新冠疫情期间儿科急诊就诊率下降方面的种族和保险状况差异。
Disparities by race and insurance-status in declines in pediatric ED utilization during the COVID19 pandemic.
作者信息
Sen Bisakha Pia, Brisendine Anne, Yang Nianlan, Ghosh Pallavi
机构信息
Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America.
SHP Research Collaborative, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America.
出版信息
PLoS One. 2022 Feb 9;17(2):e0262490. doi: 10.1371/journal.pone.0262490. eCollection 2022.
Pediatric Emergency Department (ED) utilization in the U.S. saw large declines during the COVID19 pandemic. What is relatively unexplored is whether the extent of declines differed by race and insurance status. An observational study was conducted using electronic medical record (EMR) data from the largest pediatric ED in Alabama for 2020 and 2019. The four subgroups of interest were African-American (AA), Non-Hispanic White (NHW), privately insured (PRIVATE), and publicly insured or self-insured (PUBLIC-SELF). Percentage changes in the 7-day moving average between dates in 2020 and 2019 were computed for total and high-severity ED visits by subgroup. Trends in percentage changes were plotted. T-tests were used to compare mean changes between subgroups. Large percentage declines in total ED visits and somewhat smaller percentage declines in high-severity visits were observed from March 2020. Declines were consistently larger for AA than NHW and for PUBLIC-SELF than PRIVATE. T-test results indicated mean date-specific percentage declines were significantly larger for AA than NHW for total visits (-38.92% [95% CI: -41.1, -36.8] versus -29.11% [95% CI: -30.8, -27.4]; p<0.001) and high-severity visits (-24.31% [95% CI: -26.2, -22.4] versus -19.49% [95% CI:-21.2, -17.8]; p<0.001), and larger for PUBLIC-SELF than PRIVATE for total visits (-36.32% [95% CI:-38.4, -34.3] versus 27.63% [95% CI:-29.2, -26.0]; p<0.001) and high-severity visits (-21.72% [95% CI: -23.5, -19.9] versus -20.01% [95% CI: -21.7, -18.3]; p = 0.04). In conclusion, significant differences by race and insurance status were observed in the decline in ED visits during the COVID19 pandemic, including high-severity visits. Minority-race and publicly insured or self-insured children often depend on the ED for health needs, lacking a usual source of care. Thus, these findings have worrisome implications regarding unmet healthcare needs and future exacerbations in health disparities.
在美国，新冠疫情期间儿科急诊科（ED）的就诊量大幅下降。相对未被充分探索的是，就诊量下降的幅度是否因种族和保险状况而异。一项观察性研究利用了阿拉巴马州最大的儿科急诊科2020年和2019年的电子病历（EMR）数据。研究关注的四个亚组分别是非裔美国人（AA）、非西班牙裔白人（NHW）、私人保险（PRIVATE）以及公共保险或自我保险（PUBLIC-SELF）。计算了2020年和2019年各日期之间7天移动平均值的百分比变化，按亚组划分了总急诊就诊量和高严重程度急诊就诊量。绘制了百分比变化趋势图。使用t检验比较亚组之间的平均变化。从2020年3月起，观察到总急诊就诊量大幅下降，高严重程度就诊量下降幅度略小。非裔美国人的下降幅度始终大于非西班牙裔白人，公共保险或自我保险人群的下降幅度大于私人保险人群。t检验结果表明，非裔美国人的总就诊量特定日期平均百分比下降幅度显著大于非西班牙裔白人（-38.92% [95%置信区间：-41.1，-36.8] 对 -29.11% [95%置信区间：-30.8，-27.4]；p<0.001）和高严重程度就诊量（-24.31% [95%置信区间：-26.2，-22.4] 对 -19.49% [95%置信区间：-21.2，-17.8]；p<0.001），公共保险或自我保险人群的总就诊量下降幅度大于私人保险人群（-36.32% [95%置信区间：-38.4，-34.3] 对 -27.63% [95%置信区间：-29.2，-26.0]；p<0.001）和高严重程度就诊量（-21.72% [95%置信区间：-23.5，-19.9] 对 -20.01% [95%置信区间：-21.7，-18.3]；p = 0.04）。总之，在新冠疫情期间，急诊就诊量下降，包括高严重程度就诊量下降，在种族和保险状况方面存在显著差异。少数族裔以及公共保险或自我保险的儿童通常依赖急诊科满足健康需求，缺乏常规的医疗服务来源。因此，这些发现对于未满足的医疗需求以及未来健康差距的加剧具有令人担忧的影响。
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