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Health Care Utilization and Neighborhood Violence: 2019-2023
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DOI：10.1542/peds.2025-071560.png)
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Abstract
En 中文
BACKGROUND AND OBJECTIVES Children experience the highest impact from neighborhood violence (NV) exposure. Timely access to care has proven to mitigate these untoward effects. However, robust, up-to-date information regarding patterns of health care access, including the impact of the COVID-19 pandemic among children exposed to NV, is lacking.METHODS We used an annually collected nationally representative survey (National Health Interview Survey) to examine predictors of NV in 2019 to 2023. A residential parent or other adult knowledgeable about the child's health is selected to respond to questions about the child. We used a time series model to explore the impact of the COVID-19 pandemic on NV. We constructed logistic regression models to predict the patterns of health care access and use (preventive care access, acute care use, and unmet health needs) among children aged 2 to 17 years exposed to NV and adjusted for potential covariates.RESULTS Out of a sample of 29 013 representing a weighted population of 65 140 276 individuals, we found that 1676 children (weighted 3 735 352; 5.8% [95% CI, 5.5-6.2]) were exposed to NV from 2019 to 2023. The likelihood of exposure to NV increased significantly in 2022 compared with 2021. Exposure to NV is significantly associated with not having a routine dental examination, increased use of mental health services, increased acute care use, and delayed and forgone medical, dental, and mental health care due to cost.CONCLUSIONS As challenges to prompt access to medical, dental, and mental health care persist among US children, exploring alternative strategies to pediatric health care financing is critical to robust childhood health care coverage.
Keywords:
ADVERSE CHILDHOOD EXPERIENCES
COVID-19
DISPARITIES
EXPOSURE
ASSOCIATION
CHILDREN
IMPACT
ADULTS
PLACE
CRIME
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