Alio Amina P, Salihu Hamisu M
Council on African American Affairs, 1115 U St. NW, Suite 201, Washington, DC 20009, USA.
J Natl Med Assoc. 2005 Jun;97(6):792-7.
We assessed maternal characteristics that were predictive of preventive care utilization among children 0-5 years and compared black-white differences in preventive care usage.
We used the 1996-2000 series of public use files from the Medical Expenditure Panel Survey (MEPS). Receipt of preventive care was defined as up-to-date immunization coverage of the child and at least one dental visit during the year.
A total of 10,525 children were analyzed consisting of 2,090 blacks (19.9%) and 8,435 whites (80.1%). Black mothers were in general older and less educated. Black households were larger in size and contained a greater number of children. Black mothers earned, on average, much less than their white counterparts even though they tended to be more frequently employed than whites. Despite similar levels of insurance coverage for both racial groups, the overwhelming majority of white mothers were privately insured (73.2%), in contrast to only about half of blacks with private insurance coverage [54.3% (p < 0.0001)]. Overall, the level of pediatric preventive services utilization was a paltry 15.4%. Children of black mothers were significantly less likely to receive preventive care than whites (OR = 0.78; 95% CI = 0.64-0.94). Other determinants of preventive care use were maternal age, insurance coverage, education and family size. Older, educated mothers with insurance coverage and reduced family size were more likely to have their children immunized and have dental visits.
Maternal characteristics are important markers that indicate the risk for underutilization of pediatric preventive care. A particularly important finding with policy implication is the observation that maternal insurance coverage enhances pediatric preventive care use. Health policy planners may consider parallel insurance coverage of both the child and the mother in order to enhance receipt of preventive health services by the child.
我们评估了可预测0至5岁儿童预防性保健利用情况的母亲特征，并比较了预防性保健使用方面的黑白差异。
我们使用了医疗支出面板调查（MEPS）1996 - 2000年系列的公共使用文件。预防性保健的接受情况定义为儿童最新的免疫接种覆盖率以及当年至少一次牙科就诊。
总共分析了10525名儿童，其中包括2090名黑人儿童（19.9%）和8435名白人儿童（80.1%）。黑人母亲总体上年龄较大且受教育程度较低。黑人家庭规模较大，子女数量较多。黑人母亲平均收入远低于白人母亲，尽管她们往往比白人更频繁地就业。尽管两个种族群体的保险覆盖率相似，但绝大多数白人母亲拥有私人保险（73.2%），相比之下，只有约一半的黑人有私人保险覆盖[54.3%（p < 0.0001）]。总体而言，儿科预防性服务的利用率低得可怜，仅为15.4%。黑人母亲的孩子接受预防性保健的可能性明显低于白人（OR = 0.78；95% CI = 0.64 - 0.94）。预防性保健使用的其他决定因素包括母亲年龄、保险覆盖率、教育程度和家庭规模。年龄较大、受过教育、有保险覆盖且家庭规模较小的母亲更有可能让孩子接种疫苗并进行牙科就诊。
母亲特征是表明儿科预防性保健利用不足风险的重要标志。一个具有政策意义的特别重要发现是，母亲的保险覆盖可提高儿科预防性保健的使用。卫生政策规划者可能会考虑为儿童和母亲提供并行的保险覆盖，以增加儿童获得预防性健康服务的机会。
