Department of Community Child Health, Sydney Children's Hospital Network, Randwick, New South Wales, Australia
Population Child Health Group, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.
J Epidemiol Community Health. 2020 Jun;74(6):495-501. doi: 10.1136/jech-2019-213384. Epub 2020 Mar 13.
The inverse care law suggests that those with the greatest need for services are least likely to receive them. Our aim of this study was to test the inverse care law in relation to the use of health services by children aged 4-5 years in Australia who were developmentally vulnerable and socioeconomically disadvantaged.
Cross-sectional data were collected from the Longitudinal Study of Australian Children birth cohort when the children were aged 4-5 years. Children were grouped according to the combination of developmental vulnerability (yes, no) and socioeconomic disadvantage (lower, higher), resulting in four groups (reference group: developmentally vulnerable and disadvantaged). Multivariate regression was used to examine the impact of the combination of developmental vulnerability and disadvantage on health service use, adjusting for other sociodemographic characteristics.
3967 (90%) of children had data on developmental vulnerability at 4-5 years. A third of children (32.6%) were classified as developmentally vulnerable, and 10%-25% of these children had used health services. Non-disadvantaged children who were developmentally vulnerable (middle need) had 1.4-2.0 times greater odds of using primary healthcare, specialist and hospital services; and non-disadvantaged children who were not developmentally vulnerable (lowest need) had 1.6-1.8 times greater odds of using primary healthcare services, compared with children who were developmentally vulnerable and disadvantaged (highest need).
We found some evidence of the inverse care law. Equity in service delivery remains a challenge that is critically important to tackle in ensuring a healthy start for children.
反向医疗定律表明，那些最需要服务的人最不可能得到服务。本研究旨在检验该定律在澳大利亚 4-5 岁发育脆弱和社会经济处于不利地位的儿童使用卫生服务方面的应用。
本研究使用澳大利亚儿童纵向研究的横断面数据，在儿童 4-5 岁时收集。根据发育脆弱性（是，否）和社会经济劣势（低，高）的组合将儿童分组，共分为四个组（参照组：发育脆弱且处于劣势）。使用多变量回归分析来检验发育脆弱性和劣势的组合对卫生服务使用的影响，同时调整了其他社会人口统计学特征。
3967（90%）名儿童在 4-5 岁时具有发育脆弱性数据。三分之一的儿童（32.6%）被归类为发育脆弱，其中 10%-25%的儿童使用了卫生服务。有发育脆弱性的非劣势儿童（中等需求）使用初级保健、专科和医院服务的可能性是发育脆弱和处于劣势儿童（最高需求）的 1.4-2.0 倍；而没有发育脆弱性的非劣势儿童（最低需求）使用初级保健服务的可能性则是发育脆弱和处于劣势儿童的 1.6-1.8 倍。
我们发现了一些反向医疗定律的证据。服务提供的公平性仍然是一个挑战，这对于确保儿童健康起步至关重要。
