Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
Otolaryngol Head Neck Surg. 2010 Nov;143(5):691-6. doi: 10.1016/j.otohns.2010.06.911.
Determine the impact of racial/ethnic disparities on access to care for children with frequent ear infections (FEI). Identify disparities to target for intervention.
Cross-sectional analysis of national database.
Academic medical center.
The National Health Interview Survey (1997 to 2006) was utilized to identify children with FEI (defined as three or more ear infections in the preceding year). Age, sex, race/ethnicity, income level, and insurance status were extracted. Access to care was measured by ability to afford medical care and prescription medications, specialist visitation, and emergency department visits. Multivariate analysis determined the influence of demographic variables on the ability to access health care resources.
An annualized population of 4.65 ± 0.08 million children reported FEI. Overall, 3.7 percent could not afford care, 5.6 percent could not afford prescriptions, and only 25.8 percent saw a specialist. A larger percentage of the black (42.7%) and Hispanic children (34.5%) with FEI were below the poverty level, versus white children (12.4%; P < 0.001); 18.2 percent of Hispanic children were uninsured, versus 6.5 percent of white children (P < 0.001). On multivariate analysis, children with FEI that were black or Hispanic had increased odds ratios relative to white children for 1) not being able to afford prescription medications (odds ratios [OR] 1.76 and 1.47, respectively; P < 0.002); 2) not being able to see a specialist (OR 1.62 and 1.86, respectively; P < 0.001); and 3) visiting the emergency department (OR 2.50 and 1.32, respectively; P < 0.001).
Racial/ethnic disparities among children with FEI significantly influence health care resource access and utilization. These disparities should be targeted for intervention.
确定种族/民族差异对儿童频繁耳部感染（FEI）患者获得医疗的影响。找出需要干预的差异。
国家数据库的横断面分析。
学术医疗中心。
利用国家健康访谈调查（1997 年至 2006 年），确定 FEI 患儿（定义为过去一年中发生 3 次或以上耳部感染）。提取年龄、性别、种族/民族、收入水平和保险状况。通过支付医疗费用和处方药、专科医生就诊和急诊就诊的能力来衡量获得医疗保健资源的情况。采用多变量分析确定人口统计学变量对获得医疗保健资源能力的影响。
每年有 465 万儿童报告患有 FEI，年化人口为 0.08 万人。总体而言，有 3.7%的人无法负担医疗费用，5.6%的人无法负担处方费用，只有 25.8%的人看过专科医生。患有 FEI 的黑人（42.7%）和西班牙裔儿童（34.5%）中，有更多的人生活在贫困线以下，而白人儿童为 12.4%（P<0.001）；18.2%的西班牙裔儿童没有保险，而白人儿童为 6.5%（P<0.001）。在多变量分析中，患有 FEI 的黑人和西班牙裔儿童相对于白人儿童，在以下方面的优势比更高：1）无法负担处方药物（优势比分别为 1.76 和 1.47，P<0.002）；2）无法看专科医生（优势比分别为 1.62 和 1.86，P<0.001）；3）去急诊就诊（优势比分别为 2.50 和 1.32，P<0.001）。
FEI 患儿中存在的种族/民族差异，显著影响了医疗保健资源的获取和利用。这些差异应作为干预目标。
