Alpert Medical School of Brown University, Box G-A, Providence, RI 02912, USA.
Matern Child Health J. 2012 Nov;16(8):1576-82. doi: 10.1007/s10995-011-0850-5.
Low healthcare utilization is a prime contributor to adverse health outcomes in both the general population and the Hispanic community. This study compares background characteristics and rates of prenatal and postpartum health care utilization between Hispanic and non-Hispanic white women. Using the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS), 2002-2008, we assess rates of prenatal and postpartum healthcare utilization relevant to maternal and neonatal care. Associations between maternal ethnicity and adequacy of health care utilization were quantified using survey weighted multivariable logistic regression. Compared with non-Hispanic white women, Hispanic women were younger (less than 24 years, 43.8% vs. 25.2%), had less education (less than 12 years of education, 38.2% vs. 10.6%), lower annual income levels (incomes less than $19,999, 72.2% vs. 21.7%), and lower insurance rates before pregnancy (47.8% uninsured vs. 12.8%). Hispanic women had higher odds of having delayed prenatal care (AOR 1.84, 95% CI 1.27-2.65) or inadequate prenatal care (AOR 2.01, 95% CI 1.61-2.50), and their children had higher odds of not having a 1-week check-up (AOR 1.73, 95% CI 1.21-2.47) or any well-baby care (AOR 3.44, 95% CI 1.65-7.10). Disparities in inadequate prenatal care and not having any well-baby care remained significant after adjusting collectively for age, marital status, education, income, and insurance status of mother and newborn. Although many previously uninsured women became insured during pregnancy, disparities in healthcare utilization remained. Interventions focusing on reducing barriers to access prior to and during pregnancy should consider potential structural, informational, and educational barriers.
低医疗保健利用率是造成普通人群和西班牙裔人群不良健康结果的主要因素之一。本研究比较了西班牙裔和非西班牙裔白人女性的产前和产后保健利用率的背景特征和比率。利用罗德岛妊娠风险评估监测系统（PRAMS），我们评估了 2002-2008 年与母婴保健相关的产前和产后医疗保健利用率的比率。使用调查加权多变量逻辑回归来量化产妇种族与医疗保健利用率充足性之间的关联。与非西班牙裔白人女性相比，西班牙裔女性更年轻（<24 岁，43.8%对 25.2%），受教育程度较低（<12 年教育，38.2%对 10.6%），年收入水平较低（收入<$19,999，72.2%对 21.7%），怀孕前的保险率较低（47.8%无保险对 12.8%）。西班牙裔女性有更高的延迟产前护理（AOR 1.84，95%CI 1.27-2.65）或产前护理不足（AOR 2.01，95%CI 1.61-2.50）的可能性，其子女有更高的可能性没有一周检查（AOR 1.73，95%CI 1.21-2.47）或任何婴儿健康检查（AOR 3.44，95%CI 1.65-7.10）。在综合调整母亲和新生儿的年龄、婚姻状况、教育程度、收入和保险状况后，产前护理不足和没有任何婴儿健康检查的差异仍然显著。尽管许多以前没有保险的女性在怀孕期间获得了保险，但医疗保健利用率的差异仍然存在。在怀孕前和怀孕期间关注减少获得医疗保健的障碍的干预措施应考虑潜在的结构、信息和教育障碍。
