Anker Bryan, Tripodis Yorghos, Long Webb E, Garg Arvin
1 Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
2 Boston University School of Public Health, Boston, MA, USA.
Clin Pediatr (Phila). 2018 Jun;57(7):827-834. doi: 10.1177/0009922817733697. Epub 2017 Oct 11.
This study was a secondary data analysis of the 2011-2012 National Survey of Children's Health. Data were available for a nationally representative sample of 81 090 children. Multivariable logistic regression was used to model child health with the medical home while examining the effect modification of household income and controlling for sociodemographic characteristics. Overall, the medical home was significantly associated with "excellent/very good" child health for children regardless of household income. However, the association of the medical home with "excellent/very good" child health was significantly higher for children in households earning >200% FPL (federal poverty level) compared with <200% FPL (adjusted odds ratio [aOR] 2.13 [95% CI 1.80-2.52] vs aOR 1.46 [95% CI 1.24-1.71]; P < .01). This relationship was also found among children >400% FPL compared with children between 100% and 199% FPL (aOR 2.25 [95% CI 1.74-2.9 0] vs aOR 1.28 [95% CI 1.01-1.62]; P < .01). Therefore, while the medical home is associated with beneficial child health for most children, significant disparities by income exist.
本研究是对2011 - 2012年全国儿童健康调查的二次数据分析。数据来自81090名具有全国代表性的儿童样本。采用多变量逻辑回归对儿童健康与医疗之家进行建模,同时考察家庭收入的效应修正并控制社会人口学特征。总体而言,无论家庭收入如何,医疗之家与儿童“优秀/非常好”的健康状况显著相关。然而,与家庭收入低于联邦贫困线200%的儿童相比,家庭收入高于联邦贫困线200%的儿童中,医疗之家与“优秀/非常好”儿童健康状况的关联显著更高(调整优势比[aOR]分别为2.13[95%置信区间1.80 - 2.52]和1.46[95%置信区间1.24 - 1.71];P <.01)。在家庭收入高于联邦贫困线400%的儿童与家庭收入在联邦贫困线100%至199%之间的儿童中也发现了这种关系(aOR分别为2.25[95%置信区间1.74 - 2.90]和1.28[95%置信区间1.01 - 1.62];P <.01)。因此,虽然医疗之家与大多数儿童的良好健康状况相关,但收入方面存在显著差异。