Table 4.

Adjusted Associations of Child-, Parent-, Household-, and County-Level Characteristics With Indicators of Unmet Health Care Needs

Characteristic^{^a}	Forgone Care, APR (95% CI)	Forgone Vaccinations or Well-Child Visits, APR (95% CI)	No Well-Child Visit or Vaccine-Related Visit, APR (95% CI)
Child level
Age group
5-8 years	Ref	Ref	Ref
9-12 years	1.2 (0.9-1.6)	1.3 (0.9-1.9)	1.2 (1.0-1.5)
Sex
Male	Ref	Ref	Ref
Female	0.8 (0.6-1.1)	0.9 (0.6-1.4)	1.0 (0.8-1.2)
Race/ethnicity
Non-Hispanic White	Ref	Ref	Ref
Non-Hispanic Black	1.1 (0.6-1.9)	1.1 (0.5-2.2)	1.1 (0.8-1.5)
Hispanic	1.6 (1.1-2.3)	1.8 (1.1-2.9)	1.0 (0.7-1.4)
Non-Hispanic other race or multiracial	1.7 (1.1-2.6)	2.4 (1.5-3.9)	0.9 (0.7-1.2)
Existing emotional, mental, developmental, behavioral condition
Yes	2.1 (1.5-2.8)	1.5 (0.9-2.3)	0.6 (0.5-0.9)
No	Ref	Ref	Ref
Existing physical condition
Yes	2.4 (1.6-3.5)	1.6 (1.1-2.6)	0.6 (0.4-0.9)
No	Ref	Ref	Ref
Child covered by health insurance
Yes	1.3 (0.6-2.7)	1.7 (0.7-4.5)	0.6 (0.4-0.9)
No	Ref	Ref	Ref
Experienced racism
Yes	2.7 (2.0-3.6)	2.1 (1.3-3.5)	1.0 (0.7-1.6)
No	Ref	Ref	Ref
Mode of school instruction
In-person full time or hybrid	0.7 (0.5-1.0)	0.7 (0.5-1.0)	1.1 (0.9-1.4)
Virtual full time	Ref	Ref	Ref
Parent^b and household level
Age group
18-29 years	1.6 (1.0-2.6)	1.5 (0.8-2.9)	0.8 (0.5-1.3)
30-44 years	Ref	Ref	Ref
45-59 years	1.2 (0.8-1.8)	1.3 (0.8-2.2)	1.1 (0.8-1.5)
≥60 years	1.9 (0.8-4.2)	1.4 (0.4-4.9)	0.6 (0.3-1.4)
Sex
Male	0.8 (0.6-1.1)	1.0 (0.7-1.5)	1.1 (0.9-1.3)
Female	Ref	Ref	Ref
Race/ethnicity
Non-Hispanic White	Ref	Ref	Ref
Non-Hispanic Black	1.2 (0.5-2.8)	0.9 (0.3-2.2)	0.8 (0.4-1.7)
Hispanic	1.1 (0.6-1.8)	1.2 (0.6-2.4)	0.6 (0.4-0.9)
Non-Hispanic other race or multiracial	1.3 (0.7-2.3)	1.4 (0.7-2.8)	0.8 (0.5-1.3)
Experienced childcare challenges
Often/sometimes	1.9 (1.4-2.5)	1.6 (1.1-2.4)	0.7 (0.6-0.9)
Rarely/never	Ref	Ref	Ref
Household income
<$30,000	1.2 (0.7-2.0)	0.9 (0.4-1.8)	1.3 (0.9-1.8)
$30,000 to <$60,000	1.3 (0.8-2.0)	1.1 (0.7-1.9)	1.4 (1.1-1.8)
$60,000 to <$100,000	0.9 (0.5-1.4)	0.8 (0.4-1.5)	1.4 (1.1-1.9)
≥$100,000	Ref	Ref	Ref
County level
Ratio of population to primary care physicians
Q1 (greatest access)	Ref	Ref	Ref
Q2	1.1 (0.8-1.7)	1.1 (0.7-1.7)	1.3 (1.0-1.7)
Q3	1.0 (0.6-1.9)	1.4 (0.7-2.7)	1.4 (1.1-1.8)
Q4 (least access)	1.3 (0.8-2.1)	1.0 (0.4-2.5)	1.3 (0.9-1.9)
Urban-rural classification
Urban	0.9 (0.6-1.3)	0.9 (0.5-1.4)	1.3 (1.0-1.8)
Suburban	Ref	Ref	Ref
Rural	0.8 (0.6-1.1)	0.6 (0.4-0.9)	1.7 (1.3-2.2)
Residential segregation – Black:White index
Q1 (least segregation)	1.2 (0.7-2.0)	1.2 (0.6-2.5)	1.2 (0.8-1.7)
Q2	1.3 (0.9-1.9)	1.2 (0.7-2.1)	0.8 (0.6-1.1)
Q3	1.3 (0.9-1.9)	1.4 (0.8-2.3)	0.7 (0.5-0.9)
Q4 (most segregation)	Ref	Ref	Ref
Percent of people younger than age 18 years in poverty
Q1 (least poverty)	Ref	Ref	Ref
Q2	1.2 (0.8-1.8)	1.3 (0.8-2.0)	0.9 (0.7-1.2)
Q3	1.2 (0.9-1.8)	0.9 (0.6-1.6)	1.0 (0.7-1.3)
Q4 (most poverty)	0.9 (0.5-1.5)	0.5 (0.2-1.2)	1.2 (0.8-1.9)
Percent of children younger than age 19 years without health insurance
Q1 (least uninsured)	Ref	Ref	Ref
Q2	0.8 (0.6-1.2)	0.8 (0.5-1.3)	1.0 (0.7-1.3)
Q3	0.8 (0.5-1.2)	0.9 (0.5-1.7)	1.1 (0.9-1.4)
Q4 (most uninsured)	1.1 (0.7-1.7)	0.8 (0.4-1.7)	1.0 (0.7-1.4)
Percent of inpatient beds occupied
Q1 (least occupancy)	0.9 (0.4-1.8)	0.7 (0.3-1.9)	1.4 (1.0-2.0)
Q2	0.9 (0.5-1.5)	0.6 (0.3-1.1)	1.4 (1.0-1.9)
Q3	1.0 (0.7-1.6)	0.9 (0.5-1.6)	1.1 (0.8-1.5)
Q4 (greatest occupancy)	Ref	Ref	Ref

APR = adjusted prevalence ratio; Q1 = quartile 1; Q2 = quartile 2; Q3= quartile 3; Q4 = quartile 4.
↵a See Supplemental Table 1 for details regarding measures, survey questions, data sources, and operationalization for all characteristics and indictors of unmet health care needs.
b For the parent who completed the survey.
Notes: We fit separate weighted logistic regression models using predicted marginal standardization to examine associations of each selected independent variable with each of the 3 indicators of unmet health care needs while adjusting for age, sex, and race/ethnicity of the child. See Table 1 for indicator definitions.