Abstract

Background

Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health.

Objective

To examine unmet healthcare needs among midlife adults (50–64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC).

Methods

Nationally representative data for midlife adults (50–64 years) from NHIS 2014–2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status.

Results

Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1–5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5–9.1), prescriptions (AOR = 4.8, 95% CI 3.9–5.9), or follow-up care (AOR = 5.0, 95% CI 3.7–6.6), and three to four times higher odds of all other types of foregone care.

Conclusions

Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.

中文翻译：

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患有精神困扰和多种慢性病的中年成年人的医疗保健需求未得到满足

摘要

背景

人们对中年健康的关注有限。然而，这是一个发生巨大变化的时代，包括慢性病的发作和心理健康的变化。

客观的

旨在调查美国患有严重心理困扰 (SPD) 和/或多种慢性病 (MCC) 的中年成年人（50-64 岁）未满足的医疗保健需求。

方法

对 2014-2018 年 NHIS 中年成年人（50-64 岁）的全国代表性数据进行了检查（n  = 39,329）。多重发病状态：无 MCC/SPD、仅 MCC、仅 SPD 或两者兼而有之。我们使用逻辑回归来估计按多发病状态延迟或放弃护理的调整优势比 (AOR)。

结果

近 40% 的中年成年人患有 MCC、SPD 或 SPD/MCC。无论是否患有 MCC，SPD 的社会劣势、健康状况一般/较差、活动受限以及延迟/放弃医疗保健的发生率都较高。与两者都没有的人相比，患有 SPD/MCC 的成年人更有可能因办公时间有限而延迟护理（AOR = 4.2，95% CI 3.1–5.5），并且由于所有其他原因而延迟护理的几率高出近三到四倍。患有 SPD/MCC 的患者需要但未获得心理保健（AOR = 6.4，95% CI 4.5–9.1）、处方（AOR = 4.8，95% CI 3.9–5.9）或后续护理（AOR = 5.0，95% CI 3.7-6.6），比所有其他类型放弃护理的几率高出三到四倍。

结论

患有 SPD/MCC 的中年成年人有大量未满足的医疗保健需求。中年是控制慢性病和精神疾病的关键时期。政策制定者和医疗保健系统的协调努力对于满足该人群在生命历程关键阶段的复杂医疗保健需求至关重要。