Osmond D H, Vranizan K, Schillinger D, Stewart A L, Bindman A B
Department of Epidemiology and Biostatistics, University of California, San Francisco 94143, USA.
Health Serv Res. 1996 Dec;31(5):551-71.
To examine measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California.
Telephone interviews obtained by random-digit dialing and conducted between April 1993 and July 1993 in California, with 7,264 adults (ages 18-64): 601 African Americans, 246 Asians, 917 Latinos interviewed in English; 1,045 Latinos interviewed in Spanish; and 4,437 non-Latino whites.
A cross-sectional survey was conducted from a stratified, probability telephone sample.
Interviews collected self-reported indicators of need for health care: self-rated health, activity limitation, major chronic conditions, need for ongoing treatment, bed days, and prescription medication. The outcome was self-reported number of physician visits in the previous three months.
Compared to whites, one or more of the other ethnic groups varied significantly (p < .05) on each of the six need-for-care measures after adjustment for health insurance, age, sex, and income. Latinos interviewed in Spanish reported lower percentages and means on five of the need measures but the highest percentage with fair or poor health (32 percent versus 7 percent in whites). Models regressing each need measure on the number of outpatient visits found significant interactions of ethnic group with need compared to whites. After adjustment for insurance and demographics, the estimated mean number of visits in those with the indicator of need was consistently lower in Latinos interviewed in Spanish, but the differences among the other ethnic groups varied depending on the measure used.
No single valid estimate of the relationship between need for health care and outpatient visits was found for any of the six indicators across ethnic groups. Applying need adjustment to the use of health care services without regard for ethnic variability may lead to biased conclusions about utilization.
研究加利福尼亚不同种族和族裔群体的医疗保健需求衡量指标及其与医疗服务利用之间的关系。
1993年4月至1993年7月在加利福尼亚通过随机数字拨号进行电话访谈，共7264名成年人（年龄在18 - 64岁之间）：601名非裔美国人、246名亚裔、917名用英语访谈的拉丁裔；1045名用西班牙语访谈的拉丁裔；以及4437名非拉丁裔白人。
采用分层概率电话抽样进行横断面调查。
访谈收集了自我报告的医疗保健需求指标：自评健康状况、活动受限情况、主要慢性病、持续治疗需求、卧床天数和处方药。结果是自我报告的前三个月内看医生的次数。
在调整了医疗保险、年龄、性别和收入后，与白人相比，其他种族群体中的一个或多个在六项医疗保健需求衡量指标上存在显著差异（p < 0.05）。用西班牙语访谈的拉丁裔在五项需求指标上的比例和均值较低，但健康状况为一般或较差的比例最高（32%，而白人中为7%）。将每项需求指标对门诊就诊次数进行回归分析的模型发现，与白人相比，种族与需求之间存在显著交互作用。在调整了保险和人口统计学因素后，有需求指标的人群中，用西班牙语访谈的拉丁裔的估计平均就诊次数始终较低，但其他种族群体之间的差异因所使用的衡量指标而异。
对于所有六个指标，未发现不同种族群体在医疗保健需求与门诊就诊之间的关系上有单一有效的估计值。在不考虑种族差异的情况下对医疗服务利用进行需求调整可能会导致关于利用情况的有偏差结论。
