Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children
Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children
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DOI：
10.1542/peds.2007-1243
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发表时间：
2008-02-01
期刊：
影响因子：
8
通讯作者：
Tomany-Korman, Sandra C.
中科院分区：
文献类型：
--
作者：
Flores, Glenn;Tomany-Korman, Sandra C.
背景对儿童医疗和牙科保健中种族/民族不平等的全国普遍性了解不够。这项工作的目的是检查种族/民族的差异，在医疗和口腔健康，获得护理，并在全国样本使用服务。全国儿童健康调查是2003 - 2004年对102 353名0至17岁儿童的父母和监护人进行的全国随机抽样电话调查。研究了白色、非裔美国人、拉丁美洲人、亚洲/太平洋岛民、美洲原住民和多种族儿童在选定的医疗和口腔健康及保健措施方面的差异。进行多变量分析，以调整家中的主要语言，年龄，保险范围，收入，父母教育和就业，以及家庭中儿童和成人的数量。对40项医疗和口腔健康状况、获得护理和使用服务的措施进行了分析。注意到许多重大差异;例如，白人的无保险率为6%，拉丁美洲人为21%，美洲原住民为15%，非洲裔美国人为7%，亚洲人或太平洋岛民为4%，而有通常护理来源的比例如下：白人，90%;美洲原住民，61%;拉丁美洲人，68%;非洲裔美国人，77%;亚洲人或太平洋岛民占87%。在多变量分析中，对于>= 1的少数群体，许多差异持续存在，包括次优健康状况的几率增加，超重，哮喘，活动限制，行为和言语问题，情绪困难，无保险，次优牙齿健康，没有通常的护理来源，未满足的医疗和牙科需求，护理的交通障碍，获得专科护理的问题，过去一年没有医疗或牙科就诊，急诊室就诊，不接受精神卫生保健，不接受处方药。某些差异在特定种族/族裔群体中特别明显：拉丁美洲人的健康状况和牙齿状况欠佳，没有保险，无法获得专科护理;非洲裔美国人的哮喘、行为问题、皮肤过敏、言语问题和未满足的处方需求;美洲原住民的听力或视力问题，没有常规护理来源，急诊室就诊，未满足的医疗和牙科需求;对于亚洲人或太平洋岛民来说，在过去的一年里，他们无法获得专业护理，也无法去看医生。多种族儿童也经历了许多痛苦。少数群体儿童在医疗和口腔健康、获得护理和使用服务方面面临多重差距。某些差异在特定种族/族裔群体中特别明显，多种族儿童经历许多差异。
BACKGROUND. Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care.OBJECTIVE. The purpose of this work was to examine racial/ethnic disparities in medical and oral health, access to care, and use of services in a national sample.METHODS. The National Survey of Children's Health was a telephone survey in 2003 2004 of a national random sample of parents and guardians of 102 353 children 0 to 17 years old. Disparities in selected medical and oral health and health care measures were examined for white, African American, Latino, Asian/Pacific Islander, Native American, and multiracial children. Multivariate analyses were performed to adjust for primary language at home, age, insurance coverage, income, parental education and employment, and number of children and adults in the household. Forty measures of medical and oral health status, access to care, and use of services were analyzed.RESULTS. Many significant disparities were noted; for example, uninsurance rates were 6% for whites, 21% for Latinos, 15% for Native Americans, 7% for African Americans, and 4% for Asians or Pacific Islanders, and the proportions with a usual source of care were as follows: whites, 90%; Native Americans, 61%; Latinos, 68%; African Americans, 77%; and Asians or Pacific Islanders, 87%. Many disparities persisted for >= 1 minority group in multivariate analyses, including increased odds of suboptimal health status, overweight, asthma, activity limitations, behavioral and speech problems, emotional difficulties, uninsurance, suboptimal dental health, no usual source of care, unmet medical and dental needs, transportation barriers to care, problems getting specialty care, no medical or dental visit in the past year, emergency department visits, not receiving mental health care, and not receiving prescription medications. Certain disparities were particularly marked for specific racial/ethnic groups: for Latinos, suboptimal health status and teeth condition, uninsurance, and problems getting specialty care; for African Americans, asthma, behavior problems, skin allergies, speech problems, and unmet prescription needs; for Native Americans, hearing or vision problems, no usual source of care, emergency department visits, and unmet medical and dental needs; and for Asians or Pacific Islanders, problems getting specialty care and not seeing a doctor in the past year. Multiracial children also experienced many disparities.CONCLUSIONS. Minority children experience multiple disparities in medical and oral health, access to care, and use of services. Certain disparities are particularly marked for specific racial/ethnic groups, and multiracial children experience many disparities.