Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
J Pediatr Surg. 2011 Jul;46(7):1319-24. doi: 10.1016/j.jpedsurg.2010.10.002.
BACKGROUND/PURPOSE: Disparities in access to health care are known to exist for the most vulnerable pediatric population, children with special health care needs. Timely access to surgical care in this population is critical, yet poorly studied.
A national database of pediatric hospitals in the United States was searched for nonsyndromic, healthy patients younger than 24 months who underwent cleft palate repair from 2003 to 2008. A multivariate, linear regression model was constructed to determine the relationship of public payer status and race with age at palatal repair.
Age at palate repair was significantly delayed for patients who were publicly insured (1.2 weeks, P = .01), were of nonwhite race/ethnicity (1.5-3.5 weeks, P = .009), and had a diagnosis of cleft lip in addition to cleft palate (3.4 weeks, P = .006) compared to their counterparts in a sample of 2995 patients with cleft palate.
There is a small but significant delay in age at repair for patients who are publicly insured or of nonwhite race/ethnicity. These results may herald broader access disparities that could adversely affect clinical outcomes and should be investigated further.
背景/目的：众所周知，最弱势的儿科人群，即有特殊医疗需求的儿童，在获得医疗保健方面存在差异。该人群及时获得外科护理至关重要，但研究甚少。
在美国的一家儿科医院国家数据库中搜索了 2003 年至 2008 年间接受腭裂修复的非综合征、24 个月以下的健康患者。构建了一个多变量线性回归模型，以确定公共支付人状态和种族与腭裂修复时的年龄之间的关系。
与腭裂患者的对照组相比，有公共保险的患者（1.2 周，P =.01）、非白种人/少数民族（1.5-3.5 周，P =.009）和除腭裂外还有唇裂诊断的患者（3.4 周，P =.006），其腭裂修复年龄明显延迟。
有公共保险或非白种人/少数民族的患者的修复年龄略有延迟，但意义重大。这些结果可能预示着更广泛的获得差异，可能对临床结果产生不利影响，应进一步调查。
