Socioeconomic Disparities for Hearing-Impaired Children in the United States
Socioeconomic Disparities for Hearing-Impaired Children in the United States
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DOI：
10.1002/lary.21460
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发表时间：
2011-04-01
期刊：
影响因子：
2.6
通讯作者：
Levinson, Kimberly L.
中科院分区：
文献类型：
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作者：
Boss, Emily F.;Niparko, John K.;Levinson, Kimberly L.
目的：本研究旨在评估听力受损儿童在社会经济地位和医疗保健利用方面的差异。研究设计：对1997年至2003年全国健康访谈调查的数据进行横断面分析，这是国家卫生统计中心对美国家庭进行的一项自愿调查。方法：根据家长对听力状况的反应，将儿童分为三个听力水平。chi(2)和方差分析（ANOVA）模型检验了个体社会人口学变量与听力状况的关联。多变量回归分析考察了听力障碍与家庭收入、贫困状况、常规和专业卫生服务的利用之间的关系。结果：共76012名儿童，听力损失2.6%，听力明显损失0.43%。听力受损儿童的家庭更有可能报告较差的健康状况，有医疗补助，生活在单亲母亲家庭，生活在贫困水平以下（P < 0.01）。调整混杂因素后，轻度和明显听力障碍的儿童更不可能负担得起处方药（优势比[OR] = 1.89, 95%置信区间[CI]， 1.44-2.48[轻度]；OR = 2.72, 95% CI, 1.73-4.29[有标记]），更不可能获得精神卫生服务（OR = 3.26, 95% CI, 2.41-4.69[轻度]；OR = 2.62, 95% CI, 1.34-5.12[有标记]）或牙科服务（OR 1.65, 95% CI, 1.36-2.02[轻度]；OR = 1.62, 95% CI, 1.09-2.41[有标记]）。在获得常规/生病保健服务方面没有发现差异。结论：与无听力损失儿童家庭相比，听力受损儿童家庭生活水平更接近贫困水平，使用某些医疗服务的频率更低。进一步确定家庭社会经济地位与儿童听力损失之间的因果关系，可能有助于指导旨在减轻医疗保健差距和改善听障儿童获得服务机会的政策举措。
Objectives: This study aims to evaluate disparities in socioeconomic status and healthcare utilization in hearing-impaired children using a nationally representative sample.Study Design: Cross-sectional analysis of stacked data from the 1997 to 2003 National Health Interview Survey, a voluntary U. S. household survey of the National Center for Health Statistics.Methods: Children were grouped according to three levels of hearing ability based on parental response to perceived hearing status. chi(2) and analysis of variance (ANOVA) models tested the association of individual sociodemographic variables with hearing status. Multivariate regression analyses examined the association of hearing impairment with family income, poverty status, and utilization of routine and specialty health services.Results: The total sample consisted of 76,012 children, of whom 2.6% had some hearing loss and 0.43% had marked hearing loss. Families of hearing-impaired children were more likely to report poorer health status, have Medicaid, live in single-mother households, and live below the poverty level (P < .01). After adjusting for confounders, children with mild and marked hearing impairment were less likely to afford prescription medications (odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.44-2.48 [mild]; OR = 2.72, 95% CI, 1.73-4.29 [marked]) and less likely to have access to mental health services (OR = 3.26, 95% CI, 2.41-4.69 [mild]; OR = 2.62, 95% CI, 1.34-5.12 [marked]) or dental services (OR 1.65, 95% CI, 1.36-2.02 [mild]; OR = 1.62, 95% CI, 1.09-2.41 [marked]). No difference was identified for access to routine/sick health services.Conclusions: Compared with families of children without hearing loss, families of hearing-impaired children live closer to the poverty level and utilize some medical services with less frequency. Further identification of causal relationships between familial socioeconomic status and childhood hearing loss may help direct policy initiatives designed to mitigate healthcare disparities and improve access to services for hearing-impaired children.