- 期刊
Imputed Food Insecurity as a Predictor of Disease and Mental Health in Taiwanese Elementary School Children
食物來源不穩定性在臺灣學童兒童疾病與精神健康方面的預測因子角色
摘要
本研究檢視食物來源不穩定性與台灣兒童十八類疾病相關門診服務利用的關聯性；這些疾病類型有關內分泌和新陳代謝失調、營養、免疫、感染、氣喘、精神健康、事故傷害、中毒。我們使用764,526位小學兒童的全民健保長期追蹤資料，並採用健保資料中之相關訊息來建構三種食物來源不穩定性的替代測量指標：低出生體重狀態、經濟狀況（貧窮相對於非貧窮）以及時間點（暑假時間相對於學期時間）。我們比較低出生體重之兒童和其他兒童的前述十八類疾病相關門診服務利用，也比較家境處貧窮線以下和以上之兒童的相關醫療服務利用。此研究利用「差異中之差異」分析法檢驗公共午餐計畫改善食物來源不穩定性對貧窮孩童健康傷害之能力。研究發現家境處貧窮線以下之兒童明顯使用較多有關下述疾病之門診服務：糖尿病、遺傳性代謝失調、缺鐵性貧血，以及營養、新陳代謝、發育相關之不明確徵候，還有精神狀況失調。低出生體重兒童相關醫療服務的利用除了前述疾病外，也較可能使用有關其他內分泌異常與營養不足的服務。本研究並未發現學期中提供之學校營養午餐計畫有減輕食物來源不穩定性對貧窮孩童之健康傷害，顯示可能需要更密集的食物計畫或其他方案來幫助貧窮孩童克服食物來源不穩定性和相關之健康後果。
並列摘要
This study investigated the association between food insecurity and Taiwanese children's ambulatory medical care use for treating eighteen disease types linked to endocrine and metabolic disorders, nutrition, immunity, infections, asthma, mental health, injury, and poisoning. We used longitudinal data in the Taiwan National Health Insurance scheme (NHI) for 764,526 elementary children, and employed approximate NHI data to construct three indicators imputed to food insecurity: low birth weight status, economic status (poverty versus non-poverty), and time of year (summer break time versus semester time). We compared ambulatory care for these diseases between children with low birth weight and those not, and between children living in poverty and those not. A difference-in-differences method was adopted to examine the potential for a publicly-funded lunch program to reduce the harmful health effects of food insecurity on poor children. We found that children in poverty were significantly more likely to have ambulatory visits linked with diabetes, inherited disorders of metabolism, iron deficiency anemias, ill-defined symptoms concerning nutrition, metabolism and development, as well as mental disorders. Children with low birth weight also had a significantly higher likelihood of using care for other endocrine disorders and nutritional deficiencies, in addition to the above diseases. The study failed to find any significant effect of the semester school lunch program on alleviating the harmful health effects of food insecurity for poor children, suggesting that a more intensive food program or other program approaches might be required to help poor children overcome food insecurity and its related health outcomes.