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Published on: June 20, 2020
Income and Household Material Hardship in Children With Medical Complexity
S Margaret Wright1, Isabella Zaniletti2, Emily J Goodwin1
1Division of General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri.
Insights
Household economic hardship affects children
Area of Science:
- Pediatric Health
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Household economic hardship negatively impacts child health.
- Income alone may not fully capture economic hardship.
- Household material hardship (HMH) is a key indicator of economic strain.
Purpose of the Study:
- Determine the prevalence of HMH in children with medical complexity.
- Examine the relationship between household poverty and HMH.
- Assess if income adequately reflects economic hardship in this population.
Main Methods:
- Cross-sectional survey of parents of children with medical complexity.
- Income measured as a percentage of the federal poverty limit (FPL).
- HMH assessed via food, housing, and energy insecurity; logistic regression used.
Main Results:
- 40.9% of participants experienced at least one material hardship.
- Families below 100% FPL had significantly higher odds of HMH (OR ~1.73).
- Even families above 100% FPL experienced material hardship (28.2%).
Conclusions:
- Poverty metrics underestimate the extent of household economic hardship.
- HMH is prevalent across income levels, including higher FPL groups.
- Material hardship is a critical factor in child health outcomes.
Background And Objectives:
Household economic hardship negatively impacts child health but may not be adequately captured by income. We sought to determine the prevalence of household material hardship (HMH), a measure of household economic hardship, and to examine the relationship between household poverty and material hardship in a population of children with medical complexity.
Methods:
We conducted a cross-sectional survey study of parents of children with medical complexity receiving primary care at a tertiary children's hospital. Our main predictor was household income as a percentage of the federal poverty limit (FPL): <50% FPL, 51% to 100% FPL, and >100% FPL. Our outcome was HMH measured as food, housing, and energy insecurity. We performed logistic regression models to calculate adjusted odds ratios of having ≥1 HMH, adjusted for patient and clinical characteristics from surveys and the Pediatric Health Information System.
Results:
At least 1 material hardship was present in 40.9% of participants and 28.2% of the highest FPL group. Families with incomes <50% FPL and 51% to 100% FPL had ∼75% higher odds of having ≥1 material hardship compared with those with >100% FPL (<50% FPL: odds ratio 1.74 [95% confidence interval: 1.11-2.73], P = .02; 51% to 100% FPL: 1.73 [95% confidence interval: 1.09-2.73], P = .02).
Conclusions:
Poverty underestimated household economic hardship. Although households with incomes <100% FPL had higher odds of having ≥1 material hardship, one-quarter of families in the highest FPL group also had ≥1 material hardship.
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