Department of Pediatrics, School of Medicine, and
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2018-1704. Epub 2019 Jul 10.
Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs.
Cross-sectional surveys (2013-2017) in English and Spanish of caregivers with children <4 years old were conducted at 5 hospitals. The children with SHCN screener and caregiver report of child Supplemental Security Income (SSI) receipt were used to categorize children into the following groups: (1) no SHCNs, (2) SHCNs and no SSI, or (3) SHCNs and receiving SSI. Housing instability was determined by positive endorsement of ≥1 adverse circumstance: behind on rent or mortgage, or moving twice or more in the past year, or homelessness in the child's lifetime. Analyses used multivariable logistic regression models, adjusting for demographics and housing subsidies.
Of 14 188 children, 80% had no SHCNs, 16% had SHCNs and no SSI, and 4% had SHCNs and received SSI. Compared with the no-SHCNs group, the SHCNs-no-SSI group but not the SHCN-receiving-SSI group experienced significantly greater adjusted odds of being behind on rent or mortgage (adjusted odds ratio [aOR] 1.28 [95% confidence interval (CI) 1.14-1.44]; < .001), multiple moves (aOR 1.29 [95% CI 1.05-1.59]; = .01), and homelessness (aOR 1.44 [95% CI 1.20-1.72]; < .001).
Families of children with SHCNs are at risk for housing instability. Child SSI receipt decreased the risk of housing instability among families of children with SHCNs. Protecting families of young children with SHCNs from housing instability is an important investment.
有特殊医疗保健需求的儿童（SHCN）有大量医疗和教育费用，影响家庭财务。住房不稳定可能对家庭福祉有害。我们的目的是评估有和没有 SHCN 的儿童家庭的住房不稳定情况。
2013 年至 2017 年，在 5 家医院用英语和西班牙语对 4 岁以下儿童的看护者进行了横断面调查。使用儿童 SHCN 筛查器和看护者报告的儿童补充保障收入（SSI）领取情况，将儿童分为以下几组：（1）无 SHCNs，（2）SHCNs 且无 SSI，或（3）SHCNs 且领取 SSI。通过积极认可≥1 种不利情况来确定住房不稳定：拖欠租金或抵押贷款，或过去一年搬了两次或更多次，或孩子一生中有过无家可归的经历。分析使用多变量逻辑回归模型，调整人口统计学和住房补贴因素。
在 14188 名儿童中，80%无 SHCNs，16%有 SHCNs 且无 SSI，4%有 SHCNs 且领取 SSI。与无 SHCNs 组相比，SHCNs-无-SSI 组而非 SHCNs-领取-SSI 组经历了更大的调整后的拖欠租金或抵押贷款的可能性（调整后的优势比 [aOR] 1.28 [95%置信区间（CI）1.14-1.44]；<0.001）、多次搬迁（aOR 1.29 [95%CI 1.05-1.59]；=0.01）和无家可归（aOR 1.44 [95%CI 1.20-1.72]；<0.001）。
SHCN 儿童的家庭面临住房不稳定的风险。儿童 SSI 领取减少了 SHCN 儿童家庭住房不稳定的风险。保护有 SHCN 的幼儿家庭免受住房不稳定的影响是一项重要的投资。
