The relationship of immigrant status with access, utilization, and health status for children with asthma
The relationship of immigrant status with access, utilization, and health status for children with asthma
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DOI：
10.1016/j.ambp.2007.06.004
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发表时间：
2007-11-01
期刊：
影响因子：
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通讯作者：
Mendoza, Fernando S.
中科院分区：
文献类型：
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作者：
Javier, Joyce R.;Wise, Paul H.;Mendoza, Fernando S.
目标：尽管移民家庭的儿童贫困程度较高且获得医疗保健的机会较少，但与非移民家庭的儿童相比，他们的健康状况优于预期。然而，这一观察结果尚未在慢性病儿童中得到证实。本研究的目的是确定移民家庭中患有哮喘的儿童是否比非移民家庭中患有哮喘的儿童的健康状况好于预期。方法：使用 2001 年和 2003 年加州健康访谈调查 (CHIS) 的数据来确定 2600 名年龄在 1 岁至 11 岁之间经医生诊断患有哮喘的儿童。通过双变量分析和逻辑回归，通过我们的主要自变量移民家庭状况来检查医疗保健的获取、利用和健康状况指标。结果-与非移民家庭中的哮喘儿童相比，移民家庭中的哮喘儿童更有可能缺乏常规护理来源（2.6% vs 1.0%；P < .05），报告医疗护理延迟（8.9% vs 5.2%；P < .01），并且报告没有就诊。过去一年中的医生情况（7.0% vs 3.8%；P < .05）。他们不太可能报告哮喘症状（60.8% vs 74.4%；P < .01）和去年去急诊室就诊（14.1% vs 21.1%；P < .01），但更有可能报告健康状况一般或较差（25.0% vs 10.5%；P < .01）。多变量模型显示，移民身份与健康指标之间的关系很复杂。这些模型表明，缺乏保险和贫困与获取和利用的减少有关。去年，移民家庭的儿童因哮喘而去急诊室的可能性较小（比值比 0.58，置信区间为 0.36-0.93）。贫困与功能受限以及健康状况良好或较差相关，而非英语访谈语言与功能受限较少但健康状况良好或较差相关。结论：临床医生应该意识到贫困、无保险和非英语国家的移民家庭可能存在的重要护理障碍。移民家庭中哮喘儿童的医疗保健获取和利用减少需要政策关注。进一步的研究应该探讨移民家庭中哮喘儿童的护理障碍以及父母对健康的看法。
Objective.-Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.Methods.-Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged I to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.Results.-Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.Conclusions.-Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.