Table 4.
Multivariate Associations Between Child and Family Characteristics and Children’s Access to Health Care (2002–2007)
| Demographic and Other Characteristics | Child Health Insurance Coverage Gap aRR (95% CI) | No Doctor Visits in Past 12 Moa aRR (95% CI) | Child Dentist Visits <1/yb aRR (95% CI) | Unmet Medical or Prescription Needc aRR (95% CI) | Delayed Cared aRR (95% CI) | Problems Getting Caree aRR (95% CI) |
|---|---|---|---|---|---|---|
| Family USC patterns | ||||||
| USC: yes child/yes parent(s)f | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| USC: yes child/no parent | 1.33 (1.21–1.47)g | 1.11 (1.02–1.21)g | 1.12 (1.06–1.18)g | 1.70 (1.09–2.65)g | 1.00 (0.93–1.08) | 1.06 (0.91–1.23) |
| USC: no child/yes parent(s) | 2.15 (1.92–2.41)g | 2.19 (2.02–2.38)g | 1.40 (1.28–1.52)g | 1.63 (0.98–2.69) | 1.05 (0.91–1.21) | 1.65 (1.32–2.07)g |
| USC: no child/no parent | 2.82 (2.60–3.04)g | 2.35 (2.22–2.50)g | 1.38 (1.30–1.47)g | 2.00 (1.51–2.66)g | 1.19 (1.08–1.32)g | 1.70 (1.45–2.00)g |
| Household income group, % FPL | ||||||
| >400%f | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 200% - <400% | 1.57 (1.40–1.76)g | 1.47 (1.37–1.58)g | 1.26 (1.19–1.33)g | 1.91 (1.30–2.80)g | 1.03 (0.97–1.09) | 1.25 (1.11–1.41)g |
| 125% to <200% | 2.09 (1.86–2.35)g | 1.63 (1.49–1.77)g | 1.44 (1.34–1.55)g | 2.13 (1.51–3.01)g | 1.03 (0.95–1.11) | 1.31 (1.15–1.50)g |
| 100% to <125% | 2.05 (1.76–2.39)g | 1.66 (1.51–1.84)g | 1.42 (1.30–1.56)g | 2.32 (1.42–3.81)g | 1.07 (0.96–1.18) | 1.36 (1.12–1.64)g |
| <100% | 1.67 (1.47–1.91)g | 1.60 (1.46–1.75)g | 1.40 (1.30–1.51)g | 2.19 (1.50–3.20) g | 1.09 (1.00–1.19) | 1.50 (1.29–1.74)g |
| Child’s age, y | ||||||
| 0–4f | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 5–9 | 0.99 (0.92–1.06) | 2.12 (1.98–2.29)g | 0.22 (0.21–0.24)g | 1.38 (1.07–1.78)g | 1.03 (0.98–1.09) | 1.05 (0.96–1.16) |
| 10–13 | 1.05 (0.97–1.13) | 2.39 (2.20–2.58)g | 0.20 (0.19–0.22)g | 1.26 (0.90–1.76) | 1.04 (0.97–1.11) | 1.06 (0.94–1.19) |
| 14–17 | 1.06 (0.98–1.15) | 2.50 (2.32–2.69)g | 0.30 (0.28–0.32)g | 1.48 (1.06–2.07)g | 1.09 (1.02–1.16)g | 1.16 (1.04–1.30)g |
| Child’s race/ethnicity | ||||||
| White, non- Hispanicf | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Hispanic, any race | 1.34 (1.23–1.47)g | 1.17 (1.09–1.26)g | 0.99 (0.93–1.05) | 0.56 (0.40–0.78)g | 1.09 (1.01–1.17)g | 1.07 (0.96–1.18) |
| Nonwhite, non-Hispanic | 0.86 (0.77–0.95)g | 1.24 (1.16–1.32)g | 1.00 (0.95–1.05) | 0.74 (0.57–0.97)g | 1.04 (0.98–1.11) | 1.06 (0.94–1.19) |
| Family composition | ||||||
| 2 Parents in householdf | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 1 Parent in household | 1.09 (1.01–1.18)g | 0.92 (0.88–0.97)g | 1.04 (0.99–1.09) | 1.19 (0.92–1.54) | 1.07 (1.02–1.13) g | 1.03 (0.93–1.14) |
| At least 1 parent completed high school | ||||||
| Yesf | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| No | 1.14 (1.04–1.25)g | 1.22 (1.14–1.30)g | 1.19 (1.12–1.26)g | 0.82 (0.62–1.07) | 1.06 (0.99–1.14) | 0.87 (0.77–1.00) |
| Geographic residence | ||||||
| Northeast (reference group) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| West | 1.26 (1.10–1.44)g | 1.68 (1.48–1.90)g | 1.14 (1.04–1.24)g | 0.99 (0.64–1.52) | 1.31 (1.19–1.44)g | 1.10 (0.94–1.28) |
| South | 1.38 (1.21–1.57)g | 1.39 (1.23–1.57)g | 1.14 (1.05–1.23)g | 0.98 (0.70–1.36) | 1.12 (1.02–1.23)g | 0.93 (0.81–1.06) |
| Midwest | 1.13 (0.99–1.29) | 1.42 (1.25–1.61)g | 1.12 (1.02–1.22)g | 1.00 (0.70–1.43) | 1.19 (1.08–1.31)g | 0.90 (0.77–1.05) |
| Parent’s insurance status | ||||||
| Insured all year (at least 1)f | N/A | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Not insured all year | N/A | 1.03 (0.97–1.09) | 0.97 (0.91–1.03) | 1.14 (0.89–1.46) | 1.08 (1.01–1.15) | 1.11 (0.99–1.25) |
| Child’s insurance status | ||||||
| Insured all yearf | N/A | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Partial year insurance | N/A | 1.19 (1.11–1.27)g | 1.37 (1.29–1.45)g | 2.65 (2.11–3.33)g | 1.06 (0.99–1.14) | 1.28 (1.13–1.46)g |
| Full year uninsured | N/A | 1.47 (1.37–1.59)g | 1.80 (1.69–1.91)g | 3.47 (2.69–4.46)g | 1.00 (0.90–1.11) | 1.49 (1.29–1.73)g |
| Child health status | ||||||
| Excellent/very goodf | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Good/fair/poor | 1.03 (0.97–1.09) | 0.74 (0.70–0.79)g | 1.09 (1.05–1.14)g | 2.35 (1.87–2.96)g | 1.26 (1.19–1.32)g | 1.68 (1.54–1.83)g |
Source: 2002–2007 Medical Expenditure Panel Survey-Household Component.
aRR = adjusted risk ratio; FPL = federal poverty level; USC = usual source of care.
Yearly doctor visits were chosen as an unmet need variable because the American Academy of Pediatrics recommends yearly preventive pediatric health care visits up to age 21 years.32
American Academy of Pediatric Dentistry recommends yearly dental visits begin at time of first tooth and no later than 12 months of age.33
Unmet medical or prescription need was defined as being unable to get medical care and/or prescription medications when needed within the past year.
Delayed care was defined as parental report that child did not always get care as soon as was wanted for an illness, injury, or condition that needed care right away; or did not always get an appointment for routine health care as soon as was wanted.
Problems getting care was defined as parent reporting a big or small problem that the child did not receive needed medical or prescription treatment; a big or small problem to get the child care, tests, or treatment a parent or doctor believed necessary; or a big or small problem to see a specialist the child needed to see.
Reference group.
P <.05.