Children's Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA.
Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA.
Matern Child Health J. 2024 May;28(5):798-803. doi: 10.1007/s10995-023-03844-9. Epub 2023 Nov 22.
Women and children continue to miss preventive visits. Which neighborhood factors predict inadequate prenatal care (PNC) and well-child visit (WCV) attendance remain unclear.
In a retrospective case-control study at Virginia Commonwealth University Health System, mothers with less than 50% adherence or initiation after 5 months gestation were eligible as cases and those with ≥ 80% adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with ≥ 80% of adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio and matched on birth month. Covariates were derived from the 2018 American Community Survey. A hotspot was defined as a zip code tabulation area (ZCTA) with a proportion of controls less than 0.66. ZCTAs with fewer than 5 individuals were excluded. Weighted quantile regression was used to determine which covariates were most associated with inadequate attendance.
We identified 38 and 35 ZCTAs for the PNC and WCV analyses, respectively. Five of 11 hotspots for WCV were also hotspots for PNC. Education and income predicted 51% and 34% of the variation in missed PNCs, respectively; language, education and transportation difficulties explained 33%, 29%, and 17% of the variation in missed WCVs, respectively. Higher proportions of Black residents lived in hotspots of inadequate PCV and WCV attendance.
Neighborhood-level factors performed well in predicting inadequate PCV and WCV attendance. The disproportionate impact impact of inadequate PCV and WCV in neighborhoods where higher proportions of Black people lived highlights the potential influence of systemic racism and segregation on healthcare utilization.
妇女和儿童继续错过预防就诊。哪些邻里因素预测产前护理 (PNC) 和儿童健康检查 (WCV) 就诊不足仍不清楚。
在弗吉尼亚联邦大学卫生系统的回顾性病例对照研究中，妊娠 5 个月后依从性或起始率低于 50%的母亲有资格作为病例，而依从性和起始率在 5 个月前均≥80%的母亲有资格作为对照。依从性最低五分位数的儿童有资格作为病例，而依从性≥80%的儿童有资格作为对照。病例和对照按 1:2 的比例随机选择，并按出生月份匹配。协变量来自 2018 年美国社区调查。热点定义为控制组比例小于 0.66 的邮政编码分区 (ZCTA)。排除少于 5 人的 ZCTA。加权分位数回归用于确定哪些协变量与就诊不足最相关。
我们分别为 PNC 和 WCV 分析确定了 38 个和 35 个 ZCTA。WCV 的 5 个热点也是 PNC 的热点。教育和收入分别预测了 51%和 34%的 PNC 漏诊；语言、教育和交通困难分别解释了 33%、29%和 17%的 WCV 漏诊。更多的黑人员工居住在 PNC 和 WCV 就诊不足的热点地区。
邻里因素在预测 PNC 和 WCV 就诊不足方面表现良好。在黑人居民比例较高的社区，PCV 和 WCV 就诊不足的不成比例影响突出了系统性种族主义和隔离对医疗保健利用的潜在影响。
