 (P<0.001). For every 100 women, there were 26.0 mammograms among whites and 17.1 mammograms among blacks. As compared with mammography rates in the respective most affluent group, rates in the least affluent group were 33 percent lower among whites and 22 percent lower among blacks. The black:white rate ratio was 2.45 for bilateral orchiectomy and 3.64 for amputations of all or part of the lower limb (P<0.001 for both). For every 1000 beneficiaries, there were 515 influenza immunizations among whites and 313 among blacks. As compared with immunization rates in the respective most affluent group, rates in the least affluent group were 26 percent lower among whites and 39 percent lower among blacks. Adjusting the mortality and utilization rates for differences in income generally reduced the racial differences, but the effect was relatively small.

CONCLUSIONS

Race and income have substantial effects on mortality and use of services among Medicare beneficiaries. Providing health insurance is not enough to ensure that the program is used effectively and equitably by all beneficiaries.

摘要

背景

在许多医疗保险服务的使用方面，黑人和白人之间存在巨大差异。我们研究了种族和收入对死亡率及服务使用情况的影响。

方法

我们将1990年按邮政编码划分的收入中位数普查数据与1993年2630万65岁及以上医疗保险受益人的管理数据相链接（2420万白人，210万黑人）。我们根据种族和收入计算了年龄调整死亡率以及各种诊断和治疗的年龄及性别调整率，并计算了黑人与白人的比率。1993年医疗保险当前受益人调查用于验证结果并确定流感疫苗接种率。

结果

在死亡率方面，男性的黑人与白人比率为1.19，女性为1.16（两者P均<0.001）。在医院出院方面，比率为1.14（P<0.001），在门诊就诊方面为0.89（P<0.001）。每100名女性中，白人中有26.0次乳房X光检查，黑人中有17.1次。与各自最富裕组的乳房X光检查率相比，最不富裕组的比率白人低33%，黑人低22%。双侧睾丸切除术的黑人与白人比率为2.45，下肢全部或部分截肢为3.64（两者P均<0.001）。每1000名受益人中，白人中有515次流感疫苗接种，黑人中有313次。与各自最富裕组的疫苗接种率相比，最不富裕组的比率白人低26%，黑人低39%。对收入差异调整死亡率和利用率通常会缩小种族差异，但效果相对较小。