330 - Socioeconomic Adversity and Quality of Care for U.S. Children

Poster Number: 330
Publication Number: 330.1831

Background: Children living with socioeconomic adversity such as food insecurity or housing instability often have worse health outcomes. Increasing focus on integration of social and medical care aims to better address unmet basic needs; however, few national studies have examined socioeconomic inequities in child health outcomes using self-reported information on social hardships.

Objective: To examine associations between socioeconomic adversity and the quality of primary and chronic illness care for U.S. children.

Design/Methods: We conducted a retrospective study of 11,758 nationally representative U.S. households with children (1-17 years) appearing in the 2021 Medical Expenditure Panel Survey, a population-based sample of U.S. households. Socioeconomic adversity was defined as the presence of either food, housing, transportation, or utility insecurity in the past 12 months as reported by the parent/caregiver using questions from the CMS Accountable Health Communities instrument. Main outcomes were ten quality measures of primary care, dental care, immunization, chronic illness, emergency department (ED) use and experience of care. We used multivariable regression to examine associations between socioeconomic adversity and outcomes while adjusting for individual and household covariates.

Results: One-third (33.1%) of U.S. households with children reported any socioeconomic adversity and 17.2% reported multiple hardships. Food insecurity (23.5%) was most commonly experienced followed by utility (18.7%), housing (14.7%), and transportation (5%) insecurity. Black race [adjusted Odds Ratio (OR)=2.82, 95% Confidence Interval (95% CI]: 2.10, 3.80, p<.001), Hispanic ethnicity (OR= 2.06 [95%CI: 1.57, 2.71], p<.001), and non-English language (OR= 1.42 [95%CI: 1.01, 2.01], p=0.047) were associated with increased adversity. Children with socioeconomic adversity (Figure 1) experienced lower quality of care for 6 measures [well child care (OR=0.58 [95%CI: 0.48, 0.72], routine dental care (OR=0.61 [95%CI: 0.51,0.72]), COVID immunization (OR=0.67 [95%CI: 0.54, 0.82], insufficient time with their pediatrician (OR=0.72 [95%CI: 0.54, 0.97), asthma medication ratio (OR=0.08 [95% CI: 0.01, 0.80]) and more frequent ED use (OR=1.67 [95%CI: 1.29=8, 2.18]) p <.05 for all] and similar quality of care for 4 experience of care measures.

Conclusion(s): Socioeconomic adversity is common among U.S children with disproportionate impact on Black and Latino children. There exist opportunities to improve the quality of primary and chronic illness care for children experiencing socioeconomic adversity.