健康的社会决定因素与青年慢性疼痛。

Social determinants of health and youth chronic pain.

机构信息

Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China.

Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, 518060, China.

出版信息

Complement Ther Clin Pract. 2024 Nov;57:101911. doi: 10.1016/j.ctcp.2024.101911. Epub 2024 Oct 2.

DOI:10.1016/j.ctcp.2024.101911

PMID:39368445

Abstract

OBJECTIVES

To identify the relationships between social determinants of health (SDOH) and chronic pain among U.S. youth (referring to children and adolescents).

METHODS

Data including a national sample of U.S. youth were retrieved from the 2022 National Survey of Children's Health. Twenty indicators within five SDOH-related domains (e.i., economic stability, social and community context, neighborhood and built environment, health care access and quality, and education access and quality) were included. The presence of chronic pain was assessed using a self-reported question, answered by the main caregiver. Associations of SDOH-related indicators and youth chronic pain were estimated using multi-variable logistic regression models, while adjusting for covariates (e.g., age, sex, ethnicity, weight status, and movement behaviors).

RESULTS

Data from 30,287 U S. youth aged 6-17 years (median [SD] age, 11.59 [3.30] years; 14,582 girls [48.97 %]) were collected. In 7.5 % of the final sample size, caregivers reported that they had chronic pain. Youth grow up in conditions with diverse SDOH profiles, including food insufficiency (OR = 1.46, 95 % CI: 1.01 to 2.10) and parental unemployment (OR = 1.56, 95 % CI: 1.15 to 2.12); low school engagement (OR = 1.48, 95 % CI: 1.14 to 1.92) and low school safety (OR = 1.65, 95 % CI: 1.14 to 2.39); limited access to quality health care (OR = 2.56, 95 % CI: 2.12 to 3.09), a high frequency of hospital visits (OR = 4.76, 95 % CI: 1.82 to 12.44), and alternative health care (OR = 2.57, 95 % CI: 2.07 to 3.20); bullying victimization (OR = 1.37, 95 % CI: 1.11 to 1.68) and community-based adverse childhood experiences (OR = 1.64, 95 % CI: 1.32 to 2.05); and disadvantageous amenity characteristics (OR = 1.38, 95 % CI: 1.05 to 1.79); resulted in higher odds of presenting chronic pain.

CONCLUSIONS

Different indicators included in the SDOH domains were associated with a higher probability of presenting chronic pain in U.S youth. These findings have implied relationships between the SDOH and chronic pain in youth, requiring a comprehensive approach to addressing health equity to prevent and reduce the presence of youth chronic pain.

摘要

目的

确定美国青少年（指儿童和青少年）社会决定因素（SDOH）与慢性疼痛之间的关系。

方法

从 2022 年全国儿童健康调查中检索到包括美国青少年全国样本在内的数据。纳入五个与 SDOH 相关领域（即经济稳定性、社会和社区环境、邻里和建筑环境、医疗保健可及性和质量以及教育可及性和质量）的 20 个指标。慢性疼痛的存在通过主要照顾者回答的自我报告问题进行评估。使用多变量逻辑回归模型估计 SDOH 相关指标与青少年慢性疼痛之间的关联，同时调整协变量（例如年龄、性别、种族、体重状况和运动行为）。

结果

共收集了 30287 名年龄在 6-17 岁的美国青少年（中位数[SD]年龄为 11.59 [3.30]岁；14582 名女孩[48.97%]）的数据。在最终样本量的 7.5%中，照顾者报告他们有慢性疼痛。青少年成长在社会决定因素多样性的环境中，包括食物不足（OR=1.46，95%CI：1.01 至 2.10）和父母失业（OR=1.56，95%CI：1.15 至 2.12）；低学校参与度（OR=1.48，95%CI：1.14 至 1.92）和低学校安全性（OR=1.65，95%CI：1.14 至 2.39）；获得优质医疗保健的机会有限（OR=2.56，95%CI：2.12 至 3.09）、高频次住院（OR=4.76，95%CI：1.82 至 12.44）和替代医疗保健（OR=2.57，95%CI：2.07 至 3.20）；受欺凌（OR=1.37，95%CI：1.11 至 1.68）和社区不良儿童经历（OR=1.64，95%CI：1.32 至 2.05）；以及不利的便利设施特征（OR=1.38，95%CI：1.05 至 1.79），导致出现慢性疼痛的可能性更高。