Victorino Charlemaigne C, Gauthier Anne H
Department of Pediatrics, Alberta Children's Hospital/University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada.
BMC Pediatr. 2009 Aug 17;9:53. doi: 10.1186/1471-2431-9-53.
Disparities in child health outcomes persist despite advances in medical technology and increased global wealth. The social determinants of health approach is useful in explaining the disparities in health. Our objective in this paper is four-fold: (1) to test whether the income relationship (and the related income gradient) is the same across different child health outcomes; (2) to test whether the association between income and child health outcomes persists after controlling for other traditional socioeconomic characteristics of children and their family (education and employment status); (3) to test the role of other potentially mediating variables, namely parental mental health, number of children, and family structure; and (4) to test the interaction between income and education.
This population-based cross-sectional study used data from the 2003 US National Survey of Children's Health involving 102,353 children aged 0 to 17 years. Using multivariate logistic regression models, the association between household income, education, employment status, parental mental health, number of children, family structure and the following child health outcomes were examined: presence or absence of asthma, headaches/migraine, ear infections, respiratory allergy, food/digestive allergy, or skin allergy.
While the associations of some determinants were found to be consistent across different health outcomes, the association of other determinants such as household income depended on the specific outcome. Controlling for other factors, a gradient association persisted between household income and a child having asthma, migraine/severe headaches, or ear infections with children more likely to have the illness if their family is closer to the federal poverty level. Potentially mediating variables, namely parental mental health, number of children, and family structure had consistent associations across health outcomes.
There appears to be evidence of an income gradient for certain child health outcomes, even after controlling for other traditional measures of socioeconomic status. Our study also found evidence of an association between certain child health outcomes and potential mediating factors.
尽管医疗技术取得进步且全球财富增加，但儿童健康结果的差异依然存在。健康的社会决定因素方法有助于解释健康方面的差异。本文的目标有四个：（1）检验不同儿童健康结果的收入关系（及相关收入梯度）是否相同；（2）检验在控制儿童及其家庭的其他传统社会经济特征（教育和就业状况）后，收入与儿童健康结果之间的关联是否持续存在；（3）检验其他潜在中介变量的作用，即父母心理健康、子女数量和家庭结构；（4）检验收入与教育之间的相互作用。
这项基于人群的横断面研究使用了2003年美国全国儿童健康调查的数据，涉及102,353名0至17岁的儿童。使用多变量逻辑回归模型，研究了家庭收入、教育、就业状况、父母心理健康、子女数量、家庭结构与以下儿童健康结果之间的关联：是否患有哮喘、头痛/偏头痛、耳部感染、呼吸道过敏、食物/消化过敏或皮肤过敏。
虽然发现一些决定因素在不同健康结果中的关联是一致的，但其他决定因素（如家庭收入）的关联则取决于具体结果。在控制其他因素后，家庭收入与儿童患哮喘、偏头痛/严重头痛或耳部感染之间存在梯度关联，如果家庭更接近联邦贫困线，儿童患病的可能性更大。潜在中介变量，即父母心理健康、子女数量和家庭结构在不同健康结果中的关联是一致的。
即使在控制了社会经济地位的其他传统衡量指标之后，似乎仍有证据表明某些儿童健康结果存在收入梯度。我们的研究还发现了某些儿童健康结果与潜在中介因素之间存在关联的证据。
