Measures of Neighborhood Opportunity and Adherence to Recommended Pediatric Primary Care.
Measures of Neighborhood Opportunity and Adherence to Recommended Pediatric Primary Care.
复制标题
DOI：
10.1001/jamanetworkopen.2023.30784
复制
发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
用儿童机会指数衡量的邻里机会与儿童初级保健中的预防保健获得和福祉结果相关吗？在这项横断面研究中，包括一个大型儿科初级保健网络中的338277名0至19岁儿童，与机会非常低的社区儿童相比，机会非常高的社区儿童更有可能获得最新的预防性访问和疫苗接种，并且不太可能患有肥胖症或青少年或母亲抑郁症和自杀倾向筛查阳性。这些研究结果表明，邻里机会与儿科初级保健结果有关的预防保健的访问和儿童福祉，强调了改善预防保健资源和访问机会低的社区的重要性。这项横断面研究探讨了邻里机会的关联，用儿童机会指数测量，与儿科初级保健临床上通常捕获的健康指标，反映了获得预防保健和儿童福祉。众所周知，社区条件对儿童健康有广泛的影响。迄今为止的研究还没有检查儿童机会指数（COI）的关联，这是一个多维度的邻里环境条件指标，特别是与儿科初级保健结果。确定由COI测量的邻里机会与儿科初级保健临床上通常捕获的健康指标之间的关联，反映预防保健和儿童福祉的获得。这项横断面观察性研究使用了来自美国东北部一个大型儿科初级保健网络的电子健康记录数据。参与者包括2020年11月至2022年11月期间活跃在基层医疗网络的0至19岁患者。数据于2022年12月进行分析。人口普查区一级COI总分（五分位数）。结果包括最新的预防保健和免疫状况和存在的肥胖，青少年抑郁症和自杀，和母亲抑郁症和自杀。多变量混合效应logistic回归估计这些结果与COI五分位数的相关性，并根据年龄、性别、种族和民族以及保险类型进行调整。在338 277例患者中（平均[SD]年龄，9.8 [5.9]岁; 165 223名女性[48.8%]; 158 054人[46.7%]非西班牙裔白色人，209 482人[61.9%]有商业保险），81739人（24.2%）和130361人（38.5%）分别居住在COI很低和很高的社区。生活在非常高的COI社区（相对于非常低的COI）与预防性访视的最新几率较高相关（比值比[OR]，1.40; 95% CI，1.32-1.48）和免疫接种（OR，1.77; 95%CI，1.58-2.00），肥胖几率较低（OR，0.55; 95%CI，0.52-0.58），青少年抑郁症（OR，0.78; 95% CI，0.72-0.84）和自杀倾向（OR，0.79; 95% CI，0.73-0.85）、母亲抑郁（OR，0.78; 95% CI，0.72-0.86）和自杀倾向（OR，0.71; 95% CI，0.61-0.83）。这项对电子健康记录数据的横断面研究发现，邻里机会与多种儿科初级保健结果相关。了解这些关联可以帮助卫生系统确定需要额外支持的社区，并倡导和发展与社区团体的伙伴关系，以促进儿童福祉。研究结果强调了在低COI社区改善预防保健的重要性。
Is neighborhood opportunity, measured with the Childhood Opportunity Index, associated with preventive care access and well-being outcomes in pediatric primary care? In this cross-sectional study including 338 277 children aged 0 to 19 years in a large pediatric primary care network, children in very high opportunity neighborhoods were significantly more likely to be up-to-date on preventive visits and vaccinations and were less likely to have obesity or to screen positive for adolescent or maternal depression and suicidality, compared with children in very low opportunity neighborhoods. These findings suggest that neighborhood opportunity is associated with pediatric primary care outcomes related to preventive care access and child well-being, underscoring the importance of improving preventive care resources and access in low-opportunity communities. This cross-sectional study examines the association of neighborhood opportunity, measured with the Childhood Opportunity Index, with health metrics commonly captured clinically in pediatric primary care, reflecting both access to preventive care and child well-being. Neighborhood conditions are known to broadly impact child health. Research to date has not examined the association of the Childhood Opportunity Index (COI), a multidimensional indicator of neighborhood environment conditions, specifically with pediatric primary care outcomes. To determine the association of neighborhood opportunity measured by the COI with health metrics commonly captured clinically in pediatric primary care, reflecting both access to preventive care and child well-being. This cross-sectional observational study used electronic health record data from a large pediatric primary care network in the northeastern US. Participants included patients aged 0 to 19 years who were active in the primary care network between November 2020 and November 2022. Data were analyzed in December 2022. Census tract–level COI overall score (in quintiles). Outcomes included up-to-date preventive care and immunization status and presence of obesity, adolescent depression and suicidality, and maternal depression and suicidality. Multivariable mixed-effects logistic regressions estimated associations of these outcomes with COI quintiles, adjusted for age, sex, race and ethnicity, and insurance type. Among 338 277 patients (mean [SD] age, 9.8 [5.9] years; 165 223 female [48.8%]; 158 054 [46.7%] non-Hispanic White, 209 482 [61.9%] commercially insured), 81 739 (24.2%) and 130 361 (38.5%) lived in neighborhoods of very low and very high COI, respectively. Living in very high COI neighborhoods (vs very low COI) was associated with higher odds of being up-to-date on preventive visits (odds ratio [OR], 1.40; 95% CI, 1.32-1.48) and immunizations (OR, 1.77; 95% CI, 1.58-2.00), and with lower odds of obesity (OR, 0.55; 95% CI, 0.52-0.58), adolescent depression (OR, 0.78; 95% CI, 0.72-0.84) and suicidality (OR, 0.79; 95% CI, 0.73-0.85), and maternal depression (OR, 0.78; 95% CI, 0.72-0.86) and suicidality (OR, 0.71; 95% CI, 0.61-0.83). This cross-sectional study of electronic health record data found that neighborhood opportunity was associated with multiple pediatric primary care outcomes. Understanding these associations can help health systems identify neighborhoods that need additional support and advocate for and develop partnerships with community groups to promote child well-being. The findings underscore the importance of improving access to preventive care in low COI communities.