High Cotinine and Healthcare Utilization Disparities Among Low-Income Children.
High Cotinine and Healthcare Utilization Disparities Among Low-Income Children.
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DOI：
10.1016/j.amepre.2020.06.018
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发表时间：
2021-03
影响因子：
5.5
通讯作者：
Mahabee-Gittens EM
中科院分区：
文献类型：
--
作者：
Merianos AL;Jandarov RA;Mahabee-Gittens EM
本研究评估了儿童唾液可替宁、父母报告的吸烟和儿童烟草烟雾暴露与6个月内儿童保健就诊和住院次数的关系。本研究还评估了参与者特征和儿童可替宁之间的关系。纵向数据来自313名0-9岁的临床患病儿童的样本，这些儿童与吸烟者一起生活，并在2016-2018年期间前往儿科急诊科或紧急护理。于二零二零年，对可替宁测量值进行对数转换，并进行泊松及线性回归。大多数儿童来自低收入家庭（66.1%），有公共保险/自费（95.5%）。儿童可替宁范围为0.1 - 332.0 ng/mL（几何平均值=4.8 ng/mL，95% CI=4.1，5.5）。Poisson回归结果表明，对数可替宁每增加1个单位与基线访视后6个月内儿科急诊访视的增加相关，校正RR为1.16（95% CI=1.01，1.34）。log可替宁每增加1个单位与6个月期间住院频率的增加相关，调整后的RR为1.50（95% CI=1.08，2.09）。父母报告的吸烟或儿童烟草烟雾暴露和医疗保健利用之间没有差异。线性回归结果表明，年龄较小（β=-0.227，p=0.049）、白色（几何平均值=5.5 ng/mL）、有早产病史（几何平均值=8.1 ng/mL）和冬季基线访视（几何平均值=6.5 ng/mL）的儿童可替宁较高。居住在公寓（几何平均值=5.5 ng/mL）和多单元住宅（几何平均值=5.5 ng/mL）中的儿童的可替宁高于单户住宅（几何平均值=3.6 ng/mL）。常规生化筛查可以识别需要密集的烟草烟雾暴露减少干预措施的儿童。
This study assesses the associations of child salivary cotinine, parent-reported smoking, and child tobacco smoke exposure with number of child healthcare visits and hospital admissions over a 6-month period. This study also assesses relationships between participant characteristics and child cotinine. Longitudinal data were evaluated from a sample of 313 clinically ill children aged 0–9 years who lived with a smoker and presented to a pediatric emergency department or urgent care during 2016–2018. In 2020, cotinine measurements were log-transformed, and Poisson and linear regression were performed. The majority of children came from low-income homes (66.1%) and had public insurance/self-pay (95.5%). Child cotinine ranged from 0.1 to 332.0 ng/mL (geometric mean=4.8 ng/mL, 95% CI=4.1, 5.5). Poisson regression results indicated each 1-unit increase of log-cotinine was associated with an increase in pediatric emergency department visits over a 6-month period following the baseline visit with an adjusted RR of 1.16 (95% CI=1.01, 1.34). Each 1-unit increase of log-cotinine was associated with an increase in the frequency of hospital admissions over the 6-month period with an adjusted RR of 1.50 (95% CI=1.08, 2.09). No differences were found between parent-reported smoking or child tobacco smoke exposure and healthcare utilization. Linear regression results indicated children who were younger (β= −0.227, p=0.049), white (geometric mean=5.5 ng/mL), had medical history of prematurity (geometric mean=8.1 ng/mL), and a winter baseline visit (geometric mean=6.5 ng/mL) had higher cotinine. Children living in apartments (geometric mean=5.5 ng/mL) and multi-unit homes (geometric mean=5.5 ng/mL) had higher cotinine than those in single-family homes (geometric mean=3.6 ng/mL). Routine biochemical screening could identify children who are in need of intensive tobacco smoke exposure reduction interventions.
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