种族不平等和获得COVID-19治疗的机会
Rebecca Bromley-Dulfano1,2, Michael L Barnett1,3
1Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA network open
|July 1, 2025
概括
在COVID-19治疗中存在种族和种族差异,黑人和拉丁裔患者接受的口服抗病毒处方较少. 诊断测试类型和虚拟护理访问等接触级别的因素部分解释了这些差距,建议采取干预措施来改善公平.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
- 传染病流行病学 传染病流行病学
背景情况:
- 及时对COVID-19进行门诊治疗对于高危人群至关重要,减少住院和死亡.
- 在美国各地记录了COVID-19治疗中的重大种族和种族不平等.
- 导致这些治疗差异的具体护理机制尚不清楚.
研究的目的:
- 调查结构性和接触层面因素对口服抗病毒处方中种族和种族差异的相对贡献COVID-19.
- 确定医疗保健系统中加剧治疗不平等的特定障碍.
- 为旨在改善公平获得COVID-19治疗药物的有针对性的干预措施提供信息.
主要方法:
- 一项利用来自东北地区大型医疗保健系统的电子健康记录数据进行的横截面研究.
- 在2022年1月至2024年1月期间对18岁以上的COVID-19测试阳性患者进行分析.
- 嵌套的线性概率模型根据临床,公共卫生和接触级别的特征进行调整,以分割尼马特里尔维尔/里托纳维尔或莫尔努皮拉维尔处方率的差异.
主要成果:
- 总共有201,964名患者被纳入分析.
- 与白人患者相比,黑人 (10.8个百分点) 和西班牙裔/拉丁裔 (9.8个百分点) 患者的口服抗病毒药物的未调整处方率明显较低.
- 接触层面的因素,包括诊断测试类型 (临床和家庭抗原测试) 和虚拟护理访问,解释了黑人患者的53%的差距和拉丁裔患者的39%.
结论:
- 在门诊COVID-19治疗处方中存在大量的种族和种族差异.
- 诊断测试方式,虚拟护理利用和护理地点的差异是导致这些差异的关键接触层面因素.
- 建议采取专注于扩大快速检测和虚拟护理的干预措施,以促进公平的COVID-19治疗.
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