家庭社会经济地位与学龄前儿童健康 关之探讨
A Study on the Association between Family's Socioeconomic Status and Preschool Children's Health
研 究 生:张慈桂 (Tzu-Kuei Chang) 指导教授:忠孚博士 (Dr. Chung-Fu Lan)
国阳明大学 公共卫生研究所卫生政策与管组 博士学位文
National Yang-Ming University Institute of Public Health (Health Policy and Management) Ph.D Thesis
中华民国九十三七月 July 2004
志谢
1999 进入阳明大学公共卫生研究所博士班进修,已是硕士班毕业 后,也在慈济大学公共卫生学系任教五的时候.一边工作,一边 进修,花--台的舟奔波,同时扮演著既是学生也是师的光阴, 转眼也是五个头.个中心及体的投入及甘苦,如今思,点滴心 头.
进修期间,最感谢指导师忠孚教授的谆谆教诲,师的宏观思 考和前瞻观点,是让自己融合社会学及公共卫生域学习的最佳导航; 时的鼓及提纲,是文顺完成的重要推手.慈济大学医学 系王本荣师,台湾大学预防医学研究所陈秀熙师,医机构管研 究所杨铭钦师及中正大学社会研究所陈孝平师,担任学位委 员,在文的撰写及口试,提供详实的建议,指导及鼓,与师们的 互动和讨,是充实的收获,是任事态的学习.
在职的单位,慈济大学及公卫系的同事,给予同意进修的支持,亦 深深感谢.
完成文及学位的取得,这期间曾有的欢喜或挫折,谢谢家人和挚 友们,一陪伴走过.之间情谊,是我永远珍惜的.
2004 7 月
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中文摘要
儿童是一个国家未的希望,儿童期的健康对於未青少期至成 期的健康均有所影响,奠基孩童健康等於是替国民健康的提升注入稳 固的基础.学龄前儿童健康发展对之后个体健康有莫大的重要性,儿童 的无法自主,依赖及需要照护,使得其所处之家庭背景对其健康产生明 显的影响.
本研究以横断面的调查资,收集 3~6 岁学龄前儿童家户资,探 讨家庭社会经济地位对其健康况,预防保健及医用情形之影响, 并尝试建构探讨影响学前儿童健康况,预防保健及医用之模式.
一般对於家庭社会经济地位的探讨,常以教育,职业及所得个别进 分析,本研究同时尝试以集群分析(cluster analysis)的方式,将相 关社会经济地位指标区分为高社经地位,及低社经地位,进一步探 讨整体家庭社会经济地位对学前儿童病,父母自觉儿童健康,各医 用及就医性的影响.
研究结果发现,社会经济地位对学前儿童的自觉健康,一项以上疾 病情形,牙医服务用及就医各项上有显著的关.高社会经济地 位者自觉儿童健康好的比较高(42.1% vs.34.8%),较多一项以上疾 病 问 题 (OR=1.3 , 95%CI:1.1-1.7) , 较 多 的 自 费 疫 苗 接 种 (OR=2.1 , 95%CI:1.6-2.6),较多的牙医用服务(OR=2.1,95%CI:1.5-3.0)及较 低的就医性(OR=0.4,95%CI:0.2-0.6).
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在复辑回归分析中,也发现儿童就幼稚园与否对其健康有显著 的影响.在儿童有一项以上的疾病问题,就幼稚园的儿童有 1.7 倍的 胜算比.在牙医用服务上,就幼稚园有 2.0 倍的胜算比.另外,在 儿童就医的性上,也明显地看到居住区域的差距,居住於"乡"有 10.9 倍的胜算比较"市"感受到就医方.
社会经济地位对健康的关,在学龄前儿童亦是可.未研究的 探讨上,仍需建纵贯性研究,探讨同时期社会经济地位对健康及发 展之影响情形.并结合卫生,社会及教育政策,作为对同社会经 济况家庭其学前儿童健康促进的介入.
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Abstract
The health of children is the basis of the adolescent and adulthood health. Improving the health and well-being of children is a primary goal of health care systems. Childhood is a period of dependency and development. Family socioeconomic status influences the children's opportunity to access health care and is consistently associated with health outcome. The aim of this study was to illustrate how family socioeconomic status relates to the health status of 3-6 year-old preschool children and the type of health care service provided. We implemented the cross-sectional study and conducted face-to-face interview for children's caregiver that contained 1247 samples from different urbanization levels. The urbanization levels were based on the classification in the Taiwan-Fukein Demographic Fact Book, Ministry of Interior. The subjects were asked to complete a set of questionnaire including the children's health status, family characteristics, and the utilization of medical care service. Despite the descriptive statistic, we build the logistic models to elucidate how the family socioeconomic status affected the preschool children's health and different health care utilization. Family socioeconomic status usually illustrated in parent's education, occupation, and family income. We use the cluster analysis to classify socioeconomic status as high and low level, which came from the combination of these criteria variables including parents' education, occupation, and family income. The results demonstrated the socioeconomic status significantly affected the parental-reported children health, children' morbidity level, dental service utilization, and convenience of seeking medical care. High SES had significantly more percent (42.1% vs. 34.8%) for better parental-reported children health than low SES. In logistic regression analysis, high SES had the 2.1 odds ratio (95%CI 1.5-3.0) in ever using the

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