Health Care Use by Immigrant Generation in Low-Income Children With Special Health Care Needs

We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.

This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children's Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.

We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child's health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.

Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.