Cumulative social disadvantage and child health
Cumulative social disadvantage and child health
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DOI：
10.1542/peds.2005-1647
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发表时间：
2006-04-01
期刊：
影响因子：
8
通讯作者：
Stein, REK
中科院分区：
文献类型：
--
作者：
Bauman, LJ;Silver, EJ;Stein, REK
上下文儿童健康方面的差异是一个主要的公共卫生问题。然而，目前尚不清楚这是否主要是低收入、种族或其他可能导致其健康不利的社会风险因素的结果。虽然其他人已经研究了风险因素积累的影响，但这种方法尚未应用于儿童健康。我们测试了4个社会风险因素（贫困，少数民族，父母教育程度低，不与亲生父母生活在一起），以评估它们是否对儿童健康有累积影响，并检查获得医疗保健是否会降低健康风险。我们分析了1994年和1995年国家健康访谈调查残疾补充资料中57553名18岁以下儿童的数据。在4个危险因素中，3个（贫困、父母教育程度低和单亲家庭）始终与儿童健康相关。将这些数据相加，得出社会不利因素指数（范围：0 - 3）。共有43.6%的儿童没有社会不利条件，30.8%有1个，15.6%有2个，10.0%有所有3个。与那些没有社会劣势的人相比，处于“良好，一般或不良健康状况”（与“优秀或非常好”相比）的比值比（OR）为1风险1.95，2风险3.22，3风险4.06。患有慢性疾病的OR从1.25（1种风险）增加到1.60（2种风险）到2.11（3种风险）。活动受限的OR为1.51（1种风险）至2.14（2种风险）和2.88（3种风险）。控制健康保险并不影响这些发现。儿童中社会不利地位的积累与儿童健康状况较差密切相关，有保险并没有减少观察到的健康差距。
CONTEXT. Disparities in child health are a major public health concern. However, it is unclear whether these are predominantly the result of low income, race, or other social risk factors that may contribute to their health disadvantage. Although others have examined the effects of the accumulation of risk factors, this methodology has not been applied to child health.OBJECTIVE. We tested 4 social risk factors ( poverty, minority race/ethnicity, low parental education, and not living with both biological parents) to assess whether they have cumulative effects on child health and examined whether access to health care reduced health disparities.DESIGN. We analyzed data on 57 553 children < 18 years from the 1994 and 1995 National Health Interview Survey Disability Supplement. Of the 4 risk factors, 3 ( poverty, low parental education, and single-parent household) were consistently associated with child health. These were summed, generating the Social Disadvantage Index ( range: 0 - 3).RESULTS. A total of 43.6% of children had no social disadvantages, 30.8% had 1, 15.6% had 2, and 10.0% had all 3. Compared with those with no social disadvantages, the odds ratios (ORs) of being in "good, fair, or poor health" ( versus "excellent or very good") were 1.95 for 1 risk, 3.22 for 2 risks, and 4.06 for 3 risks. ORs of having a chronic condition increased from 1.25 ( 1 risk) to 1.60 ( 2 risks) to 2.11 ( 3 risks). ORs for activity limitation were 1.51 ( 1 risk) to 2.14 ( 2 risks) and 2.88 ( 3 risks). Controlling for health insurance did not affect these findings.CONCLUSIONS. The accumulation of social disadvantage among children was strongly associated with poorer child health and having insurance did not reduce the observed health disparities.