State-level income inequality and family burden of US families raising children with special health care needs

Abstract

Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household’s absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005–06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child’s care and whether the parent stopped working due to the child’s health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child’s health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child’s impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.

Introduction

In contrast with other children, US children with special health care needs have elevated health and specialty care requirements due to chronic physical, developmental, behavioral, or emotional conditions (McPherson et al., 1998, Newacheck and Kim, 2005). Elevated needs for care among US children with special health care needs include increased physician and emergency visits, hospitalizations, prescription medications, medical procedures, therapies and ancillary care, compared to other children (Boulet et al., 2009, Chan et al., 2002, Gallaher et al., 2002, Liptak et al., 2006, Newacheck and Halfon, 1998). Thus, care for the population of children with special health care needs is expensive to both their families and to the public health system (Newacheck & Kim, 2005). The public health importance of children with special health care needs is critical, given the high costs associated with their care requirements and recent estimates that the prevalence of special health care needs among US children ranges from 13 to 16% (Newacheck and Kim, 2005, van Dyck et al., 2004).

Social determinants of health are not well understood for the population of children with special health care needs. However, the fact that the prevalence of children with special health care needs varies by race, income, and insurance status in the United States (Newacheck et al., 2008, van Dyck et al., 2004) suggests that more inquiry into the social determinants of health for this vulnerable population of children is warranted. Researchers have documented health care access and utilization disparities based on race, ethnicity, family income, parental education, and insurance status (Inkelas et al., 2007, Porterfield and McBride, 2007, Warfield and Gulley, 2006). In the United States, policy features of states’ public health insurance programs have been found to be associated with the health care access of children with special health care needs (Parish, Shattuck, & Rose, 2009).