儿童期身体残疾的年轻成年人的医疗保健利用情况：一项全国代表性的前瞻性队列研究。
Health care utilization in young adults with childhood physical disabilities: a nationally representative prospective cohort study.
机构信息
Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.
Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
出版信息
BMC Pediatr. 2022 Aug 25;22(1):505. doi: 10.1186/s12887-022-03563-0.
BACKGROUND
Young people with physical disabilities face barriers to accessing health care; however, few studies have followed adolescents with physical disabilities longitudinally through the transition of care into adulthood. The objective of this study was to investigate differences in health care utilization between adolescents with physical disabilities and those without during the transition period from adolescent to adult care.
METHODS
We utilized the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study following adolescents ages 11-18 at baseline (1994-1995) through adulthood. Baseline physical disability status was defined as difficulty using limbs, using assistive devices or braces, or having an artificial limb; controls met none of these criteria. Health care utilization outcomes were measured seven years after baseline (ages 18-26). These included yearly physical check-ups, unmet health care needs, and utilization of last-resort medical care, such as emergency departments, inpatient hospital wards, and inpatient mental health facilities. Multiple logistic regression models were used to predict health care utilization, controlling for age, sex, race/ethnicity, insurance status, and history of depression.
RESULTS
Thirteen thousand four hundred thirty-six participants met inclusion criteria, including 4.2% with a physical disability and 95.8% without. Half (50%) of the sample were women, and the average age at baseline was 15.9 years (SE = 0.12). In logistic regression models, those with a disability had higher odds of unmet health care needs in the past year (Odds Ratio (OR) 1.41 95% CI 1.07-1.87), two or more emergency department visits in the past five years (OR 1.34 95% CI 1.06-1.70), and any hospitalizations in the past five years (OR 1.36 95% CI 1.07-1.72). No statistically significant differences in preventive yearly check-ups or admission to mental health facilities were noted.
CONCLUSIONS
Young adults with physical disabilities are at higher risk of having unmet health care needs and using last-resort health care services compared to their non-disabled peers.
背景
身体残疾的年轻人在获得医疗保健方面面临障碍；然而，很少有研究对身体残疾的青少年进行纵向研究，以了解他们在从青少年期过渡到成年期期间的护理情况。本研究的目的是调查身体残疾青少年和非身体残疾青少年在从青少年期到成人期护理过渡期间在医疗保健利用方面的差异。
方法
我们利用了全国青少年健康纵向研究，这是一项对 11-18 岁青少年进行的前瞻性队列研究，从基线（1994-1995 年）到成年期进行跟踪。基线身体残疾状况定义为肢体活动困难、使用辅助设备或支架或使用假肢；对照组则没有这些标准。在基线后七年（18-26 岁）测量医疗保健利用结果。这些结果包括每年进行的体检、未满足的医疗保健需求以及利用最后手段的医疗保健，如急诊部门、住院病房和住院心理健康设施。使用多变量逻辑回归模型来预测医疗保健的利用情况，同时控制年龄、性别、种族/族裔、保险状况和抑郁史。
结果
纳入了 13436 名符合条件的参与者，其中 4.2%有身体残疾，95.8%没有。样本中有一半（50%）为女性，基线时的平均年龄为 15.9 岁（SE=0.12）。在逻辑回归模型中，残疾组在过去一年中未满足医疗保健需求的可能性更高（优势比（OR）1.41，95%置信区间（CI）1.07-1.87），过去五年中有两次或两次以上急诊就诊（OR 1.34，95% CI 1.06-1.70），以及过去五年中有任何住院治疗（OR 1.36，95% CI 1.07-1.72）。在预防年度体检或住院精神卫生机构方面，没有观察到统计学上显著的差异。
结论
与非残疾同龄人相比，身体残疾的年轻成年人在未满足医疗保健需求和使用最后手段的医疗保健服务方面的风险更高。
Zotero 插件