Beyond income: material hardship and the health and healthcare of premature children

Abstract

Objectives: To estimate national prevalence of household hardships (food insu ciency, nancial hardship, and di culty paying medical bills) among children born term and preterm; and examine associations of household hardships with preterm children's overall health status, emergency room visits, and unmet healthcare needs.Methods: We studied 24,026 children aged 0-3 years born term, preterm with moderately low birth weight (1501-2499 grams) and preterm with very low birth weight (VLBW; ≤1,500 grams). Using propensity score matching to control for correlates of poverty, we examined associations of hardships and child outcomes.Results: Compared with term, households with preterm VLBW children had >2-fold higher odds of nancial hardship (aOR:2.63; 95%CI: 1.26-5.46) and >5-fold higher odds of di culty paying bills (aOR:5.60; 95%CI: 2.35-10.35). Matching for demographics, special healthcare needs, income and receipt of public bene ts, hardships were independently associated with adverse preterm children's outcomes.Conclusions: Addressing household hardships is needed to optimize preterm child outcomes.a Reference group is lack of household material hardships b Covariates included in the propensity score regression model were child age, sex, special health care need status, race and ethnicity, insurance type, caregiver education and employment, household income, primary language, family structure, food and cash assistance. Matched 1:1.

“We Don't Want to Screen for the Sake of Screening”

“…We identified contextual factors, concrete messaging, and training procedures that may inform implementation of SDH screening and referral in NICU settings. Key Words: neonatal intensive care unit, social determinants of health screening P reterm birth occurs disproportionally among families living in poverty or near poverty 1 ; and families of preterm infants are more likely to experience adverse social determinants of health (SDH), such as food or housing insecurity, compared with families of infants born at term. 1,2 The detrimental effects of SDH on children's health and development are amplified for preterm infants requiring intensive care due to their already significant risk for chronic morbidities and developmental disabilities.…”

“…Key Words: neonatal intensive care unit, social determinants of health screening P reterm birth occurs disproportionally among families living in poverty or near poverty 1 ; and families of preterm infants are more likely to experience adverse social determinants of health (SDH), such as food or housing insecurity, compared with families of infants born at term. 1,2 The detrimental effects of SDH on children's health and development are amplified for preterm infants requiring intensive care due to their already significant risk for chronic morbidities and developmental disabilities. 2 SDH screening and resource referral interventions have proven to be effective in increasing caregiver's receipt of community resources to address adverse SDH.…”