OBJECTIVES
Children who experience socioeconomic adversity often have worse health; however, less is known about their quality of care. We sought to evaluate the association between parent/caregiver-reported socioeconomic adversity and quality of pediatric primary, acute, and chronic ambulatory care on a national level.
METHODS
This was a retrospective cohort study of 5,368 representative U.S. children (1-17 years) in the 2021 Medical Expenditure Panel Survey. Socioeconomic adversity was defined as parent/caregiver-reported food, housing, transportation, or utility insecurity in the past 12 months. Outcomes included 10 quality measures of primary, acute, and chronic care, and experience of care measured through parent/caregiver survey. We described variation in socioeconomic adversity and used multivariable regression to examine associations with quality outcomes.
RESULTS
One-third of parent/caregivers reported socioeconomic adversity. Food insecurity (23.6%) was most common followed by utility (19.5%), housing (15.0%), and transportation (4.7%) insecurity. Black (53.2%) and Hispanic (46.9%) parent/caregivers experienced the highest rates of socioeconomic adversity. Children with socioeconomic adversity received lower quality of care for 4 quality measures, including more frequent ED visits (Odds Ratio (OR)=1.69 [95% Confidence Interval (CI):1.28-2.23]), less favorable asthma medication ratio (OR=0.04 [95%CI:0.01-0.31]), and less frequent well child (OR=0.73 [95%CI:0.59-0.90]) and dental care (OR=0.76 [95%CI:0.63-0.94], p <.05 for all). There were no statistically significant differences in experience of care.
CONCLUSIONS
Socioeconomic adversity is common among U.S children with disproportionate impact on Black and Hispanic families. There are significant disparities in pediatric primary, acute, and chronic care quality, based on parent/caregiver-reported socioeconomic adversity, highlighting the need for systems-level interventions.