Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018
Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018
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DOI：
10.1001/jama.2021.9907
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发表时间：
2021-08-17
影响因子：
120.7
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Mahajan, Shiwani;Caraballo, Cesar;Krumholz, Harlan M.
要点问题1999 年至 2018 年间，美国成年人自我报告的健康状况、获得服务和负担能力方面的种族和民族差异有何变化？结果在这项纳入 596355 名成年人的连续横断面研究中，健康状况、获取和负担能力的衡量标准存在明显的种族和民族差异，有证据表明某些亚组有所改善，但总体而言仍持续存在。 2018 年，低收入黑人的健康状况不佳或一般的估计患病率最高（24.9%），而中等或高收入的白人则最低（6.3%）。意义 1999 年至 2018 年间，自我报告的健康状况和医疗保健获取方面的一些估计种族和民族差异有所改善，但许多差异仍然存在。重要性消除健康状况和医疗保健获取方面的种族和民族差异是美国的目标，但尚不清楚该国在过去 20 年是否取得了进展。目的确定美国成年人自我报告的健康状况、医疗保健获取和负担能力指标中种族和民族差异的 20 年趋势。设计、设置和参与者对 1999 年至 2018 年国家健康访谈调查数据进行的系列横断面研究，其中包括 596355 名成年人。暴露自我报告的种族、民族和收入水平。主要成果和措施自我报告的健康状况以及医疗保健获取和负担能力的比率以及种族和民族差异。结果该研究纳入了 596355 名成年人（平均 [SE] 年龄，46.2 [0.07] 岁，51.8% [SE, 0.10] 女性），其中 4.7% 为亚裔，11.8% 为黑人，13.8% 为拉丁裔/西班牙裔，69.7% 为白人。亚裔、黑人、拉丁裔/西班牙裔和白人中低收入人群的估计比例分别为 28.2%、46.1%、51.5% 和 23.9%。低收入黑人的健康状况不佳或一般的估计患病率最高（1999 年为 29.1% [95% CI, 26.5%-31.7%]，2018 年为 24.9% [95% CI, 21.8%-28.3%]），而中等收入和高收入的白人则最低（2018 年为 6.4% [95% CI, 5.9%-6.8%]）。 1999 年为 6.3% [95% CI, 5.8%-6.7%] 2018 年）。 1999 年，无论收入阶层如何，黑人的健康状况不佳或一般的估计患病率明显高于白人（P
Key PointsQuestionHow have racial and ethnic differences in self-reported health status, access, and affordability among US adults changed between 1999 and 2018? FindingsIn this serial cross-sectional study that included 596355 adults, there were marked racial and ethnic differences in measures of health status, access, and affordability, with evidence of improvement in some subgroups but persistence overall. In 2018, Black individuals with low income had the highest estimated prevalence of poor or fair health (24.9%), while White individuals with middle or high income had the lowest (6.3%). MeaningBetween 1999 and 2018, some estimated racial and ethnic differences in measures of self-reported health status and health care access improved, but many differences persisted.ImportanceThe elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. ObjectiveTo determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. Design, Setting, and ParticipantsSerial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596355 adults. ExposuresSelf-reported race, ethnicity, and income level. Main Outcomes and MeasuresRates and racial and ethnic differences in self-reported health status and health care access and affordability. ResultsThe study included 596355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P