Associations between housing instability and food insecurity with health care access in low-income children
Associations between housing instability and food insecurity with health care access in low-income children
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DOI：
10.1016/j.ambp.2007.08.004
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发表时间：
2008-01-01
期刊：
影响因子：
--
通讯作者：
Kushel, Margot B.
中科院分区：
文献类型：
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作者：
Ma, Christine T.;Gee, Lauren;Kushel, Margot B.
客观。-无家可归和饥饿与儿童获得保健的机会少有关。住房不稳定和粮食无保障是较温和和较普遍的无家可归和饥饿形式。本研究的目的是确定住房不稳定和粮食不安全与儿童的卫生保健获得和急性卫生保健利用之间的关联。我们进行了一项横断面分析，12 746名儿童从低收入家庭包括在2002年全国调查美国的家庭（NSAF）。在控制重要协变量的多变量模型中，我们测量了住房不稳定和粮食不安全之间的关系，采用3种医疗保健获取措施：1）没有通常的护理来源，2）推迟医疗保健，3）推迟药物治疗。我们还测量了3项医疗保健利用措施：1）没有接受推荐的儿童保健访问次数，2）增加急诊室访问，3）住院治疗。我们的分析显示，29.5%的低收入儿童生活在住房不稳定的家庭中，39.0%的家庭粮食不安全。在多变量logistic回归模型中，住房不稳定与推迟医疗护理、推迟药物治疗和增加急诊就诊独立相关。食物不安全与没有通常的护理来源、推迟医疗护理、推迟药物治疗以及没有接受推荐的儿童保健访问独立相关。住房不稳定和粮食无保障的家庭，虽然不一定无家可归或挨饿，但其子女获得适当保健的能力受到损害。政策制定者应考虑改善减少住房不稳定和粮食不安全的方案，临床医生应考虑筛查住房不稳定和粮食不安全，以提供全面的护理。
Objective.-Homelessness and hunger are associated with poor health care access among children. Housing instability and food insecurity represent milder and more prevalent forms of homelessness and hunger. The aim of this study was to determine the association between housing instability and food insecurity with children's health care access and acute health care utilization.Methods.-We conducted a cross-sectional analysis of 12 746 children from low-income households included in the 2002 National Survey of America's Families (NSAF). In multivariate models controlling for important covariates, we measured the association between housing instability and food insecurity with 3 health care access measures: 1) no usual source of care, 2) postponed medical care, and 3) postponed medications. We also measured 3 health care utilization measures: 1) not receiving the recommended number of well-child care visits, 2) increased emergency department visits, and 3) hospitalizations.Results.-Our analysis showed that 29.5% of low-income children lived in households with housing instability and 39.0% with food insecurity. In multivariate logistic regression models, housing instability was independently associated with postponed medical care, postponed medications, and increased emergency department visits. Food insecurity was independently associated with no usual source of care, postponed medical care, postponed medications, and not receiving the recommended well-child care visits.Conclusion.-Families that experience housing instability and food insecurity, without necessarily experiencing homelessness or hunger, have compromised ability to receive adequate health care for their children. Policy makers should consider improving programs that decrease housing instability and food insecurity, and clinicians should consider screening for housing instability and food insecurity so as to provide comprehensive care.