Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1321-1328 (doi:10.1542/peds.2005-1647)
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Cumulative Social Disadvantage and Child Health

Laurie J. Bauman, PhD, Ellen J. Silver, PhD and Ruth E.K. Stein, MD

Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York

CONTEXT. Disparities in child health are a major public health concern. However, it is unclear whether these are predominantly the result of low income, race, or other social risk factors that may contribute to their health disadvantage. Although others have examined the effects of the accumulation of risk factors, this methodology has not been applied to child health.

OBJECTIVE. We tested 4 social risk factors (poverty, minority race/ethnicity, low parental education, and not living with both biological parents) to assess whether they have cumulative effects on child health and examined whether access to health care reduced health disparities.

DESIGN. We analyzed data on 57553 children <18 years from the 1994 and 1995 National Health Interview Survey Disability Supplement. Of the 4 risk factors, 3 (poverty, low parental education, and single-parent household) were consistently associated with child health. These were summed, generating the Social Disadvantage Index (range: 0–3).

RESULTS. A total of 43.6% of children had no social disadvantages, 30.8% had 1, 15.6% had 2, and 10.0% had all 3. Compared with those with no social disadvantages, the odds ratios (ORs) of being in "good, fair, or poor health" (versus "excellent or very good") were 1.95 for 1 risk, 3.22 for 2 risks, and 4.06 for 3 risks. ORs of having a chronic condition increased from 1.25 (1 risk) to 1.60 (2 risks) to 2.11 (3 risks). ORs for activity limitation were 1.51 (1 risk) to 2.14 (2 risks) and 2.88 (3 risks). Controlling for health insurance did not affect these findings.

CONCLUSIONS. The accumulation of social disadvantage among children was strongly associated with poorer child health and having insurance did not reduce the observed health disparities.

Key Words: child health status • ethnic disparity • racial disparity • poverty

Abbreviations: NHIS—National Health Interview Survey • NHIS-D—NHIS Disability Supplement • NCHS—National Center for Health Statistics • QuICCC—Questionnaire for Identifying Children With Chronic Conditions

Accepted Sep 30, 2005.




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