Morrison Andrea K, Brousseau David C, Brazauskas Ruta, Levas Michael N
Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
J Pediatr. 2015 Apr;166(4):1037-41.e1. doi: 10.1016/j.jpeds.2014.12.009. Epub 2015 Jan 13.
To test the hypothesis that the effect of race/ethnicity on decreased radiologic testing in the pediatric emergency department (ED) varies by caregiver health literacy.
This was a secondary analysis of a cross-sectional study of caregivers accompanying children ≤ 12 years to a pediatric ED. Caregiver health literacy was measured using the Newest Vital Sign. A blinded chart review determined whether radiologic testing was utilized. Bivariate and multivariate analyses, adjusting for ED triage level, child insurance, and chronic illness were used to determine the relationship between race/ethnicity, health literacy, and radiologic testing. Stratified analyses by caregiver health literacy were conducted.
Five hundred four caregivers participated; the median age was 31 years, 47% were white, 37% black, 10% Hispanic, and 49% had low health literacy. Black race and low health literacy were associated with less radiologic testing (P < .01). In stratified analysis, minority race was associated with less radiologic testing only if a caregiver had low health literacy (aOR 0.5; 95% CI 0.3-0.9), and no difference existed in those with adequate health literacy (aOR 0.7; 95% CI 0.4-1.3).
Caregiver low health literacy modifies whether minority race/ethnicity is associated with decreased radiologic testing, with only children of minority caregivers with low health literacy receiving fewer radiologic studies. Future interventions to eliminate disparities in healthcare resource utilization should consider health literacy as a mutable factor.
检验种族/族裔对儿科急诊科（ED）放射学检查减少的影响因照顾者健康素养而异这一假设。
这是一项对陪同12岁及以下儿童前往儿科ED的照顾者进行的横断面研究的二次分析。使用最新生命体征测量照顾者的健康素养。通过盲法病历审查确定是否进行了放射学检查。采用双变量和多变量分析，并对ED分诊级别、儿童保险和慢性病进行调整，以确定种族/族裔、健康素养与放射学检查之间的关系。对照顾者健康素养进行分层分析。
504名照顾者参与研究；中位年龄为31岁，47%为白人，37%为黑人，10%为西班牙裔，49%健康素养较低。黑人种族和低健康素养与较少的放射学检查相关（P < 0.01）。在分层分析中，只有当照顾者健康素养较低时，少数种族才与较少的放射学检查相关（调整后比值比[aOR]为0.5；95%置信区间[CI]为0.3 - 0.9），而健康素养充足者之间无差异（aOR为0.7；95% CI为0.4 - 1.3）。
照顾者低健康素养改变了少数种族/族裔与放射学检查减少是否相关，只有健康素养低的少数族裔照顾者的孩子接受的放射学检查较少。未来消除医疗资源利用差异的干预措施应将健康素养视为一个可变因素。
