US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Rockville, MD 20857, USA.
Pediatrics. 2009 Dec;124 Suppl 4:S414-9. doi: 10.1542/peds.2009-1255M.
We examined the association of household language use and access to care among children with special health care needs (CSHCN). From this study we describe the demographics of children and the prevalence of selected access characteristics according to their primary household language and examine the independent effects of household language on health care access, unmet needs, and family impact while controlling for confounding variables.
Data from the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative telephone survey of 40,723 CSHCN, were analyzed. Bivariate and multivariable analyses were used to examine disparities and estimate adjusted odds ratios of health care access, satisfaction, and family-impact measures for CSHCN from non-English-primary-language (NEPL) versus English-primary-language (EPL) households.
Nearly 14% of all US children live in NEPL households. NEPL CSHCN were significantly more likely to be Hispanic or other race, be poor, have less educated parents, and reside in metropolitan areas and larger households and yet were less likely to be on cash assistance from welfare. Logistic regression showed that NEPL CSHCN were twice as likely to lack access to a medical home, a usual source of care, and family-centered care. They were 4 times as likely to lack health insurance, and their family members were also more likely to lack adequate insurance. Family members of NEPL children were almost twice as likely to have to stop employment as a result of their child's condition.
Although limited by program eligibility contingent on immigrant status and state policies, increased referrals to programs such as the State Children's Health Insurance Program and Medicaid can improve access while utilization can be improved by the availability of interpreters, community health workers, linguistically concordant providers, and outreach education efforts of NEPL parents.
我们研究了有特殊健康护理需求的儿童（CSHCN）的家庭语言使用情况和获得医疗护理的情况之间的关联。从这项研究中，我们描述了儿童的人口统计学特征以及根据主要家庭语言选择的获得医疗护理的特征的流行率，并在控制混杂变量的情况下，考察了家庭语言对医疗护理的获得、未满足的需求和家庭影响的独立影响。
对 2005-2006 年全国有特殊健康护理需求儿童调查（一项针对 40723 名 CSHCN 的全国性电话调查）的数据进行了分析。使用双变量和多变量分析来检查差异，并估计非英语主要语言（NEPL）与英语主要语言（EPL）家庭的 CSHCN 的医疗护理获得、满意度和家庭影响指标的调整比值比。
近 14%的美国儿童生活在 NEPL 家庭中。NEPL CSHCN 更有可能是西班牙裔或其他种族，更有可能贫困，父母受教育程度更低，居住在大都市区和更大的家庭中，然而，更不可能从福利方面获得现金援助。逻辑回归显示，NEPL CSHCN 获得医疗之家、常规护理来源和以家庭为中心的护理的可能性要低两倍。他们没有医疗保险的可能性要高四倍，他们的家庭成员也更有可能没有足够的保险。NEPL 儿童的家庭成员因孩子的病情而停止就业的可能性几乎是两倍。
尽管受到移民身份和州政策决定的项目资格的限制，但增加对诸如州儿童健康保险计划和医疗补助等项目的转介可以改善获得医疗护理的机会，而口译员、社区卫生工作者、语言一致的提供者的可用性以及 NEPL 父母的外展教育工作可以改善利用率。
