Sanders Lee M, Thompson Valerie T, Wilkinson James D
Department of Pediatrics, University of Miami School of Medicine, 1601 NW 12th Ave, Suite 4063, Miami, FL 33136, USA.
Pediatrics. 2007 Jan;119(1):e86-92. doi: 10.1542/peds.2005-1738.
Eighty million US adults have low health literacy, a risk factor for increased health care use among adults. The purpose of this work was to assess the association between caregiver health literacy and the use and cost of child health services.
We conducted a cross-sectional study of caregiver-child dyads from a sample of children aged 12 months to 12 years presenting to the pediatric emergency department of an urban, public hospital. Caregiver health literacy was measured by the Short Test of Functional Health Literacy in their preferred language (English or Spanish). Child health care use was measured by a 12-month retrospective review of the public hospital system's electronic database and of state Medicaid billing records for 4 types of visits: preventive care, urgent care, emergency care, and hospital care. Cost of child health care use was provided by Medicaid billing records. Multivariate analysis included caregiver education, age, and language proficiency, as well as child age, special health care needs, ethnicity, and health-insurance coverage.
A total of 290 dyads were enrolled in the study. Twenty-two percent of caregivers had low (inadequate or marginal) health literacy. Caregivers with low health literacy were more likely to have less than a high school education, to have limited English proficiency, and to have been born outside the United States. There were no differences in health care use or cost between children of caregivers with low health literacy and children of caregivers with adequate health literacy. Three caregiver characteristics were associated with increased use of child health care services: born outside the United States, age at child's birth <24 years, and limited English proficiency.
One in 5 caregivers of young children has low health literacy. Caregiver health literacy, however, was not associated with disparities in the use of child health services in this inner-city, ethnic minority population.
八千万美国成年人健康素养较低，这是成年人医疗保健使用增加的一个风险因素。这项研究的目的是评估照顾者的健康素养与儿童健康服务的使用及费用之间的关联。
我们对年龄在12个月至12岁的儿童样本进行了横断面研究，这些儿童前往一家城市公立医院的儿科急诊科就诊，研究对象为照顾者与儿童的二元组。照顾者的健康素养通过用其首选语言（英语或西班牙语）进行的健康素养功能简短测试来衡量。儿童医疗保健的使用情况通过对公立医院系统电子数据库以及州医疗补助计费记录进行为期12个月的回顾性审查来衡量，审查内容包括4种就诊类型：预防性保健、紧急护理、急诊护理和住院护理。儿童医疗保健使用的费用由医疗补助计费记录提供。多变量分析包括照顾者的教育程度、年龄、语言能力，以及儿童的年龄、特殊医疗保健需求、种族和医疗保险覆盖情况。
共有290个二元组纳入了该研究。22%的照顾者健康素养较低（不足或边缘水平）。健康素养较低的照顾者更有可能未接受过高中教育、英语水平有限且出生在美国境外。健康素养较低的照顾者的孩子与健康素养足够的照顾者的孩子在医疗保健使用或费用方面没有差异。有三个照顾者特征与儿童健康服务使用增加相关：出生在美国境外、孩子出生时照顾者年龄<24岁以及英语水平有限。
五分之一的幼儿照顾者健康素养较低。然而，在这个市中心的少数民族人群中，照顾者的健康素养与儿童健康服务使用方面的差异无关。
