Racial and ethnic disparities in the emergency department: A public health perspective
Racial and ethnic disparities in the emergency department: A public health perspective
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DOI：
10.1016/j.emc.2006.06.009
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发表时间：
2006-11-01
影响因子：
1.2
通讯作者：
Haley, Leon L., Jr.
中科院分区：
文献类型：
--
作者：
Heron, Sheryl L.;Stettner, Edward;Haley, Leon L., Jr.
医疗服务的现状似乎充满了坏消息，包括对不断上升的医疗费用、医疗差错、病人安全以及越来越多的没有保险和保险不足的美国人的担忧。使问题进一步复杂化的是，保健方面的种族和族裔差异问题不仅继续存在于提供模式中，而且似乎已经恶化。事实上，根据疾病控制和预防中心的数据，尽管人们多年来一直关注这些差异，但美国人健康方面的种族差距仍在继续扩大。在一般医学文献和急诊医学文献中，大量的研究先前都记录了种族和民族差异，表明心脏血管成形术[2,3]、冠状动脉搭桥手术[4]、乳房x光检查[5,6]、流感疫苗[7]、疼痛管理和“守门”活动[8-10]的不同使用。非洲裔美国人死于几乎所有主要疾病或原因的比例都高于白人，尤其是他杀（高出5.7倍）和艾滋病（高出8.7倍）。在美国，黑人和白人的三大死因是一样的，但黑人的死亡率却高得惊人：心脏病（高出30%）、癌症（高出30%）和中风（高出40%）。非裔美国人也有较高的高血压和许多传染病的发病率，特别是那些通过性传播的疾病。使这些关切更加复杂的是，少数民族和非英语使用者在获得保健服务方面有更大的困难。与一般人群相比，少数族裔不成比例地更有可能没有保险，并且在公共资助的卫生系统（即医疗补助计划[图1]）中所占比例过高。研究表明，即使个人拥有与非少数族裔相同的医疗保险和类似的医疗服务提供者，种族和少数族裔患者也往往比白人患者获得更低质量的医疗服务。本文从公共卫生的角度讨论了这些差异；具体来说，为什么这些种族和民族差异会阻碍改善国家健康状况的努力？作者(1)提供背景信息，包括对医学研究所（IOM）关于医疗保健差距的报告的综述；(2)从患者和卫生保健提供者的角度描述急诊科（ED）环境中个体的种族和民族构成；(3)讨论可能存在种族和民族差异的最常见的急诊科疾病；(4)就如何解决急诊卫生保健的差异给出结论和一般性建议。
The state of health care delivery seems to be filled with nothing but bad news, including continued concerns about rising health care costs, medical errors, patient safety, and the growing numbers of uninsured and underinsured Americans. To complicate matters further, the issue of racial and ethnic disparities in health care not only continues to exist in the delivery models, but also seemingly has worsened. In fact, according to the Centers for Disease Control and Prevention, despite years of attention to these disparities, the racial gap in American's health continues to widen [1].Numerous studies, in both general medical literature and literature specific to emergency medicine, have previously documented racial and ethnic disparities showing differential use of cardiac angioplasty [2,3], coronary artery bypass surgery [4], mammography [5,6], influenza vaccine [7], pain management, and "gate keeping" activities [8-10]. African Americans die from nearly every major disease or cause at rates higher than whites, especially homicide (5.7 times higher) and HIV (8.7 times higher). The top three causes of death in the United States are the same for blacks and whites, but the rates of death for black people are strikingly higher: heart disease (30% higher), cancer (30% higher), and stroke (40% higher). African Americans also have higher rates of high blood pressure and many infectious diseases, especially those that are sexually transmitted [11]. To compound these concerns, minorities and non-English speakers have greater difficulties accessing health care services. Minorities are disproportionately more likely than the general population to be uninsured, and are overrepresented among those in publicly funded health systems (ie, Medicaid [Fig. 1]) [12]. Even when individuals have the same health insurance and similar access to providers as nonminorities, research shows that racial and ethnic minorities tend to receive a lower quality of health care than white patients.This article discusses these disparities from a public health perspective; specifically, why these racial and ethnic disparities threaten to impede efforts to improve the nation's health [13]. The authors (1) provide background information, including a review of the Institute of Medicine (IOM) report on health care disparities; (2) describe the racial and ethnic compositions of individuals in the emergency department (ED) setting from the perspective of both the patient and health care provider; (3) discuss the most prevalent disease presentations to the ED that are likely to have racial and ethnic disparities; and (4) give conclusions and general recommendations on how to address disparities in emergency health care.