Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Child and Adolescent Health Measurement Initiative (C Bethell and N Gombojav), Baltimore, Md.
Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences (CK Blackwell), Chicago, Ill.
Acad Pediatr. 2022 Aug;22(6):952-964. doi: 10.1016/j.acap.2021.12.001. Epub 2021 Dec 8.
To develop, validate and estimate national and across state prevalence on a multidimensional index that assesses the complex medical, social, and relational health risks experienced by United States children.
Data from the National Survey of Children's Health were used to construct the Integrated Child Risk Index (ICRI) which includes medical health risk (MHR), social health risk (SHR) and relational health risk (RHR) domains. Confirmatory factor analysis and logistic regression analyses were employed to assess construct and predictive validity. Validity outcomes were child flourishing, school engagement/readiness, emergency room utilization and forgone care.
Confirmatory factor analysis confirmed the ICRI 3-domain structure and greater correlation between MHR and RHR than MHR and SHR. Logistic regressions confirmed strong predictive validity of the ICRI for all study outcomes and ICRI scoring approaches. Nearly two-thirds of children (64.3%) with MHR also experienced SHR and/or RHR. Nearly one-third of United States children experienced risks on 2 or more ICRI domains and 15% of publicly insured children had risks on all domains (16.2%; 9.0%-25.7% across states). Significant variations were observed across states and by age, race/ethnicity, health insurance and household income.
The ICRI is a valid national and state level index associated with children's flourishing and educational preparedness and emergency and forgone care. National child health policies and Medicaid risk stratification and payment models should consider children's RHR in addition to SHR and MHR. Results call for integrated systems of care with the capacity to address medical, social and relational health risks and promote well-being. Substate and clinical applications require research.
开发、验证并估计美国儿童多维指数的全国和州级流行率，该指数评估了美国儿童所经历的复杂医疗、社会和关系健康风险。
使用国家儿童健康调查的数据构建综合儿童风险指数（ICRI），该指数包括医疗健康风险（MHR）、社会健康风险（SHR）和关系健康风险（RHR）领域。采用验证性因子分析和逻辑回归分析评估结构和预测效度。有效性结果包括儿童繁荣、学校参与/准备情况、急诊室利用和放弃护理。
验证性因子分析证实了 ICRI 的 3 个领域结构，MHR 和 RHR 之间的相关性大于 MHR 和 SHR 之间的相关性。逻辑回归证实了 ICRI 对所有研究结果和 ICRI 评分方法的强大预测效度。近三分之二的有 MHR 的儿童（64.3%）也经历了 SHR 和/或 RHR。近三分之一的美国儿童在 2 个或更多 ICRI 领域存在风险，15%的有保险的儿童在所有领域都存在风险（16.2%；9.0%-25.7%，各州不同）。各州之间以及按年龄、种族/族裔、健康保险和家庭收入观察到显著差异。
ICRI 是一个有效的全国和州级指数，与儿童的繁荣和教育准备以及急诊和放弃护理有关。国家儿童健康政策和医疗补助风险分层和支付模式应考虑儿童的 RHR，除 SHR 和 MHR 之外。结果呼吁建立有能力解决医疗、社会和关系健康风险并促进福祉的综合护理系统。州以下和临床应用需要研究。
