Yu Stella M, Bellamy Hilary A, Kogan Michael D, Dunbar Jennifer L, Schwalberg Renee H, Schuster Mark A
Maternal and Child Health Bureau, Office of Data and Information Management, Rockville, Maryland 20857, USA.
Pediatrics. 2002 Dec;110(6):e73. doi: 10.1542/peds.110.6.e73.
This study examined the factors that affect children's receipt of recommended well-child and dental visits using nationally representative data.
We analyzed the Child Public Use File of the 1999 National Survey of America's Families, including 35 938 children who were younger than 18 years. Bivariate and multivariate analyses were conducted to examine the relationship between dependent variables, including receipt of well-child visits as recommended by the American Academy of Pediatrics' periodicity schedule and dental visits as recommended by the American Academy of Pediatric Dentistry and Bright Futures, and independent variables, including health status and sociodemographic and economic indicators.
Overall, 23.4% of children did not receive the recommended well-child visits, whereas 46.8% did not receive the recommended number of dental visits. The factors that predict nonreceipt of care differed for well-child and dental care and with child's age. Logistic regression reveals that children who were young (<10 years old), uninsured, non-Hispanic white, had a parent who was less than college educated, or in poor health were least likely to meet the recommendations for well-child care. Children who did not meet the dental recommendation were more likely to be black, uninsured, from families with low incomes, have a parent who was less than college educated, and have postponed dental care in the last year. These risk factors increased with children's age.
A substantial proportion of US children do not receive preventive care according to professionally recommended standards, particularly dental care. Publicly insured children experience higher rates of recommended well-child visits; however, much improvement is needed among public programs in providing recommended dental care, especially among adolescents and children in poor general health.
本研究利用具有全国代表性的数据，考察了影响儿童接受推荐的健康检查和牙齿检查的因素。
我们分析了1999年全美国家庭调查的儿童公共使用文件，其中包括35938名18岁以下的儿童。进行了双变量和多变量分析，以考察因变量（包括按照美国儿科学会的定期检查时间表接受健康检查，以及按照美国儿童牙科学会和光明未来计划的建议接受牙齿检查）与自变量（包括健康状况、社会人口统计学和经济指标）之间的关系。
总体而言，23.4%的儿童未接受推荐的健康检查，而46.8%的儿童未接受推荐次数的牙齿检查。预测未接受护理的因素在健康检查和牙齿护理方面以及随儿童年龄而有所不同。逻辑回归显示，年龄较小（<10岁）、未参保、非西班牙裔白人、父母受教育程度低于大学水平或健康状况不佳的儿童最不可能达到健康检查的建议。未达到牙齿检查建议的儿童更有可能是黑人、未参保、来自低收入家庭、父母受教育程度低于大学水平，并且在过去一年中推迟了牙齿护理。这些风险因素随着儿童年龄的增长而增加。
相当大比例的美国儿童未按照专业推荐标准接受预防性护理，尤其是牙齿护理。参加公共保险的儿童接受推荐的健康检查的比例较高；然而，公共项目在提供推荐的牙齿护理方面仍有很大改进空间，尤其是在总体健康状况较差的青少年和儿童中。
