Can universal access to health care eliminate health inequities between children of poor and nonpoor families? A case study of childhood asthma in Alberta
Can universal access to health care eliminate health inequities between children of poor and nonpoor families? A case study of childhood asthma in Alberta
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DOI：
10.1378/chest.124.1.51
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发表时间：
2003-07-01
期刊：
影响因子：
9.6
通讯作者：
Man, SFP
中科院分区：
文献类型：
--
作者：
Sin, DD;Svenson, LW;Man, SFP
研究目标：来自贫困家庭的儿童比来自非贫困家庭的儿童更有可能因哮喘而接受紧急就诊，这可能与穷人获得良好预防性护理的经济障碍有关。我们试图确定在提供免费门诊和医院服务的医疗保健系统中，哮喘急诊就诊率的差异是否会在收入梯度中不太明显。设计：纵向、以人群为基础的研究。地点：加拿大艾伯塔省。参与者：1985 年至 1988 年期间出生于加拿大艾伯塔省的所有儿童 (n = 90,845) 根据其父母报告的年收入被分为三个相互排斥的组。上一年：非常贫困、贫困和非贫困群体。 测量和结果：我们在 10 年随访期间使用 Cox 比例风险模型比较了非常贫困、贫困和非贫困家庭的儿童因儿童哮喘紧急就诊的相对风险 (RR)。我们发现，根据各种因素进行调整后，非常贫困的儿童因哮喘而紧急就诊的可能性比非贫困家庭的儿童高 23%（RR，1.23；95% 置信区间 [CI]，1.14 至 1.33）。然而，贫困组的哮喘紧急就诊风险与非贫困组相似（RR，0.97；95% CI，0.91 至 1.04）。非常贫困群体和非贫困群体因哮喘就诊的平均次数相似。结论：在普遍获得医疗保健的情况下；贫困家庭和非贫困家庭的儿童哮喘急诊就诊率相似；然而，非常贫困的儿童仍然面临着过高的风险。这些研究结果表明，全民医疗保健系统可以减少但不能完全消除不同收入类别在哮喘紧急治疗方面的差异。
Study objectives: Children from poor families are much more likely to have emergency visits for asthma than those from nonpoor families, which may be related to financial access barriers to good preventive care for the poor. We sought to determine whether in a health-care system that provides free access to outpatient and hospital services, the disparities in the rates of emergency visits for asthma would be less apparent across the income gradient.Design: Longitudinal, population-based study.Setting: Alberta, Canada..Participants: All children born in Alberta, Canada between 1985 and 1988 (n = 90,845) were classified into three mutually exclusive groups based on the reported annual income of their parents from the previous year: very poor, poor, and nonpoor groups.Measurements and results: We compared the relative risk (RR) of emergency visits for childhood asthma among children of very poor, poor, and nonpoor families using a Cox proportional hazard model during a 10-year follow-up. We found that the very poor children were 23% more likely to have had an emergency visit for asthma than those from nonpoor families (RR, 1.23; 95% confidence interval [CI], 1.14 to 1.33), adjusted for a variety of factors. The poor group, however, had a similar risk of asthma emergency visits as the nonpoor group (RR, 0.97; 95% CI, 0.91 to 1.04). The average number of office visits for asthma was similar between the very poor and nonpoor groups.Conclusions: In a setting of universal access to health care; children of poor and nonpoor families had similar rates of asthma emergency visits; the very poor children, however, continued to experience an excess risk. These findings suggest that a universal health-care system can reduce, but not fully eliminate, the disparities in emergency utilization of asthma across income categories.