Medicare在65岁时提供几乎全民保险。然而,医疗保险资格如何影响医疗保险覆盖面的差距,获得护理,和健康状况之间的个人性取向和性别认同是知之甚少。
■为了评估医疗保险资格与医疗保险覆盖范围差异的关联,获得护理,以及个人通过性取向和性别认同自我报告的健康状况。
这项横断面研究使用65岁时医疗保险资格的年龄不连续性来隔离医疗保险与医疗保险的关联,获得护理,和自我报告的健康状况,他们的性取向和性别认同。数据来自2014年至2021年51至79岁受访者的行为危险因素监测系统。数据分析于2022年9月至2023年4月进行。
■65岁的医疗保险资格。
■拥有医疗保险的受访者比例,通常的护理来源,护理的成本障碍,流感疫苗接种,和自我报告的健康状况。
■研究人群包括927952名个体(平均[SD]年龄,64.4[7.7]岁;524972[56.6%]女性和402670[43.4%]男性),其中28077人(3.03%)被认定为性少数族裔女同性恋,同性恋,双性恋,或另一个性少数群体身份(LGB+)和3286(0.35%)作为变性人或性别多样化。确认为异性恋的受访者在65岁时的保险覆盖率(4.2个百分点[pp];95%CI,4.0-4.4pp)比确认为LGB的受访者(3.6pp;95%CI,2.3-4.8pp)有更大的改善,除非分析仅限于已婚受访者的子样本。为了获得护理,改善通常的护理来源,护理的成本障碍,与LGB+受访者相比,异性恋受访者在65岁时接种流感疫苗的比例更高,尽管LGB+个体的置信区间重叠且不太精确。对于自我报告的健康状况,分析发现,与异性恋受访者相比,LGB+受访者在65岁时的改善更大.在几乎有资格获得医疗保险(接近65岁)的个人中,按性取向划分的国家差异存在相当大的异质性,美国南部和中部各州表现出最大的差距。在前10个差距最大的州中,与异性恋受访者相比,LGB+受访者的医疗保险资格与覆盖率(6.7ppvs5.0pp)和获得常规护理来源(1.4ppvs0.6pp)的更大增加相关。
■这项横断面研究的结果表明,与异性恋和/或顺性个体相比,LGBTQI+个体在医疗保险覆盖面和获得护理方面的持续更大改善并不相关。然而,在性少数群体中,医疗保险可能与缩小自我报告健康状况的差距有关,在差距最大的州中,它可以提高医疗保险的覆盖面,获得护理,和自我报告的健康状况。
UNASSIGNED: Medicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood.
UNASSIGNED: To assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity.
UNASSIGNED: This cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023.
UNASSIGNED: Medicare eligibility at age 65 years.
UNASSIGNED: Proportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status.
UNASSIGNED: The study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority-lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents.
UNASSIGNED: The findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals. However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.