Racial differences in skilled nursing care and home health use: The mediating effects of family structure and social class
Racial differences in skilled nursing care and home health use: The mediating effects of family structure and social class
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DOI：
10.1093/geronb/54b.4.s223
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发表时间：
1999-07-01
影响因子：
6.2
通讯作者：
Agree, EM
中科院分区：
文献类型：
--
作者：
Cagney, KA;Agree, EM
目标。本研究探讨熟练护理设施（SNF）护理和医疗保险家庭健康的利用是否因种族而异。然后，它试图理解家庭结构和社会阶层在多大程度上解释所观察到的任何差异。将1989年全国长期护理调查的措施与医疗保险索赔数据联系起来，我们使用Cox比例风险模型对SNF护理和家庭健康使用作为竞争风险进行建模。第一次使用的年龄是结果衡量标准，与长期护理使用作为生命过程过渡的分析一致。黑人将家庭保健和SNF护理推迟到比白人更晚的年龄，而子女和孙辈都在推迟使用这些服务方面发挥了作用。当需要正式援助时，黑人比白人更倾向于使用家庭保健而不是SNF护理。SNF使用的种族差异甚至比之前报道的所有类型的养老院使用的总和还要大。社会阶层对风险差异影响不大。与预期相反，黑人老年人并没有用更高的家庭保健使用率来抵消他们较低的SNF使用率。这表明在需求、偏好或获取方面存在差异，这些差异尚未确定。未来的研究应考虑家庭结构与非正式护理之间的关系，医生转诊模式的种族差异，以及传统非裔美国人社区长期护理的可用性。
Objectives. This study investigates whether utilization of skilled nursing facility (SNF) care and Medicare home health differ by race. It then seeks to understand the extent to which family structure and social class explain any differences observed.Methods. Linking measures from the 1989 National Long-Term Care Survey with Medicare claims data, we model SNF care and home health use as competing risks using a Cox proportional hazards model. Age at first use is the outcome measure, consistent with the analysis of long-term care use as a life-course transition.Results. Blacks postpone both home health and SNF care until later ages than Whites, and both children and grandchildren play a part in deferring their use until even later ages. When formal assistance is needed, Blacks are more apt than Whites to use home health over SNF care. The race difference in SNF use is even greater than that previously reported for all types of nursing home use combined. Social class has little influence on the risk differential.Discussion. Contrary to expectations, Black elders are not counterbalancing their lower rate of SNF use with a higher rare of home health use. This suggests that there are differences in need, preference, or access that are yet to be identified. Future research should consider the relationship between family structure and informal caregiving, variation in physician referral patterns by race, and the availability of long-term care in traditionally African American communities.