Table 1_Disparities exist among US adolescents in the receipt of transition to adult healthcare services: the differential impact of social determinants of health, healthcare needs, and COVID-19.docx

IntroductionWe examined the influence of special healthcare needs, onset of the COVID-19 pandemic, and their interaction on receiving transition services to prepare for future adult care among US adolescents, and whether social determinants of health moderated the relationship of these factors with receiving transition services.
MethodsWe analyzed the National Survey of Children's Health (2019, 2020–2021) using adjusted multivariable logistic regression models. We assessed a repeated cross-sectional, nationally representative sample of adolescents aged 12–17 years old. Sampling weights were used to generalize samples to the populations of interest. The main outcome was receipt of transition services to prepare for future adult healthcare. Measures included pre vs. post COVID-19 onset, special healthcare needs, and social determinants of health (health insurance, food sufficiency, neighborhood safety, household language, race/ethnicity, and household poverty level). Sex and two-parent households were included as covariates.
ResultsA total of 45,935 adolescents were included, with N=12,230 in the pre COVID-19 group and N=33,705 in the post COVID-19 group. We found statistically significant higher odds of receiving transition services among adolescents with special healthcare needs (95 CI = 1.23, 1.58), females (95 CI = 1.09, 1.39), and during pre COVID-19 (95 CI = 1.14, 1.45). Private insurance (95 CI = 1.03, 1.37), English as primary household language (95 CI = 1.19, 2.27), and race/ethnicity were significant predictors of receipt of transition services. Neighborhood safety significantly moderated (95 CI = 1.70, 6.60) the relationship between special healthcare needs and receipt of transition services.
DiscussionThis population-based study identified significant disparities in receipt of transition services provided to US adolescents via the differential impact of social determinants of health, special healthcare needs, and COVID-19 onset on receipt of services.

研究背景
本研究探讨了特殊医疗需求、新冠疫情暴发及其交互作用对美国青少年获取过渡服务（transition services）以筹备未来成人照护的影响，同时检验了健康社会决定因素（social determinants of health）是否会调节上述因素与过渡服务获取之间的关联。

研究方法
本研究采用校正后的多变量logistic回归模型，对2019年、2020–2021年的《美国儿童健康调查》（National Survey of Children's Health）数据进行分析。研究纳入12~17岁青少年的重复横截面全国代表性样本，通过抽样权重将样本推论至目标研究人群。本研究的主要结局指标为是否获取用于筹备未来成人医疗照护的过渡服务。研究变量包括新冠疫情暴发前后分组、特殊医疗需求，以及健康社会决定因素（健康保险、食物充足性、社区安全、家庭语言、种族/族裔与家庭贫困水平）。协变量纳入性别与双亲家庭。

研究结果
本研究共纳入45935名青少年，其中新冠疫情前组12230人，新冠疫情后组33705人。研究发现，存在特殊医疗需求的青少年、女性以及新冠疫情暴发前时期，其获取过渡服务的比值比存在统计学意义上的显著升高（95%置信区间分别为1.23~1.58、1.09~1.39、1.14~1.45）。私人医疗保险（95%置信区间：1.03~1.37）、以英语为家庭主要语言（95%置信区间：1.19~2.27）以及种族/族裔均为过渡服务获取的显著预测因子。社区安全对特殊医疗需求与过渡服务获取之间的关系具有显著的调节作用（95%置信区间：1.70~6.60）。

讨论
本项基于人群的研究通过分析健康社会决定因素、特殊医疗需求与新冠疫情暴发对过渡服务获取的差异化影响，揭示了美国青少年在过渡服务获取方面存在的显著差异。