Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study
Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study
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DOI：
10.1136/bmj.318.7184.642
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发表时间：
1999-03-06
影响因子：
--
通讯作者：
Jones, M
中科院分区：
文献类型：
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作者：
Saxena, S;Majeed, A;Jones, M
目的 确定儿童在疾病发作、预防活动和家访方面的咨询率如何因社会阶层的不同而变化。设计对 1991 年 9 月至 1992 年 8 月期间进行的第四次全国全科医生发病率调查前瞻性收集的数据进行分析。在英格兰和威尔士设置 60 个全科诊所。受试者 106 102 名 0 至 15 岁的儿童在参与的诊所登记。主要结果指标潜在疾病、预防性事件、家访和特定诊断类别（感染、哮喘和损伤）。 结果 总体咨询率以线性模式从总登记官的社会阶层 I-II 增加到 IV-V 阶层（IV-V 与 I-II 比率为 1.18；95% 置信区间为 1.14 至 1.22）。 IV-V 社会阶层的儿童比 I-II 社会阶层的儿童更频繁地就诊疾病（I 饮食比率 1.23；1.15 至 1.30），包括感染、哮喘、受伤和中毒。他们对未成年人的咨询率也明显更高；中度和严重疾病以及较高的家访率（比率比 2.00；1.81 至 2.18）。 TV-V 社会阶层儿童的预防活动咨询率低于 I-II 社会阶层儿童（比率 0.95；0.86 至 1.05）。 结论 从 I-II 社会阶层到 IV-V 社会阶层，儿童期疾病发作的咨询率有所增加。关于潜在疾病严重程度的研究结果表明，来自较低社会阶层的儿童的健康状况比来自较高社会阶层的儿童更差。这些结果强化了根据儿童的社会经济背景确定并针对儿童提供预防性医疗保健的必要性。
Objective To establish how consultation rates in children for episodes of illness, preventive activities, and home visits vary by social class.Design Analysis of prospectively collected data from the fourth national survey of morbidity in general practice, carried out between September 1991 and August 1992.Setting 60 general practices in England and Wales.Subjects 106 102 children aged 0 to 15 years registered with the participating practices.Main outcome measures Mean overall consultation rates for any reason, illness by severity of underlying disease, preventive episodes, home visits, and specific diagnostic category (infections, asthma, and injuries).Results Overall consultation rates increased from registrar general's social classes I-II to classes IV-V in a linear pattern (for IV-V v I-II rate ratio 1.18; 95% confidence interval 1.14 to 1.22). Children from social classes IV-V consulted more frequently than children from classes I-II for illnesses (I ate ratio 1.23; 1.15 to 1.30), including infections, asthma, and injuries and poisonings. They also had significantly higher consultation rates for minor; moderate, and serious illnesses and higher home visiting rates (rate ratio 2.00; 1.81 to 2.18). Consultations for preventive activities were lower in children from social classes TV-V than in children from social classes I-II (rate ratio 0.95; 0.86 to 1.05).Conclusions Childhood consultation rates for episodes of illness increase from social classes I-II through to classes IV-V. The findings on severity of underlying illness suggest the health of children from lower social classes is worse than that of children from higher social classes. These results reinforce the need to identify and target children for preventive health care in their socioeconomic context.