Study objective

To determine whether insurance status can function as a sufficient proxy for socioeconomic status in emergency medicine research by examining the concordance between insurance status and direct socioeconomic status measures in a sample of pediatric patients.

Methods

We conducted a cross-sectional pilot study of patients aged 5 to 17 years in the emergency department of a quaternary care children’s hospital. Socioeconomic status was measured using the highest level of the caregiver’s education (low: less than bachelor’s degree; high: bachelor’s or greater) and previous year household income (low: <$75,000; high: ≥$75,000). We calculated the misclassification rate of insurance status (low: public; high: private) using education and income as reference standards. Results were expressed as percentages with 95% confidence intervals.

Results

In total, 300 patients were enrolled (median age 11 years, 44% female). Insurance status misclassified 23% (95% CI 18% to 28%) and 14% (95% CI 10% to 19%) of patients when using caregiver education and income, respectively, as reference standards.

Conclusions

Insurance status misclassified socioeconomic status in up to 23% of pediatric patients, as measured by caregivers’ education and income. Emergency medicine studies of pediatric patients using insurance as a covariate to adjust for socioeconomic status may need to consider this misclassification and the resulting potential for bias. These findings require confirmation in larger, more diverse samples, including adult patients.

中文翻译：

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作为儿科急诊科社会经济地位代理的保险类型评估：试点研究

学习目的

通过检查儿科患者样本中保险状况与直接社会经济状况指标之间的一致性，确定保险状况是否可以作为急诊医学研究中社会经济状况的充分代理。

方法

我们对四级护理儿童医院急诊科 5 至 17 岁的患者进行了一项横断面试点研究。社会经济地位通过看护者的最高教育水平（低：低于学士学位；高：学士或更高）和上一年家庭收入（低：<75,000 美元；高：≥75,000 美元）来衡量。我们以教育和收入为参考标准计算了保险状况的错误分类率（低：公共；高：私人）。结果以百分比表示，置信区间为 95%。

结果

总共招募了 300 名患者（中位年龄 11 岁，44% 为女性）。当使用护理人员教育和收入作为参考标准时，保险状况分别错误分类了 23%（95% CI 18% 至 28%）和 14%（95% CI 10% 至 19%）的患者。

结论

根据护理人员的教育程度和收入来衡量，高达 23% 的儿科患者的社会经济状况被保险状况错误分类。使用保险作为协变量来调整社会经济状况的儿科患者的急诊医学研究可能需要考虑这种错误分类以及由此产生的潜在偏差。这些发现需要在更大、更多样化的样本中得到证实，包括成年患者。