Gradients in the Health Status and Developmental Risks of Young Children: The Combined Influences of Multiple Social Risk Factors

摘要

Objectives: To analyze child vulnerability as a profile of multiple risk factors for poorer health based on race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health. Profiles are examined in relation to disparities in the health status and developmental risks of young children. Data Sources: Cross-sectional data on 2,068 children ages 4–35 months from the 2000 National Survey of Early Childhood Health. Study Design: Multiple logistic regression models are used to examine risk profiles in relation to child health status and developmental risk (based on parent concerns about development). The profiles are also examined in relation to three measures of basic access to health care: telephone contact with a physician, well-child visit in the past year, and missed or delayed needed care. Principal Findings: About one-third of (or 3.1 million) young children in the United States have two or more risk factors (RF) for poor health. Controlling for other family factors, having more RFs is associated with poorer health status (i.e., percent reported “good/fair/poor” vs. “excellent/very good”) and being higher risk for developmental delays. For example, the likelihood of having either poorer health or higher developmental risk increases with each RF (vs. zero): 1 RF (OR = 1.70, CI: 1.20–2.38), 2 RFs (OR = 3.28, CI: 2.27–4.73), 3 RFs (OR = 4.69, CI: 2.84–7.73), 4 RFs (OR = 14.58, CI: 4.98–42.64). Higher RFs were also associated with poorer health care access. Conclusions: This study demonstrates a dose–response relationship of higher risk profiles with poorer child health status and higher developmental risk. Because children with higher profiles of risk are also more likely to lack access to care, this suggests that children who most need care have the greatest difficulty obtaining it. Addressing health gradients for vulnerable children will require explicit attention to these multiple, overlapping risk factors.