Concerns in a primary care population about genetic discrimination by insurers
Concerns in a primary care population about genetic discrimination by insurers
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DOI：
10.1097/01.gim.0000162874.58370.c0
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发表时间：
2005-05-01
影响因子：
8.8
通讯作者：
Thomson, EJ
中科院分区：
文献类型：
--
作者：
Hall, MA;McEwen, JE;Thomson, EJ
对基因歧视的恐惧可能会阻止参与研究或治疗。这是限制保险公司使用遗传信息的法律的主要推动力，但关于一般人群中这种恐惧的程度以及它如何因社会因素而变化的信息很少。研究方法：这项研究的措施有关的基因检测，作为初级保健筛查遗传性血色病（铁超载）的一部分，保险问题的关注。数据来自一项多种族、基于初级保健的调查，调查对象为美国（AL、CA、DC、HI、OR）五个现场中心和加拿大（安大略）一个现场中心的86，859名成年人。逻辑回归被用来模拟同意这个问题的概率：“基因检测不是一个好主意，因为你可能很难获得或保留你的保险。结果：总体而言，40.0%的参与者表示同意。调整其他特征，非洲裔美国人和亚洲人不太可能（OR = 0.52和0.39），西班牙裔更可能（OR = 1.124），比白人表达对保险歧视的担忧。65岁以下的参与者、美国居民和没有高中文凭的参与者更有可能感到担忧（OR范围为1.4-1.6），心理健康评分较低的参与者也是如此。受教育程度呈非线性关系，与高中毕业生相比，高中以下学历和大学学历的人的关注程度明显更高。结论：对基因歧视的关注因种族和其他人口因素以及国籍而异。对加拿大人和64岁以上的人关注较少的一个可能的解释是，这两个群体都有医疗保健社会保险（医疗保险）。然而，美国居民在一些法律的保护对基因歧视有更多，而不是更少，关注比加拿大人或美国居民在国家没有法律的保护。
Purpose: Fear of genetic discrimination might deter participation in research or therapy. This is a major impetus for laws limiting insurers' use of genetic information, yet there is little information about the extent of this fear in the general population and how it varies by social factors. Methods: This study measures concern about insurance problems relating to genetic testing, as part of primary-care screening for hereditary hemochromatosis (iron overload). Data come from a multiethnic, primary care-based survey of 86,859 adults in five field centers in the United States (AL, CA, DC, HI, OR), and one in Canada (Ontario). Logistic regression was used to model the probability of agreeing to the question "Genetic testing is not a good idea because you might have trouble getting or keeping your insurance." Results: Overall, 40.0% of participants agreed. Adjusting for other characteristics, African Americans and Asians were much less likely (OR = 0.52 and 0.39), and Hispanics were more likely (OR = 1.124), than Caucasians to express concern about insurance discrimination. Participants under 65 years old, US residents, and those without a high school diploma were substantially more likely to be concerned (ORs ranging from 1.4-1.6), as were participants with lower mental health scores. Education showed a nonlinear relationship, with significantly higher concern among both those with less than a high school education and those with a college degree, compared to high school graduates. Conclusions: Concern about genetic discrimination varies substantially by race and other demographic factors and by nationality. One possible explanation for lower concern about Canadians and by people over 64 is that both groups are covered by social insurance for health care (Medicare). However, US residents in states with some legal protections against genetic discrimination had more, not less, concern than either Canadians or US residents in states with no legal protections.