Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Center on the Developing Child, Cambridge, Massachusetts.
Pediatrics. 2023 Sep 1;152(3). doi: 10.1542/peds.2022-057581.
Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States.
Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3 categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions.
In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45).
Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.
尽管广义上的系统性不平等与成年人的健康差异有关，但将排斥性政策或偏见态度的背景衡量标准与儿童健康受损联系起来的研究很少，尤其是在拉丁裔人群中。在这项研究中，我们研究了与美国拉丁裔儿童多种健康问题同时发生相关的系统性不平等的综合衡量标准。
参与者包括来自全国儿童健康调查（2016-2020 年）的 17855 名 3 至 17 岁的拉丁裔儿童。我们使用一个因子分数来衡量州一级的系统性不平等，该分数结合了对移民的排斥性州政策指数和对移民和拉丁裔个人的偏见态度的综合调查数据。照顾者报告了儿童健康问题的 3 个类别：过去一年的常见健康困难、当前慢性身体健康状况和当前心理健康状况。对于每个类别，我们构建了一个反映 0、1 或 2 个或更多条件的变量。
在调整了社会人口学协变量、人际歧视和州一级收入不平等的模型中，系统性不平等与慢性身体健康状况的几率增加 1.13 倍（95%置信区间：1.02-1.25）和 2 个或更多心理健康状况的几率增加 1.24 倍（95%置信区间：1.06-1.45）。
与系统性不平等程度较低的州相比，居住在系统性不平等程度较高的州的拉丁裔儿童更有可能经历心理健康或慢性身体健康状况。
