Healthcare access and adverse family impact among U.S. children ages 0–5 years by prematurity status

Abstract

Background: Many children and their families are affected by premature birth. Yet, little is known about their healthcare access and adverse family impact during early childhood. This study aimed to (1) examine differences in healthcare access and adverse family impact among young children by prematurity status and (2) determine associations of healthcare access with adverse family impact among young children born prematurely. Methods: This was a secondary analysis of cross-sectional 2016 and 2017 National Survey of Children's Health data. The sample included 19,482 U.S. children ages 0-5 years including 242 very low birthweight (VLBW) and 2205 low birthweight and/or preterm (LBW/PTB) children. Prematurity status was defined by VLBW (i.e., < 1500 g at birth) and LBW/PTB (i.e., 1500-2499 g at birth and/or born at < 37 weeks with or without LBW). Healthcare access measures were adequate health insurance, access to medical home, and developmental screening receipt. Adverse family impact measures were ≥ $1000 in annual out-of-pocket medical costs, having a parent cutback or stop work, parental aggravation, maternal health not excellent, and paternal health not excellent. The relative risk of each healthcare access and adverse family impact measure was computed by prematurity status. Propensity weighted models were fit to estimate the average treatment effect of each healthcare access measure on each adverse family impact measure among children born prematurely (i.e., VLBW or LBW/PTB). Results: Bivariate analysis results showed that VLBW and/or LBW/PTB children generally fared worse than other children in terms of medical home, having a parent cutback or stop working, parental aggravation, and paternal health. Multivariable analysis results only showed, however, that VLBW children had a significantly higher risk than other children of having a parent cutback or stop work. Adequate health insurance and medical home were each associated with reduced adjusted relative risk of ≥$1000 in annual out-of-pocket costs, having a parent cutback or stop work, and parental aggravation among children born prematurely. Conclusions: This study's findings demonstrate better healthcare access is associated with reduced adverse family impact among U.S. children ages 0-5 years born prematurely. Population health initiatives should target children born prematurely and their families.

Factors Contributing to the Health of 0- to 5-Year-Old Low-Birth-Weight Children in the United States: Application of the Multiple Disadvantage Model

“…Moreover, close examination of the data revealed that child chronic health condition(s)' interaction terms with family income at or below 100% of the FPL (OR = 0.09, p < 0.05) and family income at 101-200% of the FPL (OR = 4.37 × 10 −7 , p < 0.01) yielded strongly negative associations with child health, implying low-birth-weight children with chronic conditions in low-income families would have an escalated risk of poor/fair health. On the other hand, although the present study's finding on the insignificant impact of parent's employment status was contrary to the result of a prior study [27], another close examination of the data showed that the interaction term between parent employment and family income at 101-200% of the FPL (OR = 17.15, p < 0.05) had a strong positive association with low-birth-weight children's likelihood of "excellent/very good/good" health. In other words, parent's full employment did help low-birth-weight children gain good health among many low-income families.…”

“…While this study found low-birth-weight children who were Black to be 95% less likely than low-birth-weight White children to have "excellent/very good/good" health, other low-birth-weight children from racial/ethnic minorities had no significant health difference with low-birth-weight White children. Moreover, consistent with the results of a prior study [27], the present study demonstrated that parents' low education and having a family income at or below 100% of the FPL significantly reduced low-birth-weight children's likelihood of "excellent/very good/good" health. Moreover, close examination of the data revealed that child chronic health condition(s)' interaction terms with family income at or below 100% of the FPL (OR = 0.09, p < 0.05) and family income at 101-200% of the FPL (OR = 4.37 × 10 −7 , p < 0.01) yielded strongly negative associations with child health, implying low-birth-weight children with chronic conditions in low-income families would have an escalated risk of poor/fair health.…”

“…In fact, within the first two years of life among low-birth-weight children, children from racial/ethnic minorities have a greater risk of death than White children have [25]. Other social structural factors-parents' low education, under-employment, and low income-also heighten the risk of lowbirth-weight infants' mortality [24,26] and low-birth-weight children's poor health within their first five years of life [27]. For low-income families who cannot afford sufficient food, their low-birth-weight infants' mortality risk is escalated [28].…”

“…Without social support, single-motherhood is likely to increase the risk of low-birth-weight infants' mortality [26]. Furthermore, many low-birth-weight children have chronic conditions (e.g., asthma, poor cholesterol and blood pressure levels, and developmental delays) [27,34,35] that require constant parental attention and may generate parental distress. Also, low-birth-weight children tend to have negative affect and difficulties in social interactions [36,37]; consequently, many parents have difficulties in communicating with their low-birth-weight children and react with negative parenting behaviors [38].…”

“…A lack of health insurance coverage is the fifth socioeconomic disadvantage affecting families with low-birth-weight children. Low-birth-weight children are more likely than other children to be covered by public health insurance [27]. Medicaid and Children's Health Insurance Program (CHIP) are two public health insurance programs in the U.S.…”