Renneberg Camilla Klinge, Brund René Børge Korsgaard, Heuckendorff Signe, Gunaseelan Artika, Kruse Lisbeth Venø, Fonager Kirsten
Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.
Psychiatry Region North Jutland, Aalborg, Denmark.
Eur J Public Health. 2024 Feb 5;34(1):85-90. doi: 10.1093/eurpub/ckad187.
The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt.
In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR).
The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92-0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14-1.23) of asthma-related hospitalization.
Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.
在一个实行全民医保的国家，支付哮喘药物费用的义务可能会导致哮喘急性发作增加，以及低收入家庭儿童获得医疗服务的机会不平等。因此，本研究的目的是探讨家庭收入与儿童/学龄前儿童哮喘在住院和药物使用方面的关联。
在这项基于全国登记的队列研究中，我们纳入了所有居住在丹麦、2000年至2014年出生的3岁儿童及其相关联的父母，并跟踪他们直至6岁生日。家庭收入分为四分位数。哮喘被分为两个相互排斥的组，即开具两份哮喘药物处方或接受医院诊断。我们使用泊松回归来估计风险比（RR）。
分析纳入了834422名学龄前儿童。仅依赖药物治疗的哮喘患病率为7.3%，而1.8%的儿童需要因哮喘住院治疗。在所有收入四分位数中，收入不平等都很明显。值得注意的是，来自最低收入四分位数的儿童开具哮喘药物处方的风险比为0.95（95%可信区间：0.92 - 0.98），相反，因哮喘住院的风险比为1.18（95%可信区间：1.14 - 1.23）。
尽管有全民医保，但收入不平等对低收入家庭儿童有双重影响。他们开具哮喘药物处方的风险降低，但哮喘相关住院的易感性更高，这表明获得医疗服务的机会不平等。优先努力减少儿童健康不平等至关重要。然而，需要进一步研究，特别是定性研究，以更好地理解潜在机制，从而应对收入不平等的复杂性。
