Chen Likwang, Wahlqvist Mark L, Teng Nai-Chi, Lu Hsin-Ming
Division of Health Policy Research and Development, The Institute of Population Health Sciences, National Health Research Institutes, No.35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan.
Asia Pac J Clin Nutr. 2009;18(4):605-19.
This study investigated the association between food insecurity and Taiwanese children's ambulatory medical care use for treating eighteen disease types linked to endocrine and metabolic disorders, nutrition, immunity, infections, asthma, mental health, injury, and poisoning. We used longitudinal data in the Taiwan National Health Insurance scheme (NHI) for 764,526 elementary children, and employed approximate NHI data to construct three indicators imputed to food insecurity: low birth weight status, economic status (poverty versus non-poverty), and time of year (summer break time versus semester time). We compared ambulatory care for these diseases between children with low birth weight and those not, and between children living in poverty and those not. A difference-in-differences method was adopted to examine the potential for a publicly- funded lunch program to reduce the harmful health effects of food insecurity on poor children. We found that children in poverty were significantly more likely to have ambulatory visits linked with diabetes, inherited disorders of metabolism, iron deficiency anemias, ill-defined symptoms concerning nutrition, metabolism and development, as well as mental disorders. Children with low birth weight also had a significantly higher likelihood of using care for other endocrine disorders and nutritional deficiencies, in addition to the above diseases. The study failed to find any significant effect of the semester school lunch program on alleviating the harmful health effects of food insecurity for poor children, suggesting that a more intensive food program or other program approaches might be required to help poor children overcome food insecurity and its related health outcomes.
本研究调查了粮食不安全与台湾儿童因治疗与内分泌和代谢紊乱、营养、免疫、感染、哮喘、心理健康、伤害及中毒相关的18种疾病类型而进行的门诊医疗护理之间的关联。我们使用了台湾国民健康保险计划（NHI）中764,526名小学生的纵向数据，并采用近似的NHI数据构建了三个归因于粮食不安全的指标：低出生体重状况、经济状况（贫困与非贫困）以及一年中的时间（暑假时间与学期时间）。我们比较了低出生体重儿童与非低出生体重儿童之间以及贫困儿童与非贫困儿童之间针对这些疾病的门诊护理情况。采用差异-in-差异方法来研究公共资助午餐计划减少粮食不安全对贫困儿童健康有害影响的可能性。我们发现，贫困儿童因糖尿病、遗传性代谢紊乱、缺铁性贫血、营养、代谢和发育方面不明症状以及精神障碍而进行门诊就诊的可能性显著更高。除上述疾病外，低出生体重儿童因其他内分泌疾病和营养缺乏而接受护理的可能性也显著更高。该研究未发现学期学校午餐计划对减轻粮食不安全对贫困儿童健康有害影响有任何显著效果，这表明可能需要更强化的食品计划或其他计划方法来帮助贫困儿童克服粮食不安全及其相关健康问题。
