Family Income Gradients in the Health and Health Care Access of US Children

Abstract

This study sought to examine the shape and magnitude of family income gradients in US children’s health, access to care, and use of services. We analyzed cross-sectional data from the 2003 National Survey of Children’s Health, a telephone survey of 102,353 parents of children aged 0–17 years. Associations between family income [Below 100% Federal Poverty Level (FPL), 100–199% FPL, 200–299% FPL, 300–399% FPL, 400% FPL or Greater] and a set of 32 health and health care indicators were examined using linear polynomial testing and multivariate logistic regression. The percentage of children in better health increased with family income for 15 health outcomes. In multivariate logistic regression models that controlled for health insurance coverage and socio-demographic confounders, odds ratios >2 comparing the lowest to the highest income groups were noted for health conditions across both physical and developmental domains (diabetes, headaches, ear infections, learning disabilities, behavior/conduct problems, speech problems). Parent-reported global child health status, activity limitation, and oral health status showed steeper gradients than specific chronic and acute conditions. Ten measures of health care access and utilization were associated with family income in multivariate logistic regression models. Income gradients are pervasive across many health indicators at an early age. Social and health policy interventions are needed to address the multitude of factors that can affect children’s health and initiate disparities in development.

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

“…Research has confirmed this finding with recent studies demonstrating that poverty, and the unmet basic needs that result from it, results in greater susceptibility to disease and poorer health across the life span. [3][4][5][6]23,[28][29][30][31][32][33][34][36][37][38] Despite numerous leaders in the field advocating for addressing social needs as part of primary care [9][10][11][12]39 and professional guidelines emphasizing the need to address social determinants, [13][14][15][16][17] there has been little evidence to help guide this practice. 27,40 A previous study by our group demonstrated that a similar system can lead to more discussion and referrals for family psychosocial problems by pediatric trainees.…”

“…2 Children raised in poverty experience poorer health than children from more advantaged backgrounds and commonly face unmet basic needs such as food security, stable housing, or an adequately heated home. [3][4][5][6][7][8] For decades, leaders in the field of pediatrics have argued that addressing a child's social needs falls within the purview of the child health provider. [9][10][11][12] Numerous American Academy of Pediatrics policy statements and Bright Futures health supervision guidelines support this view and have been published in an effort to reinforce this practice.…”

Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting

“…It is evident that there is a strong gradient effect of social risk factors on child well-being; as social risk factors increase in number, so does the risk for poor mental health. 14,15 This gradient is also seen specifically in the following relationship between family income and child health; increases in family income are associated with a corresponding increase in child physical health, behavioral health, development, and health care access and utilization. 14 Thus, children from families across the spectrum of lower income levels incur some risk for adverse health outcomes, with children from families facing the greatest poverty experiencing the greatest risk.…”

Rigor, vigor, and the study of health disparities

“…Although some health problems emanate from genetic vulnerabilities or random exposures or events, childhood health is also a function of parental SES (18). Rates of many childhood illnesses (e.g., asthma, ear infections, injury, respiratory infections, conduct problems) increase as family SES decreases (4,19), and effects of parental SES can be seen early in life. Children of low-SES parents are more likely to be born prematurely and to have low birth weight, even after adjusting for covariates (20,21).…”