Trends in Health Care Use Among Black and White Persons in the US, 1963-2019.
Trends in Health Care Use Among Black and White Persons in the US, 1963-2019.
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DOI：
10.1001/jamanetworkopen.2022.17383
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Woolhandler, Steffie
中科院分区：
文献类型：
--
作者：
Dickman, Samuel L.;Gaffney, Adam;McGregor, Alecia;Himmelstein, David U.;McCormick, Danny;Bor, David H.;Woolhandler, Steffie
在过去的60年里，美国黑人和白色人在平等获得医疗保健方面取得了多大进展？在这项使用60年国家数据的重复横断面分析中，以就诊率或医疗保健总支出衡量的医疗保健使用的黑白不平等在实施医疗保险和医疗补助后缩小，但随后扩大。这些发现表明，需要改变政策，以解决美国医疗保健系统中根深蒂固的种族不平等问题。这项横断面研究考察了1963年至2019年期间黑人和白色人之间医疗保健使用的差异，这些差异是通过医疗保健支出和就诊率来衡量的。在美国，黑人比白色人得到的医疗保健更少。缺乏关于这些差距长期趋势的数据，这些数据为解释当代不平等现象提供了历史背景。评估自1963年以来黑人和白人在医疗保健使用方面的差异趋势。这项横断面研究分析了1963年至2019年间对非制度化黑人和非西班牙裔白色平民进行的29项美国调查。自我报告的种族和民族。年人均就诊率（门诊、牙科和急诊）、住院率和人均医疗总支出。分析了1963年至2019年调查的154 859名黑人和446 944名白色（非西班牙裔）人的数据（316 503 [52.6%]女性;平均[SD]年龄，37.0 [23.3]岁）。在20世纪70年代，随着具有里程碑意义的民权立法以及医疗保险和医疗补助的实施，差距缩小了，但随后扩大了。例如，门诊护理访视的黑白差距从1963年的每年1.2次（95%CI，1.0-1.4）访视降至20世纪70年代的每年0.8次（95%CI，0.6-1.0）访视，然后增加，在2014年至2019年达到每年3.2次（95%CI，3.0-3.4）访视。即使在18至64岁的私人保险成年人中，2014年至2019年，白色人使用的门诊护理（每年多2.6 [95% CI，2.4-2.8]次）也比黑人多。同样，以人均美元衡量，白色人的整体医疗保健使用每年都超过黑人。白人与黑人的支出比率从1960年代的1.96缩小到1970年代的1.26之后，在1980年代开始扩大，1990年代达到1.46;在随后的时期，这一比率保持在1.31至1.39之间。这项研究的结果表明，在保健方面的种族不平等现象已经持续了60年，近年来有所扩大，这表明在获得保健方面结构性种族主义的持续存在甚至强化。改革的努力应该包括培训更多的黑人医疗保健专业人员，投资于为黑人服务的医疗设施，并实施消除成本障碍的全民医疗保险。
How much progress has been made during the past 6 decades in equalizing access to health care for Black and White people in the US? In this repeat cross-sectional analysis using 6 decades of national data, Black-White inequalities in health care use, measured as visit rates or total health care expenditures, narrowed after the implementation of Medicare and Medicaid but subsequently widened. These findings suggest that policy changes are needed to address entrenched racial inequalities in the US health care system. This cross-sectional study examines disparities in health care use between Black and White people as measured by health care expenditures and visit rates between 1963 and 2019. In the US, Black people receive less health care than White people. Data on long-term trends in these disparities, which provide historical context for interpreting contemporary inequalities, are lacking. To assess trends in Black-White disparities in health care use since 1963. This cross-sectional study analyzed 29 US surveys conducted between 1963 and 2019 of noninstitutionalized Black and non-Hispanic White civilians. Self-reported race and ethnicity. Annual per capita visit rates (for ambulatory, dental, and emergency department care), inpatient hospitalization rates, and total per capita medical expenditures. Data from 154 859 Black and 446 944 White (non-Hispanic) individuals surveyed from 1963 to 2019 were analyzed (316 503 [52.6%] female; mean [SD] age, 37.0 [23.3] years). Disparities narrowed in the 1970s in the wake of landmark civil rights legislation and the implementation of Medicare and Medicaid but subsequently widened. For instance, the White-Black gap in ambulatory care visits decreased from 1.2 (95% CI, 1.0-1.4) visits per year in 1963 to 0.8 (95% CI, 0.6-1.0) visits per year in the 1970s and then increased, reaching 3.2 (95% CI, 3.0-3.4) visits per year in 2014 to 2019. Even among privately insured adults aged 18 to 64 years, White individuals used far more ambulatory care (2.6 [95% CI, 2.4-2.8] more visits per year) than Black individuals in 2014 to 2019. Similarly, White peoples’ overall health care use, measured in dollars per capita, exceeded that of Black people in every year. After narrowing from 1.96 in the 1960s to 1.26 in the 1970s, the White-Black expenditure ratio began widening in the 1980s, reaching 1.46 in the 1990s; it remained between 1.31 and 1.39 in subsequent periods. This study’s findings indicate that racial inequities in care have persisted for 6 decades and widened in recent years, suggesting the persistence and even fortification of structural racism in health care access. Reform efforts should include training more Black health care professionals, investments in Black-serving health facilities, and implementing universal health coverage that eliminates cost barriers.
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