School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA.
BMJ Open. 2023 Feb 28;13(2):e069075. doi: 10.1136/bmjopen-2022-069075.
We used the National Health Interview Survey (NHIS) data set to examine the prevalence of comorbid medical conditions; explore barriers to accessing healthcare and special educational services; and assess the associations between sickle cell disease (SCD) status and demographics/socioeconomic status (SES), and social determinants of health (SDoH) on comorbidities among children in the USA.
Cross-sectional.
NHIS Sample Child Core questionnaire 2007-2018 data set.
133 481 children; presence of SCD was determined by an affirmative response from the adult or guardian of the child.
Multivariate logistic regression was used to compare the associations between SCD status, SES and SDoH for various medical conditions for all races and separately for black children at p<0.05.
133 481 children (mean age 8.5 years, SD: 0.02), 215 had SCD and ~82% (weighted) of the children with SCD are black. Children with SCD were more likely to suffer from comorbid conditions, that is, anaemia (adjusted OR: 27.1, p<0.001). Furthermore, children with SCD had at least two or more emergency room (ER) visits (p<0.001) and were more likely to have seen a doctor 1-15 times per year (p<0.05) compared with children without SCD. Household income (p<0.001) and maternal education were lower for children with SCD compared with children without SCD (52.4% vs 63.5% (p<0.05)). SCD children with a maternal parent who has < / > High School degree were less likely to have no ER visits or 4-5 ER visits, and more likely to have 2-3 ER visits within 12 months.
Children with SCD experienced significant comorbid conditions and have high healthcare usage, with black children being disproportionately affected. Moreover, maternal education status and poverty level illustrates how impactful SES can be on healthcare seeking behaviour for the SCD population. SDoH have significant implications for managing paediatric patients with SCD in clinical settings.
我们利用国家健康访谈调查（NHIS）数据集，研究合并症的流行情况；探讨获得医疗保健和特殊教育服务的障碍；评估美国儿童镰状细胞病（SCD）状态与人口统计学/社会经济地位（SES）和健康社会决定因素（SDoH）之间的关联，以及这些关联对合并症的影响。
横断面研究。
NHIS 样本儿童核心问卷 2007-2018 数据集。
133481 名儿童；通过儿童的成人或监护人的肯定回答来确定 SCD 的存在。
多变量逻辑回归用于比较 SCD 状态、SES 和 SDoH 与各种医疗条件之间的关联，所有种族的儿童均进行比较，黑人儿童单独进行比较，p<0.05。
133481 名儿童（平均年龄 8.5 岁，标准差：0.02），215 名儿童患有 SCD，其中约 82%（加权）的儿童为黑人。患有 SCD 的儿童更容易患有合并症，即贫血（调整后的优势比：27.1，p<0.001）。此外，患有 SCD 的儿童至少有两次或更多次急诊就诊（p<0.001），并且更有可能每年看医生 1-15 次（p<0.05），而没有 SCD 的儿童则没有。与没有 SCD 的儿童相比，患有 SCD 的儿童的家庭收入（p<0.001）和母亲教育程度较低（52.4% vs 63.5%（p<0.05））。母亲受教育程度< / >高中的 SCD 儿童不太可能没有急诊就诊或 4-5 次急诊就诊，而更有可能在 12 个月内有 2-3 次急诊就诊。
患有 SCD 的儿童患有显著的合并症，并且医疗保健利用率较高，其中黑人儿童受影响的程度不成比例。此外，母亲的教育状况和贫困程度说明了 SES 对 SCD 人群寻求医疗保健行为的影响有多大。SDoH 对临床环境中管理患有 SCD 的儿科患者具有重要意义。
