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Well-Child Visits and Immunization Encounters in South Carolina Medicaid: A 3-Year Retrospective Comparison Between
Farah Tahsin1, Leah Holcomb2, Elizabeth Charron3,4
1Department of Political Science, 2023 Barre Hall, Clemson University, Clemson, SC 29634, USA.
Insights
Rural children with neonatal opioid withdrawal syndrome (NOWS) in South Carolina had fewer well-child visits (WCVs) and immunizations. Interventions like telehealth and expanded Medicaid could improve care access for these vulnerable children.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Neonatal opioid withdrawal syndrome (NOWS) affects infants, requiring consistent healthcare.
- Access to regular well-child visits (WCVs) and immunizations is crucial for children's development.
- Disparities in healthcare access may exist between rural and urban populations, particularly for vulnerable children.
Purpose of the Study:
- To compare well-child visits (WCVs) and immunization encounters between rural and urban South Carolina Medicaid-enrolled children with NOWS from birth to age three.
- To examine the association between rural status and WCV adherence and immunization rates in this population.
Main Methods:
- Retrospective cohort study design.
- Analysis of South Carolina Medicaid data for children with NOWS born between 2006 and 2014.
- Application of logistic and Poisson regression models to assess differences in WCVs and immunizations based on geographic location (rural vs. urban).
Main Results:
- Rural children with NOWS had significantly fewer WCVs and immunization encounters compared to urban children across all age groups studied (birth to 35 months).
- Rural status was associated with decreased WCVs from birth to 23 months and lower WCV adherence from 12 to 23 months.
- Rural children experienced significantly lower rates of immunization encounters from birth to 35 months.
Conclusions:
- Rurality is a significant factor associated with reduced well-child visits and immunization rates among South Carolina children with a history of NOWS.
- Targeted policy interventions, such as expanding telehealth services and improving Medicaid access, are recommended to address these healthcare disparities.
- Improving access to preventive care is essential for the health outcomes of rural children with NOWS.
Abstract:
Background/Objectives: This retrospective cohort study compared well-child visits (WCVs) and immunization encounters from birth to age three among rural and urban South Carolina (SC) Medicaid-enrolled children with neonatal opioid withdrawal syndrome (NOWS). Methods: We applied logistic and Poisson regression models to examine associations between rural status and the number of WCVs, WCV adherence, and immunization encounters. Results: The sample included 833 urban and 161 rural children with NOWS born between 2006 and 2014. Significant differences existed between groups in the number of WCVs and immunization encounters each year from birth to age three (p = < 0.01 for all the comparisons). After covariate adjustment, rural compared to urban status was associated with decreased WCVs from birth to 11 months (incidence rate ratio (IRR): 0.85; 95% CI: 0.77-0.93) and 12 to 23 months (IRR: 0.80; 95% CI: 0.69-0.93). Rural status was not significantly associated with decreased WCVs from 24 to 35 months (IRR: 0.81; 95% CI: 0.63-1.03). Rural compared to urban status was associated with a 34% lower odds of WCV adherence from 12 to 23 months (odds ratio (OR): 0.66; 95% CI: 0.44-0.99). Furthermore, rural compared to urban status was associated with decreased immunization encounters from birth to 11 months (IRR: 0.60; 95% CI: 0.52-0.69), 12 to 23 months (IRR: 0.61; 95% CI: 0.50-0.71), and 24 to 35 months (IRR: 0.55; 95% CI: 0.40-0.76). Conclusions: Rurality was associated with decreased WCVs and immunization encounters among children with a history of NOWS residing in SC. Policy interventions, including telehealth services and expanded Medicaid access, could improve WCV and immunization rates among these children.
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