Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018.
Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018.
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DOI：
10.1001/jamahealthforum.2022.3856
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发表时间：
2022-10-07
期刊：
影响因子：
--
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Caraballo, Cesar;Ndumele, Chima D.;Roy, Brita;Lu, Yuan;Riley, Carley;Herrin, Jeph;Krumholz, Harlan M.
从1999年到2018年，美国成年人获得及时医疗服务的障碍方面的种族和民族差异的趋势发生了怎样的变化？这项包括590名 603名美国成年人的系列横断面研究发现，在所有种族和民族群体中，与护理费用没有直接关系的5种及时医疗护理障碍的流行率都有所增加。到2018年，黑人和西班牙裔/拉丁裔的障碍流行率明显高于白人，他们比白人更有可能经历漫长的等待时间和缺乏交通工具。这一系列横断面研究的结果表明，种族和族裔群体之间的显著差异以及与费用没有直接关系的及时医疗保健的障碍可能是造成健康差距的原因之一。由于与护理费用没有直接关系的原因造成的延迟医疗方面的种族和族裔差异仍未得到充分研究。描述近20年来成年人在获得及时医疗方面的种族和民族差异的趋势。这是一项对美国590名 603名非制度化成年人进行的一系列横断面研究，使用了1999年至2018年全国健康访谈调查的数据。数据分析从2021年12月到2022年8月进行。自我报告的种族、民族、家庭收入和性别。关于及时医疗的5个具体障碍的时间趋势：无法通过电话接通、没有足够快的预约、等待时间长、办公室或诊所时间不便以及缺乏交通工具。研究队列包括590名 603名成年受访者(平均年龄46.00[0.07]岁；329名 638[51.9%]女性；27名 447[4.7%]亚裔，83名 929[11.8%]黑人，98名 692[13.8%]西班牙裔/拉丁裔，380名 [69.7%]白人)。1999年，在亚裔群体中，每个种族和族裔群体报告的5种及时医疗障碍中的任何一种的比例为7.3%；黑人为6.9%；西班牙裔/拉丁裔为7.9%；白人为7.0%(与白人相比，P >； .05)。从1999年到2018年，这一比例在所有4个种族和族裔群体中都有所增加(亚裔、黑人、西班牙裔/拉丁裔和白人分别增加了5.7%、8.0%、8.1%和5.9%；P<； .001)，略微扩大了群体之间的差距。2018年，与白人相比，黑人和西班牙裔/拉丁裔个人报告任何障碍的比例分别高出2.1%和3.1%(分别为P = .03和P = .001)。亚裔和白人之间的患病率没有显著差异。黑人和白人之间的患病率差异显著增加，他们报告说，由于在诊所或医务室等待时间较长以及由于缺乏交通工具而延误护理(分别为1.5pp和1.8pp；P = .03和P = .01)。此外，报告由于等待时间过长而延误护理的西班牙裔/拉丁裔和白人之间的患病率差异显著增加(2.6pp；P <； .001)。这项对全国健康访谈调查数据进行的一系列横断面研究的结果表明，从1999年到2018年，美国所有人口群体获得及时医疗服务的障碍都有所增加，种族和民族群体之间的差异也相应增加。除了目前实施的干预措施外，还需要采取其他干预措施，以改善获得医疗保健的机会，消除种族和族裔群体之间的差异。这项针对美国成年人的大型系列横断面研究使用了国家健康访谈调查(1999-2018)的数据，检查了与医疗费用没有直接关系的5个阻碍及时医疗的种族和民族趋势。
How have trends in racial and ethnic disparities in barriers to timely medical care among adults in the US changed from 1999 to 2018? This serial cross-sectional study including 590 603 adults in the US found that the prevalence of 5 barriers to timely medical care that are not directly related to cost of care increased across all race and ethnicity groups. By 2018, barrier prevalence was significantly higher among Black and Hispanic/Latino individuals who were more likely than White individuals to report experiencing long waiting times and lack of transportation. The findings of this serial cross-sectional study suggest that the marked differences among race and ethnicity groups and barriers to timely medical care that are not directly cost related may be contributing to health disparities. Racial and ethnic disparities in delayed medical care for reasons that are not directly associated with the cost of care remain understudied. To describe trends in racial and ethnic disparities in barriers to timely medical care among adults during a recent 20-year period. This was a serial cross-sectional study of 590 603 noninstitutionalized adults in the US using data from the National Health Interview Survey from 1999 to 2018. Data analyses were performed from December 2021 through August 2022. Self-reported race, ethnicity, household income, and sex. Temporal trends in disparities regarding 5 specific barriers to timely medical care: inability to get through by telephone, no appointment available soon enough, long waiting times, inconvenient office or clinic hours, and lack of transportation. The study cohort comprised 590 603 adult respondents (mean [SE] age, 46.00 [0.07] years; 329 638 [51.9%] female; 27 447 [4.7%] Asian, 83 929 [11.8%] Black, 98 692 [13.8%] Hispanic/Latino, and 380 535 [69.7%] White). In 1999, the proportion of each race and ethnicity group reporting any of the 5 barriers to timely medical care was 7.3% among the Asian group; 6.9%, Black; 7.9%, Hispanic/Latino; and 7.0%, White (P > .05 for each difference compared with White individuals). From 1999 to 2018, this proportion increased across all 4 race and ethnicity groups (by 5.7, 8.0, 8.1, and 5.9 percentage points [pp] among Asian, Black, Hispanic/Latino, and White individuals, respectively; P < .001 for each), slightly increasing the disparities between groups. In 2018, compared with White individuals, the proportion reporting any barrier was 2.1 and 3.1 pp higher among Black and Hispanic/Latino individuals (P = .03 and P = .001, respectively). There was no significant difference in prevalence between Asian and White individuals. There was a significant increase in the difference in prevalence between Black individuals and White individuals who reported delaying care because of long waiting times at the clinic or medical office and because of a lack of transportation (1.5 pp and 1.8 pp; P = .03 and P = .01, respectively). In addition, the difference in prevalence between Hispanic/Latino and White individuals who reported delaying care because of long waiting times increased significantly (2.6 pp; P < .001). The findings of this serial cross-sectional study of data from the National Health Interview Survey suggest that barriers to timely medical care in the US increased for all population groups from 1999 to 2018, with associated increases in disparities among race and ethnicity groups. Interventions beyond those currently implemented are needed to improve access to medical care and to eliminate disparities among race and ethnicity groups. This large serial cross-sectional study of US adults uses data from the National Health Interview Survey (1999-2018) to examine racial and ethnic trends in 5 barriers to timely medical care that are not directly related to cost of care.
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DOI：
10.1161/circoutcomes.119.006139
发表时间：
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影响因子：
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通讯作者：
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