摘要：Objectives. We sought to disentangle the relationships between race/ethnicity, socioeconomic status (SES), and unmet medical care needs. Methods. Data from the 2003–2004 Community Tracking Study Household Survey were used to examine associations between unmet medical needs and SES among African American and White women. Results. No significant racial/ethnic differences in unmet medical needs (24.8% of Whites, 25.9% of African Americans; P = .59) were detected in bivariate analyses. However, among women with 12 years of education or less, African Americans were less likely than were Whites to report unmet needs (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.42, 0.79). Relative to African American women with 12 years of education or less, the odds of unmet needs were 1.69 (95% CI = 1.24, 2.31) and 2.18 (95% CI = 1.25, 3.82) among African American women with 13 to 15 years of education and 16 years of education or more, respectively. In contrast, the relationship between educational level and unmet needs was nonsignificant among White women. Conclusions. Among African American women, the failure to recognize unmet medical needs is related to educational attainment and may be an important driver of health disparities, representing a fruitful area for future interventions. African Americans are more likely than Whites to have unmet medical care needs according to objective clinical standards such as burden of disease (e.g., higher rates of heart disease and cancer deaths), clinical symptoms of ill health, and preventable hospitalizations. 1 , 2 Unmet medical need, considered a critical indicator of lack of access to care, is also commonly assessed through subjective indices such as self-reported ability to obtain needed medical care or postponing of needed medical care. 3 , 4 Studies based on these subjective measures often reveal that African Americans report less need for medical care than Whites, 5 – 7 but this finding has not been consistent. 8 – 10 In any event, such a finding suggests that subjective measures capture personal perceptions of need for care rather than (or in addition to) true clinical need. 3 , 4 , 11 Complex and poorly studied factors influence the link between true medical needs and perceived medical needs, especially among members of racial/ethnic minority groups. Theoretical and empirical research has underscored the limitations of subjective measures of medical need. Signs and symptoms of disease may be a better proxy for unmet medical needs among vulnerable populations. 1 , 11 – 14 For example, Cunningham and Hadley 11 recently showed that, among members of racial/ethnic minority groups, symptom-specific measures of unmet need were more accurate than general measures. In the United States, race/ethnicity, socioeconomic status (SES), and health have been historically intertwined. 15 SES (e.g., education, occupation, and income) accounts for a large portion of the health disparities observed between members of racial/ethnic minority groups and members of more advantaged groups. 15 , 16 Also, SES may partly account for differences in how illness severity and risk are perceived. Individuals of low SES, especially members of racial/ethnic minority groups, are more likely than individuals of high SES to underestimate illness severity and the need of medical care for serious conditions such as cancer, stroke, and obesity. 17 – 21 African Americans and all individuals with low incomes are more likely to underestimate their risk for heart attack, stroke, and cancer than are their counterparts and are less likely to use screening programs and seek appropriate care. 22 , 23 Thus, perceptions of medical need among members of racial/ethnic minority groups are strongly linked to SES. 24 Although the literature clearly documents strong links between race/ethnicity, SES, and medical need, the overall picture is not clear. Nationally representative studies with detailed adjustment for SES among specific demographic populations are not available. More specifically, women are more likely than are men to delay or not obtain needed medical care, 25 , 26 and their unmet needs are more likely to result in mortality. 27 The relationship between SES and health may be critically shaped by gender. 28 For example, lower SES is associated with poorer health, and, in general, women have lower levels of education than men. 29 , 30 However, little has been done to disentangle the complex interrelationships among race/ethnicity, SES, and perceptions of unmet or delayed need, especially among women. In an attempt to fill this important gap, we used data from a nationally representative, community-based survey of African American and White women to examine how race/ethnicity and SES are associated with perceived unmet medical care needs. More specifically, we attempted to answer the following question: how does SES influence the relationship between race/ethnicity and perceptions of unmet or delayed need for care among women? Our study was guided by the King and Williams 24 conceptual framework for understanding racial differences in health. According to that framework, race is a proxy variable representing how biological, cultural, socioeconomic, sociopolitical, and discrimination factors … jointly influence health practices, psychosocial and environmental stress, medical care, and ultimately health outcomes.24(p107)
