Zlotnick Cheryl, Tam Tammy, Ye Yu
CHORI Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital Oakland, 5700 Martin Luther King Jr Way, Oakland, CA, 94609, USA.
Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA, 94608, USA.
Matern Child Health J. 2017 Oct;21(10):1939-1948. doi: 10.1007/s10995-017-2310-3.
Introduction In 2007, the California signed legislation mandating a dental visit for all children entering kindergarten or first grade; no such mandate was made for physician visits. This study examines the impact of this policy change on the risk factors associated with obtaining pediatric dental and physician health care visits. Methods Every 2 years, California Health Interview Survey conducts a statewide survey on a representative community sample. This cross-sectional study took advantage of these data to conduct a "natural experiment" assessing the impact of this policy change on both pediatric physician and dental care visits in the past year. Samples included surveys of adults and children (ages 5-11) on years 2005 (n = 5096), 2007 (n = 4324) and 2009 (n = 4100). Results Although few changes in risk factors were noted in pediatric physician visits, a gradual decrease in risk factors was found in pediatric dental visits from 2005 to 2009. Report of no dental visit was less likely for: younger children (OR -0.81, CI 0.75-0.88), insured children (OR 0.34, CI 0.22-0.53), and children who had a physician's visit last year (OR 0.37, CI 0.25-0.53) in 2005. By 2007, absence of insurance was the only risk factor related to having no dental visit (OR 0.34, CI 0.19-0.61). By 2009, no a priori measured risk factors were associated with not having a dental visit for children aged 5-11 years. Conclusions A statewide policy mandating pediatric dental visits appears to have reduced disparities. A policy for medical care may contribute to similar benefits.
引言 2007年，加利福尼亚州签署立法，规定所有进入幼儿园或一年级的儿童都要进行牙科检查；但对于医生检查并未做出此类规定。本研究探讨了这一政策变化对获得儿童牙科和医生医疗检查相关风险因素的影响。方法 加利福尼亚健康访谈调查每两年对具有代表性的社区样本进行一次全州范围的调查。这项横断面研究利用这些数据进行了一项“自然实验”，评估这一政策变化对过去一年儿童医生和牙科检查的影响。样本包括2005年（n = 5096）、2007年（n = 4324）和2009年（n = 4100）对成人和儿童（5至11岁）的调查。结果 虽然儿童医生检查的风险因素几乎没有变化，但从2005年到2009年，儿童牙科检查的风险因素逐渐减少。2005年，年龄较小的儿童（比值比 -0.81，可信区间0.75 - 0.88）、有保险的儿童（比值比0.34，可信区间0.22 - 0.53）以及去年看过医生的儿童（比值比0.37，可信区间0.25 - 0.53）进行牙科检查的可能性较小。到2007年，未参保是与未进行牙科检查相关的唯一风险因素（比值比0.34，可信区间0.19 - 0.61）。到2009年，对于5至11岁的儿童，没有先验测量的风险因素与未进行牙科检查相关。结论 一项规定儿童牙科检查的全州性政策似乎减少了差异。一项医疗护理政策可能会带来类似的益处。
