Department of Pediatrics, University of Washington, Seattle, Washington.
Seattle Children's Research Institute, Seattle, Washington.
J Hosp Med. 2020 Apr 1;15(4):211-218. doi: 10.12788/jhm.3359. Epub 2020 Feb 11.
Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness.
From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data.
A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores.
Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.
了解儿童健康相关生活质量（HRQoL）方面的差异可能揭示出有针对性改善的机会。本研究考察了社会劣势、获得医疗服务的机会与儿童急性呼吸道疾病住院前后身体机能之间的关联。
2014 年 7 月 1 日至 2016 年 6 月 30 日期间，年龄在 8 至 16 岁之间的儿童或其 2 周至 16 岁儿童的看护者在五所三级儿童保健医院因三种常见呼吸道疾病入院时和出院后 2 至 8 周内完成了一项调查。调查项目评估了社会劣势（少数民族种族/族裔、英语水平有限、低教育程度和低收入）、获得医疗服务的困难/延迟情况以及使用儿童生活质量问卷（PedsQL，范围 0-100）评估的基线和随访 HRQoL 身体机能。我们使用多变量混合效应线性回归模型和缺失数据的多重插补敏感性分析，在基线和随访时检查了这三个变量之间的关联。
共有 1325 名患者及其看护者完成了 PedsQL 评估。与没有社会劣势指标的患者相比，具有社会劣势指标的患者的调整后平均基线 PedsQL 评分明显较低（3 个以上指标为 78.7，无指标为 85.5，差异为-6.1 分[95%CI：-8.7，-3.5]）。社会劣势指标的数量与平均随访 PedsQL 评分无关。获得医疗服务的困难/延迟与两个时间点的 PedsQL 评分较低有关，但它不是社会劣势和 PedsQL 评分之间的显著效应修饰剂。
具有社会劣势指标或获得医疗服务的困难/延迟与较低的基线身体机能有关；然而，住院后差异有所减少。
