Javier Joyce R, Wise Paul H, Mendoza Fernando S
Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Ambul Pediatr. 2007 Nov-Dec;7(6):421-30. doi: 10.1016/j.ambp.2007.06.004.
Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.
Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.
Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.
Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.
尽管移民家庭的儿童贫困程度高且获得医疗保健的机会较少，但与非移民家庭的儿童相比，他们的健康状况好于预期。然而，这一观察结果在慢性病患儿中尚未得到证实。本研究的目的是确定移民家庭中患有哮喘的儿童是否比非移民家庭中患有哮喘的儿童健康状况好于预期。
利用2001年和2003年加利福尼亚健康访谈调查（CHIS）的数据，确定了2600名年龄在1至11岁之间、经医生诊断患有哮喘的儿童。进行双变量分析和逻辑回归，以我们的主要自变量移民家庭状况来检验医疗保健的可及性、利用率和健康状况指标。
与非移民家庭中患有哮喘的儿童相比，移民家庭中患有哮喘的儿童更有可能没有固定的医疗保健来源（2.6%对1.0%；P<.05），报告就医延迟（8.9%对5.2%；P<.01），并报告在过去一年中未看过医生（7.0%对3.8%；P<.05）。他们报告哮喘症状的可能性较小（60.8%对74.4%；P<.01），在过去一年中去急诊室就诊的可能性也较小（14.1%对21.1%；P<.01），但报告自我感觉健康状况为一般或较差的可能性更大（25.0%对10.5%；P<.01）。多变量模型显示，移民身份与健康指标之间的关系很复杂。这些模型表明，缺乏保险和贫困与可及性和利用率降低有关。移民家庭中的儿童在过去一年中因哮喘去急诊室就诊的可能性较小（优势比0.58，置信区间0.36 - 0.93）。贫困与功能受限以及自我感觉健康状况为一般或较差有关，而非英语访谈语言与功能受限较少但自我感觉健康状况为一般或较差的程度较高有关。
临床医生应意识到贫困、未参保且不讲英语的移民家庭可能存在的重要就医障碍。移民家庭中患有哮喘的儿童医疗保健可及性和利用率降低需要政策关注。进一步的研究应探讨就医障碍以及移民家庭中患有哮喘儿童的父母对健康的认知。
