Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.
CMAJ. 2012 Sep 4;184(12):E665-74. doi: 10.1503/cmaj.111697. Epub 2012 Jun 11.
Previous studies of differences in mental health care associated with children's sociodemographic status have focused on access to community care. We examined differences associated with visits to the emergency department.
We conducted a 6-year population-based cohort analysis using administrative databases of visits (n = 30,656) by children aged less than 18 years (n = 20,956) in Alberta. We measured differences in the number of visits by socioeconomic and First Nations status using directly standardized rates. We examined time to return to the emergency department using a Cox regression model, and we evaluated time to follow-up with a physician by physician type using a competing risks model.
First Nations children aged 15-17 years had the highest rate of visits for girls (7047 per 100,000 children) and boys (5787 per 100,000 children); children in the same age group from families not receiving government subsidy had the lowest rates (girls: 2155 per 100,000 children; boys: 1323 per 100,000 children). First Nations children (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.30-2.05), and children from families receiving government subsidies (HR 1.60, 95% CI 1.30-1.98) had a higher risk of return to an emergency department for mental health care than other children. The longest median time to follow-up with a physician was among First Nations children (79 d; 95% CI 60-91 d); this status predicted longer time to a psychiatrist (HR 0.47, 95% CI 0.32-0.70). Age, sex, diagnosis and clinical acuity also explained post-crisis use of health care.
More visits to the emergency department for mental health crises were made by First Nations children and children from families receiving a subsidy. Sociodemographics predicted risk of return to the emergency department and follow-up care with a physician.
先前关于儿童社会人口统计学状况与心理健康护理差异的研究主要集中在社区护理的可及性上。我们研究了与急诊就诊相关的差异。
我们使用艾伯塔省（Alberta） 18 岁以下儿童（n=20956）的行政就诊数据库进行了一项为期 6 年的基于人群的队列分析。我们使用直接标准化率衡量了社会经济地位和第一民族地位差异与就诊次数的关系。我们使用 Cox 回归模型来研究返回急诊的时间，使用竞争风险模型来研究按医生类型就诊的时间。
15-17 岁的第一民族儿童的就诊率最高，女孩为 7047/10 万儿童，男孩为 5787/10 万儿童；来自未领取政府补贴家庭的同年龄组儿童的就诊率最低，女孩为 2155/10 万儿童，男孩为 1323/10 万儿童。第一民族儿童（危险比[HR]1.64；95%置信区间[CI]1.30-2.05）和领取政府补贴的家庭儿童（HR 1.60，95% CI 1.30-1.98）心理健康护理急诊就诊后返回急诊的风险更高。与其他儿童相比，第一民族儿童的医生随访中位时间最长（79 天；95% CI 60-91 天）；这一状况预测了精神科医生就诊时间的延长（HR 0.47，95% CI 0.32-0.70）。年龄、性别、诊断和临床严重程度也解释了危机后的医疗保健使用情况。
更多的第一民族儿童和领取补贴家庭的儿童因心理健康危机而更多地前往急诊就诊。社会人口统计学预测了返回急诊的风险和与医生的随访护理。
