Weinreb L, Goldberg R, Bassuk E, Perloff J
Department of Family and Community Medicine, University of Massachusetts Medical Center, Worcester 01655-0309, USA.
Pediatrics. 1998 Sep;102(3 Pt 1):554-62. doi: 10.1542/peds.102.3.554.
Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children.
Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes.
Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings.
Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.
以往对无家可归儿童的研究表明，他们比有家可归的儿童存在更多健康问题且使用医疗服务的频率更高，但未能控制这些儿童之间可能存在差异的潜在混杂因素。这项观察性研究考察了627名无家可归及低收入的有家可归儿童中，无家可归状况及其他决定因素与健康状况和医疗服务使用模式之间的关系。
在马萨诸塞州伍斯特市对293名无家可归儿童和334名3个月至17岁的低收入有家可归儿童及其母亲进行病例对照研究。收集了有关母亲住房历史、收入、教育程度、情绪困扰和受害经历的信息。使用标准化工具评估儿童的健康状况。医疗服务使用问题改编自全国性调查。主要结局指标包括健康状况、急性疾病发病率、急诊科就诊和门诊就诊情况。采用多变量回归分析来考察包括无家可归状况在内的家庭和环境决定因素与健康状况及医疗服务使用结局之间的关联。
与有家可归儿童的母亲相比，无家可归儿童的母亲更有可能报告其子女健康状况为一般或较差。据报告，无家可归儿童出现更多急性疾病症状，包括发烧、耳部感染、腹泻和哮喘。无家可归儿童组的急诊科就诊和门诊就诊次数更多。在控制了潜在解释因素后，无家可归儿童健康状况为一般或较差的可能性仍然更高（调整优势比[OR]=2.83；95%置信区间[CI]，1.16，4.87），门诊就诊频率更高（OR=1.71；95%CI，1.18，2.48），急诊科就诊频率更高（OR=1.21；95%CI，0.83，1.74）。母亲的情绪困扰与急性疾病症状以及频繁使用门诊和急诊科有关。
无家可归是儿童健康状况不佳和医疗服务高使用率的一个独立预测因素。目前的研究结果凸显了预防性干预措施以及努力增加无家可归儿童获得初级保健机会的重要性。
