670 - Health, Resource Use, and Social Needs in Immigrant Children with Special Healthcare Needs Living in Poverty
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 670 Publication Number: 670.318
Marina Masciale, Baylor College of Medicine, Houston, TX, United States; Todd Leroux, Stonewall Analytics, Palmer, AK, United States; Michelle Lopez, Baylor College of Medicine, Houston, TX, United States; Hye-Chung Kum, The Texas A&M University, College Station, TX, United States
Assistant Professor of Pediatrics Baylor College of Medicine Houston, Texas, United States
Background: Children with special health care needs (CSHCN) account for majority of pediatric healthcare expenditures. Little data describes healthcare needs and resource use among CSHCN from low-income immigrant families. Objective: To describe healthcare status, access to care, and social needs in CSHCN from low income households by generational status and whether generation is associated with resource use. Design/Methods: This was a retrospective cross-sectional study using the National Survey of Children’s Health including CSHCN < 18 years with household income < 200% of the federal poverty level from 2018-2020. We compared demographics, healthcare access, and social needs across generation (gen). First gen children are born in a country outside of the United States (US), second gen children are born in the US with a foreign-born caregiver, and third gen children and their caregivers are born in the US. Outcomes were 1 or more emergency room (ER) visit and 1 or more hospital admission. Adjusted Wald Chi-square tests calculated differences across gen. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using logistic regression. Results: 6565 CSHCN were included (117 1st gen, 756 2nd gen, and 5692 3rd gen). Table 1 shows demographics, healthcare needs, and social needs across gen. 11% of 1st gen), 4% of 2nd gen, and 5% of 3rd gen were uninsured (p< 0.001). 11% of 1st and 2nd gen children had “fair or poor” health, compared to 9% of 3rd gen (p< 0.05). 15% of 1st gen children had a medical home, compared to 29% 2nd gen and 36% 3rd gen (p< 0.01). 41% of 1st gen caregivers left a job/cut hours due to child healthcare needs, compared to 30% of 2nd gen and 22% of 3rd gen (p< 0.05). There were no differences in ER visits or hospitalizations across groups. When controlling for other factors, gen was not associated with ER visits or hospitalizations. “Fair or poor health status” (OR 2.9; CI: 1.1,7.4), transportation difficulty (OR 2.0; CI: 0.9,4.0), and lack of medical home (OR 4.2; CI 1.1,15.0) were associated with ER visits. Hispanic had higher odds of admission compared to White CSHCN (OR 4.1; CI: 1.2,14.0).
Conclusion(s): Compared to 2nd and 3rd gen CSHCN living in poverty, 1st gen CSHCN have higher uninsured rates and are less connected to medical homes. Generational status alone was not associated with ER visits or hospitalizations. However, Hispanic ethnicity was associated with increased hospitalizations. Further work is needed to understand whether additional factors such as bias, mistrust, or communication may contribute to worse outcomes for Hispanic CSHCN from low income households.
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