Racial/ethnic disparities in access to physician care and medications among US stroke survivors
Racial/ethnic disparities in access to physician care and medications among US stroke survivors
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DOI：
10.1212/wnl.0b013e318203e952
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发表时间：
2011-01-04
期刊：
影响因子：
9.9
通讯作者：
Allison, J. J.
中科院分区：
文献类型：
--
作者：
Levine, D. A.;Neidecker, M. V.;Allison, J. J.
背景资料：与非西班牙裔白人相比，墨西哥裔美国人和非西班牙裔黑人的卒中复发率更高，卒中二级预防率更低。作为这种差异的一种可能解释，我们评估了美国卒中幸存者全国样本中获得医生护理和药物治疗的种族/民族差异。方法：在所有4,864名年龄>45岁的中风幸存者中，他们回答了2000-2006年的国家健康访谈调查，我们比较了过去12个月内按种族/民族在按年龄分层（45-64岁vs ≥ 65岁）之前和之后获得护理的情况。通过logistic回归，我们调整了性别、合并症、神经功能障碍、健康状况、年龄、收入和健康保险等方面的获取措施与种族/民族之间的关联。在45-64岁的中风幸存者中，墨西哥裔美国人，非西班牙裔黑人，非西班牙裔白人报告说，（约15%）和无力支付药物（约20%）。然而，在≥ 65岁的卒中幸存者中，与白人相比，墨西哥裔美国人和黑人报告的无通才就诊（15%，12%，8%; p = 0.02）和无力负担药物治疗（20%，11%，6%; p < 0.001）的频率更高。与白人相比，墨西哥裔美国人和黑人更经常报告没有医疗专家就诊（54%，49%，40%; p < 0.001），并且比率没有年龄差异。完整的协变量调整并没有完全解释这些种族/民族differentiations.Conclusions：在美国中风幸存者至少65岁，墨西哥裔美国人和黑人报告更糟糕的访问医生的护理和药物比白人。这种减少的获取可能导致这些高危少数群体的风险因素修正不足和卒中复发。神经病学（R）2011; 76：53-61
Background: Mexican Americans and non-Hispanic blacks have higher stroke recurrence rates and lower rates of secondary stroke prevention than non-Hispanic whites. As a potential explanation for this disparity, we assessed racial/ethnic differences in access to physician care and medications in a national sample of US stroke survivors.Methods: Among all 4,864 stroke survivors aged >45 years who responded to the National Health Interview Survey years 2000-2006, we compared access to care within the last 12 months by race/ethnicity before and after stratification by age (45-64 years vs >= 65 years). With logistic regression, we adjusted associations between access measures and race/ethnicity for sex, comorbidity, neurologic disability, health status, year, income, and health insurance.Results: Among stroke survivors aged 45-64 years, Mexican Americans, non-Hispanic blacks, and non-Hispanic whites reported similar rates of no generalist physician visit (approximately 15%) and inability to afford medications (approximately 20%). However, among stroke survivors aged >= 65 years, Mexican Americans and blacks, compared with whites, reported greater frequency of no generalist visit (15%, 12%, 8%; p = 0.02) and inability to afford medications (20%, 11%, 6%; p < 0.001). Mexican Americans and blacks more frequently reported no medical specialist visit (54%, 49%, 40%; p < 0.001) than did whites and rates did not differ by age. Full covariate adjustment did not fully explain these racial/ethnic differences.Conclusions: Among US stroke survivors at least 65 years old, Mexican Americans and blacks reported worse access to physician care and medications than whites. This reduced access may lead to inadequate risk factor modification and recurrent stroke in these high-risk minority groups. Neurology (R) 2011; 76:53-61