Marina Masciale MD, MPH , Todd Leroux PhD, MHPA , Karla Fredricks MD, MPH , Jean L. Raphael MD, MPH , Claire Bocchini MD, MS , Hye-Chung Kum PhD , Michelle A. Lopez MD, MPH
{"title":"有特殊医疗需求的低收入儿童移民一代的医疗保健使用情况。","authors":"Marina Masciale MD, MPH , Todd Leroux PhD, MHPA , Karla Fredricks MD, MPH , Jean L. Raphael MD, MPH , Claire Bocchini MD, MS , Hye-Chung Kum PhD , Michelle A. Lopez MD, MPH","doi":"10.1016/j.acap.2025.102852","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.</div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children’s Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.</div></div><div><h3>Results</h3><div>We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child’s health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102852"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Health Care Use by Immigrant Generation in Low-Income Children With Special Health Care Needs\",\"authors\":\"Marina Masciale MD, MPH , Todd Leroux PhD, MHPA , Karla Fredricks MD, MPH , Jean L. Raphael MD, MPH , Claire Bocchini MD, MS , Hye-Chung Kum PhD , Michelle A. Lopez MD, MPH\",\"doi\":\"10.1016/j.acap.2025.102852\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.</div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children’s Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.</div></div><div><h3>Results</h3><div>We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child’s health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.</div></div>\",\"PeriodicalId\":50930,\"journal\":{\"name\":\"Academic Pediatrics\",\"volume\":\"25 6\",\"pages\":\"Article 102852\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1876285925000774\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876285925000774","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Health Care Use by Immigrant Generation in Low-Income Children With Special Health Care Needs
Objective
We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.
Methods
This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children’s Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.
Results
We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child’s health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.
Conclusions
Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.
期刊介绍:
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.