Maness Philip, Tumin Dmitry, Cholera Rushina, Collier David N, Bonilla-Hernandez Luisa, Lazorick Suzanne
Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America.
Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America.
PLOS Glob Public Health. 2023 Apr 13;3(4):e0001816. doi: 10.1371/journal.pgph.0001816. eCollection 2023.
Following the 2016 US Presidential election, immigration enforcement became more aggressive, with variation by state and region depending on local policies and sentiment. Increases in enforcement created an environment of risk for decreased use of health care services among especially among Latino families. of Hispanic ethnicity and/or from Latin American origin (as a group subsequently referred to as Latino). For Latino children with chronic health conditions, avoidance of routine health care can result in significant negative health consequences such as disease progression, avoidable use of acute health care services, and overall increased costs of care. To investigate for changes in visit attendance during the periods before and since increased immigration enforcement, we extracted data on children followed by subspecialty clinics of one healthcare system in the US state of North Carolina during 2015-2019. For each patient, we calculated the proportion of cancelled visits and no-show visits out of all scheduled visits during the 2016-2019 follow-up period. We compared patient characteristics (at the 2015 baseline) according to whether they cancelled or did not show to any visits in subsequent years by clinic and patient factors, including ethnicity. Data were analyzed using multinomial logistic regression of attendance at each visit, including an interaction between visit year and patient ethnicity. Among 852 children 1 to 17 years of age (111 of Latino ethnicity), visit no-show was more common among Latino patients, compared to non-Latino White patients; while visit cancellation was more common among non-Latino White patients, compared to Latino patients. There was no significant interaction between ethnicity and trends in visit no-show or cancellation. Although differences in pediatric specialty clinic visit attendance by patient ethnicity were seen at study baseline, changing immigration policy and negative rhetoric did not appear to impact use of pediatric subspecialty care.
2016年美国总统大选后，移民执法力度加大，各州和地区因当地政策和民意而有所不同。执法力度的增强营造了一种风险环境，尤其是拉丁裔家庭（指具有西班牙裔种族和/或来自拉丁美洲血统的群体，以下简称为拉丁裔）使用医疗服务的情况有所减少。对于患有慢性健康问题的拉丁裔儿童来说，避免常规医疗保健会导致严重的负面健康后果，如疾病进展、不必要地使用急性医疗服务以及总体医疗成本增加。为了调查移民执法力度加大前后就诊率的变化，我们提取了2015 - 2019年期间美国北卡罗来纳州一个医疗系统的专科诊所跟踪的儿童数据。对于每位患者，我们计算了2016 - 2019年随访期间所有预约就诊中取消就诊和爽约就诊的比例。我们根据患者在后续年份是否取消或未出现任何就诊情况，按诊所和患者因素（包括种族）比较了患者特征（以2015年为基线）。使用每次就诊出勤率的多项逻辑回归分析数据，包括就诊年份与患者种族之间的相互作用。在852名1至17岁的儿童中（111名拉丁裔），与非拉丁裔白人患者相比，拉丁裔患者爽约就诊更为常见；而与拉丁裔患者相比，非拉丁裔白人患者取消就诊更为常见。种族与爽约或取消就诊趋势之间没有显著的相互作用。尽管在研究基线时观察到患者种族在儿科专科诊所就诊率上存在差异，但移民政策的变化和负面言论似乎并未影响儿科专科护理的使用。
