The Association of Mobility, Social Deprivation, and Pediatric Primary Care Outcomes in Community Health Centers.
The Association of Mobility, Social Deprivation, and Pediatric Primary Care Outcomes in Community Health Centers.
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社区卫生中心流动性、社会剥夺和儿科初级保健成果协会。
DOI：
10.1016/j.jpeds.2023.113465
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Marino,Miguel
中科院分区：
文献类型：
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作者：
Lucas,JenniferA;Hsu,Audree;Heintzman,John;Bailey,SteffaniR;Suglia,ShakiraF;Bazemore,Andrew;Giebultowicz,Sophia;Marino,Miguel
目的总体上并按种族和民族分层，研究社会剥夺和居住流动性与在社区卫生中心 (CHC) 寻求护理的儿童的初级保健使用情况之间的关系。研究设计我们使用了来自 OCHIN 网络的 15 个美国 CHC 接受护理的 152 896 名儿童的电子健康记录开放队列数据。患者年龄为 3-17 岁，2012 年至 2017 年期间接受过 2 次以上初级保健就诊，并拥有经过地理编码的地址数据。我们使用负二项式回归来计算相对于社区层面的社会剥夺的初级保健就诊率和流感疫苗接种率的调整率。结果观察到，始终居住在高度贫困社区的儿童（RR = 1.11，95% CI = 1.05-1.17）和从低贫困社区搬到高贫困社区的儿童（RR = 1.05，95%）的诊所利用率较高。 CI = 1.01-1.09）与始终生活在低贫困社区的儿童相比，遭遇 CHC 的比例更高。流感疫苗接种的趋势与此类似。当按种族和民族进行分层分析时，我们发现这些关系对于总是生活在高度贫困社区的拉丁裔儿童和非拉丁裔白人儿童来说是相似的。居住流动性与较低的初级保健率相关。结论这些研究结果表明，生活在或搬到社会贫困程度较高的社区的儿童比生活在社会贫困程度较低的地区的儿童使用更多的初级保健 CHC 服务，但搬家本身与较少的护理有关。临床医生和服务系统对患者流动性及其影响的认识对于解决初级保健的公平性非常重要。
ObjectiveTo examine how social deprivation and residential mobility are associated with primary care use in children seeking care at community health centers (CHCs) overall and stratified by race and ethnicity.Study designWe used electronic health record open cohort data from 152 896 children receiving care from 15 U S CHCs belonging to the OCHIN network. Patients were aged 3-17 years, with ≥2 primary care visits during 2012-2017 and had geocoded address data. We used negative binomial regression to calculate adjusted rates of primary care encounters and influenza vaccinations relative to neighborhood-level social deprivation.ResultsHigher rates of clinic utilization were observed for children who always lived in highly deprived neighborhoods (RR = 1.11, 95% CI = 1.05-1.17) and those who moved from low-to-high deprivation neighborhoods (RR = 1.05, 95% CI = 1.01-1.09) experienced higher rates of CHC encounters compared with children who always lived in the low-deprivation neighborhoods. This trend was similar for influenza vaccinations. When analyses were stratified by race and ethnicity, we found these relationships were similar for Latino children and non-Latino White children who always lived in highly deprived neighborhoods. Residential mobility was associated with lower rates of primary care.ConclusionsThese findings suggest that children living in or moving to neighborhoods with high levels of social deprivation used more primary care CHC services than children who lived in areas with low deprivation, but moving itself was associated with less care. Clinician and delivery system awareness of patient mobility and its impacts are important to addressing equity in primary care.