美国拉丁裔儿童的语言差异与医疗之家的存在对儿童健康的影响。
Linguistic Disparities in Child Health and Presence of a Medical Home Among United States Latino Children.
机构信息
Department of Pediatrics, Boston Medical Center, Boston University School of Medicine (EG Cordova-Ramos and MG Parker), Boston, Mass.
Department of Biostatistics, Boston University School of Public Health (Y Tripodis), Boston, Mass.
出版信息
Acad Pediatr. 2022 Jul;22(5):736-746. doi: 10.1016/j.acap.2021.09.011. Epub 2021 Sep 24.
OBJECTIVE
The impact of household language on Latino-White and Latino intragroup disparities in child health and having a medical home in the United States is poorly understood. This study aimed to examine these disparities 1) between Whites and Latinos (overall and stratified by English-primary-language [EPL] and non-English-primary-language [NEPL] households); 2) within Latinos, stratified by household language; and 3) potential moderation of disparities by social determinants.
METHODS
Cross-sectional analysis of nationally representative sample of children 0 to 17 years old from the 2016-2018 National Survey of Children's Health. We evaluated associations of child race/ethnicity and household language with child health and presence of a medical home. Multivariable logistic regression was used to compare groups of interest, adjusting for sociodemographic factors and health needs. Moderation was assessed using interaction terms for household income, parental educational attainment, and child insurance coverage.
RESULTS
Among 81,514 children, 13.5% were NEPL Latino, and 19.4% were EPL Latino. Compared with EPL Whites, both EPL and NEPL Latinos had reduced odds of excellent/very good health (adjusted odds ratio [aOR]: 0.70; 95% confidence interval [CI]: 0.58-0.84; and aOR: 0.42; 95% CI: 0.33-0.53) and presence of a medical home (aOR: 0.62; 95% CI: 0.56-0.69; and aOR: 0.45; 95% CI: 0.37-0.54), respectively. Among Latinos, NEPL (vs EPL) was also associated with reduced odds of excellent/very good health (aOR: 0.61; 95% CI: 0.46-0.83), and presence of a medical home (aOR: 0.66; 95% CI: 0.48-0.78); these associations were magnified by adverse social determinants.
CONCLUSIONS
Striking Latino-White and within-Latino medical-home disparities persist in the United States, particularly for NEPL Latino children. Interventions should target social determinants and the rich sociocultural and linguistic diversity of the Latino population.
目的
家庭语言对美国拉丁裔-白人和拉丁裔内部儿童健康和拥有医疗之家的差距的影响尚未得到充分理解。本研究旨在检查这些差距：1）在白人和拉丁裔之间（总体上以及按英语为主要语言[EPL]和非英语为主要语言[NEPL]家庭划分）；2）在拉丁裔内部，按家庭语言划分；3）社会决定因素对差异的潜在调节作用。
方法
使用 2016-2018 年全国儿童健康调查的全国代表性 0 至 17 岁儿童样本进行横断面分析。我们评估了儿童种族/民族和家庭语言与儿童健康和拥有医疗之家的关联。多变量逻辑回归用于比较感兴趣的组，调整社会人口因素和健康需求。使用家庭收入、父母教育程度和儿童保险覆盖范围的交互项评估调节作用。
结果
在 81514 名儿童中，13.5%为非英语为主要语言的拉丁裔，19.4%为英语为主要语言的拉丁裔。与英语为主要语言的白人相比，英语为主要语言和非英语为主要语言的拉丁裔儿童健康状况良好/非常好的几率均降低（调整后的优势比[OR]：0.70；95%置信区间[CI]：0.58-0.84；和 OR：0.42；95% CI：0.33-0.53），拥有医疗之家的几率也降低（OR：0.62；95% CI：0.56-0.69；和 OR：0.45；95% CI：0.37-0.54）。在拉丁裔中，非英语为主要语言（与英语为主要语言相比）也与健康状况良好/非常好的几率降低相关（OR：0.61；95% CI：0.46-0.83），拥有医疗之家的几率也降低（OR：0.66；95% CI：0.48-0.78）；这些关联在社会不利因素的作用下更加明显。
结论
在美国，拉丁裔-白人和拉丁裔内部的医疗之家差距仍然很大，尤其是对于非英语为主要语言的拉丁裔儿童。干预措施应针对社会决定因素和拉丁裔人口丰富的社会文化和语言多样性。
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