Matossian Debora, Romero Carlos C Becerril, Verghese Priya S
Ann and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave Box 37, Chicago, IL, USA.
Pediatr Nephrol. 2025 Jul 12. doi: 10.1007/s00467-025-06881-4.
Hispanics, the fastest growing minority in the USA, suffer from high chronic kidney disease (CKD) burden. Barriers to accessing medical care increase disparities and quality of care for Hispanic children with CKD.
As a part of the grant-funded "Kidney Initiative in Community Kids" (KICK), the voluntary "Barriers to Care Questionnaire" was distributed to self-identified Hispanic young adult patients (> 18 years of age) or parents (if patient < 18 years of age), between January 2021 to June 2021, in a single urban pediatric nephrology ambulatory clinic site. Survey was available in English and Spanish. Sociodemographic and health data was obtained from the medical record and Area Deprivation Index (ADI) was collected as a surrogate marker for socioeconomic disadvantage.
Of the 179 completed surveys (49% Spanish, 51% English), skills (strategies necessary to navigate the healthcare system) and pragmatic (logistical issues that might delay/prevent utilization) barriers were identified with mean (± standard deviation) scores of 74 (± 26) and 75 (± 21), respectively (100 = no barriers). Spanish-speaking preference families had higher skills barriers (p < 0.001). The mean ADI was 55 ± 20: higher ADI score (more disadvantaged population) correlated with higher total barriers (p = 0.04) and was exacerbated by preferred language (p = 0.003).
Hispanic pediatric patients with kidney disease have significant barriers which may impact their interaction with healthcare. Spanish-speaking families are particularly vulnerable. Prospective studies are necessary to advocate for program and policy changes to reduce racial and ethnic disparities in access to pediatric nephrology care.
西班牙裔是美国增长最快的少数族裔，慢性肾脏病（CKD）负担沉重。就医障碍加剧了患有CKD的西班牙裔儿童的医疗差距和医疗质量问题。
作为由赠款资助的“社区儿童肾脏倡议”（KICK）的一部分，2021年1月至2021年6月期间，在一个城市儿科肾脏病门诊站点，向自我认定的西班牙裔青年患者（>18岁）或家长（如果患者<18岁）发放了自愿性的“就医障碍问卷”。调查问卷有英文和西班牙文两种版本。从病历中获取社会人口统计学和健康数据，并收集地区贫困指数（ADI）作为社会经济劣势的替代指标。
在179份完成的调查问卷中（49%为西班牙文，51%为英文），识别出技能（应对医疗系统所需的策略）和实际问题（可能延迟/阻碍就医的后勤问题）障碍，平均（±标准差）得分分别为74（±26）和75（±21）（满分100分表示无障碍）。偏好说西班牙语的家庭技能障碍更高（p<0.001）。平均ADI为55±20：ADI得分越高（人口劣势越大），总障碍越高（p=0.04），且因偏好语言而加剧（p=0.003）。
患有肾脏疾病的西班牙裔儿科患者存在重大障碍，这可能会影响他们与医疗服务的互动。偏好说西班牙语的家庭尤其脆弱。有必要进行前瞻性研究，以倡导改变项目和政策，减少儿科肾脏病护理获取方面的种族和族裔差异。
