Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore (AE Fuller, NM Brown, L Grado, and SO Oyeku), Bronx, NY; Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center (RS Gross), New York, NY.
Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore (AE Fuller, NM Brown, L Grado, and SO Oyeku), Bronx, NY.
Acad Pediatr. 2019 Sep-Oct;19(7):733-739. doi: 10.1016/j.acap.2019.01.009. Epub 2019 Mar 8.
Material hardships, defined as difficulty meeting basic needs, are associated with adverse child health outcomes, including suboptimal health care utilization. Children with special health care needs (CSHCN) may be more vulnerable to the effects of hardships. Our objective was to determine associations between material hardships and health care utilization among CSHCN.
We conducted a cross-sectional study surveying caregivers of 2- to 12-year-old CSHCN in a low-income, urban area. Independent variables were parent-reported material hardships: difficulty paying bills, food insecurity, housing insecurity, and health care hardship. Dependent variables were parent-reported number of emergency department (ED) visits, any hospital admission, and any unmet health care need. We used negative binomial and logistic regression to assess for associations between each hardship and each outcome.
We surveyed 205 caregivers between July 2017 and May 2018 and analyzed the data in 2018. After adjustment, difficulty paying bills (incidence rate ratio [IRR], 1.51; 95% confidence interval [CI], 1.08-2.12) and health care hardship (IRR, 1.72; 95% CI, 1.08-2.75) were associated with higher rates of ED visits. There were no associations between hardships and hospital admission. Difficulty paying bills (adjusted odds ratio [AOR], 2.13; 95% CI, 1.14-3.98), food insecurity (AOR, 1.95; 95% CI, 1.02-3.71), and housing insecurity (AOR, 2.71; 95% CI, 1.36-5.40) were associated with higher odds of unmet health care need.
Material hardships were associated with higher rates of ED visits and greater unmet health care need among low-income CSHCN. Future examination of the mechanisms of these associations is needed to enhance support for families of CSHCN.
物质困难是指难以满足基本需求，与儿童健康不良后果有关，包括医疗保健利用不足。有特殊医疗需求的儿童（CSHCN）可能更容易受到困难的影响。我们的目的是确定物质困难与 CSHCN 医疗保健利用之间的关联。
我们对低收入城市地区 2 至 12 岁 CSHCN 的照顾者进行了横断面研究。自变量是父母报告的物质困难：账单支付困难、粮食不安全、住房不安全和医疗保健困难。因变量是父母报告的急诊部（ED）就诊次数、任何住院和任何未满足的医疗需求。我们使用负二项和逻辑回归来评估每种困难与每种结果之间的关联。
我们在 2017 年 7 月至 2018 年 5 月期间调查了 205 名照顾者，并于 2018 年分析了数据。调整后，账单支付困难（发病率比 [IRR]，1.51；95%置信区间 [CI]，1.08-2.12）和医疗保健困难（IRR，1.72；95%CI，1.08-2.75）与 ED 就诊率较高相关。困难与住院无关联。账单支付困难（调整优势比 [AOR]，2.13；95%CI，1.14-3.98）、粮食不安全（AOR，1.95；95%CI，1.02-3.71）和住房不安全（AOR，2.71；95%CI，1.36-5.40）与未满足的医疗保健需求的可能性较高相关。
物质困难与低收入 CSHCN 的 ED 就诊率较高和未满足的医疗保健需求较高有关。需要进一步研究这些关联的机制，以加强对 CSHCN 家庭的支持。
