DeVoe Jennifer E, Tillotson Carrie, Wallace Lorraine S
Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, Mailcode FM, Portland, OR 97239, USA.
JAMA. 2008 Oct 22;300(16):1904-13. doi: 10.1001/jama.2008.516.
Millions of US children and adolescents lack health insurance coverage. Efforts to expand their insurance often focus on extending public coverage to uninsured parents. Less is known about the uninsured whose parents already have coverage.
To identify predictors of uninsurance among US children and adolescents with insured parents.
Cross-sectional and full-year analyses of pooled 2002-2005 data from the nationally representative Medical Expenditure Panel Survey (MEPS).
Children and adolescents younger than 19 years in 4 yearly MEPS files with positive full-year weights who had at least 1 parent residing in the same household. There were 39,588 in the unweighted cross-sectional analysis and 39,710 in the unweighted full-year analysis.
Prevalence of uninsurance among children and adolescents with at least 1 insured parent; predictors of uninsurance among children with at least 1 insured parent.
In the cross-sectional study population, 1380 of 39,588 children and adolescents were uninsured with at least 1 insured parent (weighted prevalence, 3.3%; 95% confidence interval [CI], 3.0%-3.6%). In multivariate analyses of children and adolescents with at least 1 insured parent, those uninsured were more likely Hispanic (odds ratio [OR], 1.58; 95% CI, 1.23-2.03) than white, non-Hispanic; low income (OR, 2.02; 95% CI, 1.42-2.88) and middle income (OR, 1.48; 95% CI, 1.09-2.03) than high income; from single-parent homes (OR, 1.99; 95% CI, 1.59-2.49) than from homes with 2 married parents; and living with parents who had less than a high school education (OR, 1.44; 95% CI, 1.10-1.89) than those with at least 1 parent who had completed high school. Those whose parents had public coverage were less likely to be uninsured (OR, 0.64; 95% CI, 0.43-0.96) than were those whose parents reported private health insurance. These predictors remained significant in full-year analyses. Similar patterns of vulnerability were also found among a subset of uninsured children with privately covered parents.
Among all US children, more than 3% were uninsured with at least 1 insured parent. Predictors of such uninsurance included having low and middle income. Having a parent covered by only public insurance was associated with better children's coverage rates.
数百万美国儿童和青少年缺乏医疗保险。扩大他们保险范围的努力通常集中在将公共保险范围扩大到未参保的父母身上。对于父母已有保险的未参保儿童，人们了解得较少。
确定父母有保险的美国儿童和青少年中未参保的预测因素。
对具有全国代表性的医疗支出小组调查（MEPS）2002 - 2005年汇总数据进行横断面和全年分析。
4份年度MEPS文件中19岁以下、全年权重为正且至少有1名父母居住在同一家庭的儿童和青少年。未加权横断面分析中有39588人，未加权全年分析中有39710人。
至少有1名参保父母的儿童和青少年中未参保的患病率；至少有1名参保父母的儿童中未参保的预测因素。
在横断面研究人群中，39588名儿童和青少年中有1380人父母至少有一方参保但自己未参保（加权患病率为3.3%；95%置信区间[CI]，3.0% - 3.6%）。在对至少有1名参保父母的儿童和青少年进行的多变量分析中，未参保者比非西班牙裔白人更可能是西班牙裔（优势比[OR]，1.58；95% CI，1.23 - 2.03）；与高收入者相比，低收入（OR，2.02；95% CI，1.42 - 2.88）和中等收入（OR，1.48；95% CI，1.09 - 2.03）者未参保的可能性更大；与有2名已婚父母的家庭相比，来自单亲家庭的儿童未参保的可能性更大（OR，1.99；95% CI，1.59 - 2.49）；与至少有1名父母完成高中学业的家庭相比，父母教育程度低于高中的儿童未参保的可能性更大（OR，1.44；95% CI，1.10 - 1.89）。父母有公共保险的儿童比父母有私人医疗保险的儿童未参保的可能性更小（OR，0.64；95% CI，0.43 - 0.96）。这些预测因素在全年分析中仍然显著。在父母有私人保险但未参保的儿童子集中也发现了类似的脆弱性模式。
在美国所有儿童中，超过3%的儿童父母至少有一方参保但自己未参保。这种未参保的预测因素包括低收入和中等收入。父母仅参加公共保险与儿童更高的参保率相关。
