JAMA INTERN MED｜美国65岁成年人在获得医疗保健方面的种族和族裔差

　　JAMA INTERN MEDEarly Recent, July 26, 202110.1001/jamainternmed.2021.3922本文由“天纳”临床学术信息人工智能系统自动翻译Is Medicare eligibility associated with reductions in racial and ethnic disparities in access to care and health?医疗保险资格是否与减少在获得医疗和保健方面的种族和民族差异有关？In this cross-sectional study using a regression discontinuity design, eligibility for Medicare at age 65 years was associated with reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health across the US, but not mortality.在这项采用回归不连续设计的横断面研究中，65岁时获得医疗保险的资格与美国各地在保险覆盖率、获得护理和自我报告健康方面的种族和种族差异减少有关，但与死亡率无关。Expanding eligibility for Medicare may be a viable means to reduce racial and ethnic disparities and advance health equity by closing gaps in insurance coverage.扩大医疗保险的资格可能是一个可行的手段，以减少种族和种族差异，并通过缩小保险覆盖范围的差距，促进健康公平。Medicare provides nearly universal health insurance to individuals at age 65 years. How eligibility for Medicare affects racial and ethnic disparities in access to care and health is poorly understood.医疗保险为65岁的人提供几乎普遍的健康保险。获得医疗保险的资格如何影响获得医疗和保健的种族和民族差异，人们对此知之甚少。To assess the association of Medicare with racial and ethnic disparities in access to care and health.评估医疗保险与获得护理和健康的种族和民族差异的关系。This cross-sectional study uses regression discontinuity to compare racial and ethnic disparities before and after age 65 years, the age at which US adults are eligible for Medicare. There are a total of 2?434?320 respondents in the Behavioral Risk Factor Surveillance System and 44?587 state-age-year observations in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Data (eg, the mortality rate for individuals age 63 years in New York in 2017) from January 2008 to December 2018. The data were analyzed between February and May 2021.这项横断面研究使用回归不连续性来比较65岁之前和之后的种族和种族差异，65岁是美国成年人有资格享受医疗保险的年龄。一共有2个?434?行为危险因素监测系统的320名受访者和44名?2008年1月至2018年12月，美国疾病控制和预防中心对587个州的年龄年进行了观察。这些数据在2021年2月至5月期间进行了分析，用于流行病学研究数据（例如，2017年纽约63岁个人的死亡率）。Eligibility for Medicare at age 65 years.65岁时有资格享受医疗保险。Proportions of respondents with health insurance, as well as self-reported health and mortality. To examine access, whether respondents had a usual source of care, encountered cost-related barriers to care, or received influenza vaccines was assessed.有医疗保险的受访者比例，以及自我报告的健康和死亡率。为了检查获得情况，评估了受访者是否有通常的护理来源，是否遇到了与成本相关的护理障碍，是否接受了流感疫苗。Of 2?434?320 participants, 192?346 were Black individuals, 104?294 were Hispanic individuals, and 892?177 were men. Immediately after age 65 years, insurance coverage increased more for Black respondents (from 86.3% to 95.8% or 9.5 percentage points; 95% CI, 7.6-11.4) and Hispanic respondents (from 77.4% to 91.3% or 13.9 percentage points; 95% CI, 12.0-15.8) than White respondents (from 92.0% to 98.5% or 6.5 percentage points; 95% CI, 6.1-7.0). This was associated with a 53% reduction compared with the size of the disparity between White and Black individuals before age 65 years (5.7% to 2.7% or 3.0 percentage points; 95% CI, 0.9-5.1; P?=?.003) and a 51% reduction compared with the size of the disparity between White and Hispanic individuals before age 65 years (14.6% to 7.2% or 7.4 percentage points; 95% CI, 5.3-9.5; P?<?.001). Medicare eligibility was associated with narrowed disparities between White and Hispanic individuals in access to care, lowering disparities in access to a usual source of care from 10.5% to 7.5% (P?=?.05), cost-related barriers to care from 11.4% to 6.9% (P?<?.001), and influenza vaccination rates from 8.1% to 3.3% (P?=?.01). For disparities between White and Black individuals, access to a usual source of care before and after age 65 years was notsignificantly different: 1.2% to 0.0% (P?=?.24), cost-related barriers to care from 5.8% to 4.3% (P?=?.22), and influenza vaccinations from 11.0% to 10.3% (P?=?.60). The share of people in poor self-reported health decreased by 3.8 percentage points for Hispanic respondents, 2.6 percentage points for Black respondents, and 0.2 percentage points for White respondents. Mortality-related disparities at age 65 years were unchanged. Medicare’s association with reduced disparities largely persisted after the US Affordable Care Act took effect in 2014.第2页?434?320人，192人?346人是黑人，104人?294人是西班牙裔，892人是西班牙裔?177人是男人。在65岁之后，黑人受访者的保险覆盖率增加更多（从86.3%增加到95.8%或9.5个百分点；95%可信区间（7.6-11.4）和拉美裔（77.4%-91.3%或13.9个百分点）；95%可信区间（12.0-15.8）高于白人（92.0-98.5%或6.5个百分点；95%可信区间6.1-7.0）。这与65岁之前白人和黑人之间的差距缩小53%有关（5.7%至2.7%或3.0个百分点；95%可信区间0.9-5.1；P?=?.与65岁之前的白人和西班牙裔之间的差距相比减少了51%（14.6%至7.2%或7.4个百分点；95%可信区间5.3-9.5；P?<?.001). 医疗保险资格与白人和西班牙裔在获得护理方面的差距缩小有关，将获得普通护理的差距从10.5%降低到7.5%（P?=?.05），与成本相关的护理障碍从11.4%降至6.9%（P?<?.流感疫苗接种率从8.1%到3.3%（P?=?.01). 对于白人和黑人之间的差异，65岁之前和之后获得普通护理的机会没有显著差异：1.2%到0.0%（P?=?.24），与成本相关的护理障碍从5.8%降至4.3%（P?=?.流感疫苗接种率从11.0%到10.3%（P?=?.60). 西班牙裔受访者自我报告健康状况不佳的比例下降了3.8个百分点，黑人受访者下降了2.6个百分点，白人受访者下降了0.2个百分点。65岁时死亡率相关的差异没有变化。2014年美国平价医疗法案生效后，医疗保险与缩小差距的关联基本上一直存在。In this cross-sectional study that uses a regression discontinuity design, eligibility for Medicare at age 65 years was associated with marked reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health.在这项采用回归不连续设计的横断面研究中，65岁时获得医疗保险的资格与保险覆盖率、获得护理和自我报告健康方面的种族和民族差异显著减少有关。1. 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