RESUMO
PURPOSE: Midlife and older adults have high rates of chronic conditions, and differences in health insurance coverage may affect their access to care. Women may be particularly at risk for access problems. This study examines the association of gender and health insurance status with delays in care, a dimension of access to care, among midlife (age 45-64) and older (age > or = 65) adults with diabetes and cardiovascular conditions. METHODS: Data were from the 2004 through 2006 national Medical Expenditure Panel Survey. A total of 4,706 adults with self-identified diabetes and 17,636 adults with self-identified cardiovascular conditions, aged 45 years and older, were included. The analyses examined associations of gender and insurance status with self-reported delays in medical care, dental care, prescription medication, and illness/injury care, using bivariate and multivariate analyses adjusted for race/ethnicity, education, income, and perceived health status. MAIN FINDINGS: Midlife women with diabetes or cardiovascular conditions were more likely to report delays in care than men, even after adjusting for key factors (85%-111% higher odds of delays among diabetes patients, 56%-84% higher odds of delays among cardiovascular patients; all p < .01). Many, but not all, of these gender differences were eliminated among Medicare-insured older adults. Among midlife adults, health insurance coverage differences were also significantly associated with delays in care. CONCLUSION: Women are more likely to experience delays in health care, even after adjusting for health coverage. Efforts are needed to understand factors that influence gender differences in these delays and to determine whether policy reforms eliminate or exacerbate these differences.
Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Saúde da Mulher , Idoso , Doenças Cardiovasculares/terapia , Diabetes Mellitus Tipo 2/terapia , Feminino , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/organização & administração , Análise de Regressão , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Serviços de Saúde da Mulher/organização & administraçãoAssuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Avaliação das Necessidades/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Gestão da Qualidade Total/organização & administração , Política de Saúde , Humanos , Grupos Minoritários/estatística & dados numéricos , Papel do Profissional de Enfermagem , Pesquisa em Enfermagem , Assistência Centrada no Paciente/organização & administração , Pobreza/estatística & dados numéricos , Estados Unidos , United States Agency for Healthcare Research and QualityRESUMO
BACKGROUND: Until recently, minority and poor men have been characterized as "an invisible population," overlooked by public and private efforts to improve the health status of women, children, and the elderly. OBJECTIVE: This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. MEASURES/SUBJECTS: Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Interview Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests. RESULTS: Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61-0.69), cardiovascular risk factor screening and management (RR, 0.84-0.88), and vaccinations (RR, 0.47-0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39-0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites. CONCLUSION: Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about "minority" men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks.
Assuntos
Qualidade da Assistência à Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Asiático , População Negra , Doenças Cardiovasculares/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Bases de Dados como Assunto , Hispânico ou Latino , Humanos , Falência Renal Crônica/terapia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Grupos Minoritários , Assistência Centrada no Paciente , Pobreza , Indicadores de Qualidade em Assistência à Saúde , Risco , Fatores de Risco , Fatores Sexuais , Classe Social , Fatores Socioeconômicos , Vacinação , População BrancaRESUMO
Racial and ethnic disparities in health care are well documented and can be discussed in 3 broad categories: health system factors, patient-level factors, and patient/provider interaction. Clinicians and others working in health care and related fields are knowledgeable about disparities in health, but the general US population is not. Racial/ethnic disparities are most striking in life expectancy, infant mortality, and lack of health insurance. The inaugural edition of the National Healthcare Disparities Report, due out in 2003, will provide valuable insights into the state of health care in America, including a comprehensive view of disparities in health care. The Agency for Healthcare Research and Quality is conducting and supporting research, data collection, and other initiatives aimed at reducing racial/ethnic disparities in health care. The documented disparities in health care represent a critical opportunity for quality improvement that requires input from all sectors, including policymakers, providers, community leaders, and patients.