TABLE 3.
Factors Associated With Child Underinsurance (Lacking Continuous and Adequate Insurance Coverage)
| Characteristic | Child Underinsurance | ||
|---|---|---|---|
| Change From 2016 to 2019, % (95% CI) | Pooled 2016–2019, No. (% [95% CI])a | Likelihood, aOR (95% CI)b | |
| Overall Sample | +3.4 (1.9 to 4.9) | 23 652 955 (32.4 [31.8 to 33.0]) | |
| Child health complexity | *** | ||
| Non-CSHCN | +3.1 (1.4 to 4.8) | 18 561 908 (31.4 [30.7 to 32.0]) | Reference |
| Less complex CSHCN | +3.3 (−2.3 to 8.9) | 1 298 337 (32.2 [30.2 to 34.3]) | 1.2 (1.1 to 1.3) |
| More complex CSHCN | +5.1 (1.4 to 8.9) | 3 792 137 (38.9 [37.4 to 40.5]) | 1.9 (1.8 to 2.1) |
| Insurance type | *** | ||
| Public | +1.3 (−1.0 to 3.7) | 3 394 549 (15.3 [14.4 to 16.3]) | Reference |
| Private | +3.3 (1.6 to 5.0) | 14 279 667 (34.2 [33.6 to 34.9]) | 3.5 (3.1 to 3.9) |
| Public and private | +1.6 (−6.1 to 9.4) | 1 014 992 (30.9 [27.9 to 33.9]) | 2.3 (2.0 to 2.8) |
| Household income (% FPL) | *** | ||
| ≥400 | +3.7 (1.5 to 6.0) | 7 132 686 (31.8 [30.9 to 32.6]) | Reference |
| <100 | +1.2 (−2.8 to 5.2) | 4 150 718 (28.0 [26.4 to 29.6]) | 1.3 (1.1 to 1.4) |
| 100–199 | +1.3 (−2.1 to 4.8) | 4 954 796 (31.0 [29.6 to 32.4]) | 1.3 (1.2 to 1.5) |
| 200–399 | +5.4 (2.6 to 8.2) | 7 528 798 (37.5 [36.4 to 38.5]) | 1.4 (1.3 to 1.5) |
| Child age, y | *** | ||
| 0 − 5 | +3.9 (1.3 to 6.5) | 6 691 866 (28.4 [27.5 to 29.4]) | Reference |
| 6 − 11 | +1.9 (−0.8 to 4.6) | 8 096 995 (32.9 [31.9 to 33.9]) | 1.1 (1.1 to 1.2) |
| 12 − 17 | +4.3 (1.8 to 6.8) | 8 863 521 (35.7 [34.8 to 36.7]) | 1.2 (1.1 to 1.3) |
| Sex | P = .85 | ||
| Male | +3.3 (1.3 to 5.4) | 12 103 123 (32.5 [31.7 to 33.3]) | — |
| Female | +3.4 (1.3 to 5.6) | 11 549 259 (32.4 [31.5 to 33.2]) | — |
| Child race and ethnicity | *** | ||
| White, non−Hispanic | +4.0 (2.5 to 5.5) | 12 272 596 (33.0 [32.4 to 33.6]) | Reference |
| Hispanic | +2.7 (−1.5 to 7.0) | 6 212 872 (33.9 [32.3 to 35.6]) | 1.1 (1.0 to 1.3) |
| Black, non−Hispanic | +0.3 (−3.8 to 4.4) | 2 670 412 (27.8 [26.2 to 29.5]) | 0.9 (0.8 to 1.0) |
| Other/multiracial | +5.8 (1.9 to 9.7) | 2 496 502 (31.6 [30.2 to 33.1]) | 1.0 (0.9 to 1.0) |
| Child born in the United States | *** | ||
| Yes | +3.6 (2.1 to 5.1) | 22 217 145 (31.9 [31.3 to 32.5]) | Reference |
| No | −1.1 (−10.0 to 7.8) | 1 284 377 (43.5 [40.3 to 46.9]) | 1.3 (1.1 to 1.5) |
| Family structure | *** | ||
| Two parents, married | +2.9 (1.1 to 4.6) | 15 727 591 (33.8 [33.1 to 34.5]) | Reference |
| Two parents, not married | +4.9 (−1.0 to 10.8) | 1 873 560 (30.1 [28.0 to 32.3]) | 1.0 (0.9 to 1.2) |
| Single parent | +4.0 (0.5 to 7.5) | 4 169 834 (31.0 [29.7 to 32.4]) | 1.1 (1.0 to 1.2) |
| Grandparent | c | 497 346 (22.6 [19.4 to 26.2]) | 0.7 (0.5 to 0.9) |
| Other | +12.5 (−0.3 to 25.3) | 720 372 (28.4 [25.3 to 31.6]) | 0.9 (0.8 to 1.1) |
| Highest parental educational attainment | *** | ||
| College or more | +4.5 (2.8 to 6.3) | 11 848 484 (33.1 [32.5 to 33.8]) | Reference |
| Less than high school | +6.5 (−1.6 to 14.5) | 2 387 649 (36.0 [33.0 to 39.1]) | 1.0 (0.8 to 1.2) |
| High school | +0.9 (−2.8 to 4.5) | 4 097 081 (29.4 [27.9 to 30.9]) | 1.0 (0.9 to 1.1) |
| Some college | +1.2 (−1.8 to 4.2) | 5 141 484 (32.1 [31.0 to 33.2]) | 1.1 (1.0 to 1.1) |
Row percentages unless otherwise noted. aOR, adjusted odds ratio; —, not applicable.
a
χ2 analysis.
b
Multivariable logistic regression analysis adjusted for all variables included in the final model.
c
Unable to trend grandparent-led household because this response option was not included in the 2016 survey.
***
p<.001