Flores Glenn, Abreu Milagros, Tomany-Korman Sandra C
Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Pediatrics. 2006 Sep;118(3):e730-40. doi: 10.1542/peds.2005-2599.
Latinos continue to be the most uninsured racial/ethnic group of US children, but not enough is known about the risk factors for and consequences of not being insured in Latino children.
[corrected] The objective of this study was to identify the risk factors for and consequences of being uninsured in Latino children.
A cross-sectional survey was conducted of parents at urban, predominantly Latino community sites, including supermarkets, beauty salons, and laundromats. Parents were asked 76 questions on access and health insurance.
Interviews were conducted of 1100 parents, 900 of whom were Latino. Uninsured Latino children were significantly more likely than insured Latino children to be older (mean age: 9 vs 7 years) and poor (89% vs 72%) and to have parents who are limited in English proficiency (86% vs 65%), non-US citizens (87% vs 64%), and both employed (35% vs 27%). Uninsured Latinos were significantly less likely than their insured counterparts to have a regular physician (84% vs 99%) and significantly more likely not to be brought in for needed medical care because of expense, lack of insurance, difficulty making appointments, inconvenient office hours, and cultural issues. In multivariable analyses, parents who are undocumented or documented immigrants, both parents working, the child's age, and the $4000 to $9999 and $15000 to $19999 family income quintiles were the only factors that were significantly associated with a child's being uninsured; neither Latino ethnicity nor any other of 6 variables were associated with being uninsured. Compared with insured Latino children, uninsured Latino children had 23 times the odds of having no regular physician and were significantly more likely not to be brought in for needed medical care because of expense, lack of health insurance, difficulty making appointments, and cultural barriers.
After adjustment, parental noncitizenship, having 2 parents work, low family income, and older child age are associated with being an uninsured child, but Latino ethnicity is not. The higher prevalence of other risk factors seems to account for Latino children's high risk for being uninsured. Uninsured Latino children are significantly more likely than insured Latino children to have no regular physician and not to get needed medical care because of expense, lack of health insurance, difficulty making appointments, and cultural barriers. These findings indicate specific high-risk populations that might benefit most from targeted Medicaid and State Child Health Insurance Program outreach and enrollment efforts.
拉丁裔仍然是美国儿童中未参保率最高的种族/族裔群体，但对于拉丁裔儿童未参保的风险因素及后果，我们了解得还不够。
本研究的目的是确定拉丁裔儿童未参保的风险因素及后果。
在城市中以拉丁裔为主的社区场所开展了一项横断面调查，这些场所包括超市、美容院和自助洗衣店。向家长询问了76个关于医保获取和健康保险的问题。
共对1100名家长进行了访谈，其中900名是拉丁裔。未参保的拉丁裔儿童比参保的拉丁裔儿童更有可能年龄较大（平均年龄：9岁对7岁）、家庭贫困（89%对72%），且其父母英语水平有限（86%对65%）、非美国公民（87%对64%）以及父母双方均有工作（35%对27%）。与参保的拉丁裔相比，未参保的拉丁裔拥有固定医生的可能性显著更低（84%对99%），并且因费用、缺乏保险、预约困难、办公时间不便以及文化问题而未接受所需医疗护理的可能性显著更高。在多变量分析中，无合法身份或有合法身份的移民父母、父母双方均工作、孩子的年龄以及家庭收入处于第四和第五五分位数（4000至9999美元和15000至19999美元）是与儿童未参保显著相关的仅有的因素；拉丁裔种族以及其他6个变量中的任何一个均与未参保无关。与参保的拉丁裔儿童相比，未参保的拉丁裔儿童没有固定医生的几率高出23倍，并且因费用、缺乏健康保险、预约困难以及文化障碍而未接受所需医疗护理的可能性显著更高。
调整后，父母非公民身份、父母双方均工作、家庭收入低以及孩子年龄较大与儿童未参保相关，但拉丁裔种族并非如此。其他风险因素的较高患病率似乎是拉丁裔儿童未参保风险高的原因。与参保的拉丁裔儿童相比，未参保的拉丁裔儿童没有固定医生且因费用、缺乏健康保险、预约困难以及文化障碍而未获得所需医疗护理的可能性显著更高。这些发现表明了特定的高风险人群，他们可能从有针对性的医疗补助和州儿童健康保险计划的宣传及参保工作中获益最多。
