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.
↵a 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
↵b American Academy of Pediatric Dentistry recommends yearly dental visits begin at time of first tooth and no later than 12 months of age.33
↵c Unmet medical or prescription need was defined as being unable to get medical care and/or prescription medications when needed within the past year.
↵d 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.
↵e 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.
↵f Reference group.
↵g P <.05.