Poverty And Disparities In Health Outcomes For School-Aged Children Involved In The Child Welfare System

Purpose: Poverty is a risk factor for poor child health outcomes, and these risks may be more pronounced in high risk populations, including those in the child welfare system. The objective of our study was to analyze the association between family poverty level and child health outcomes in school-aged children referred to protective services for abuse or neglect. Methods: We conducted a secondary analysis using longitudinal cohort data of school-age children 5-9 years old from the Second National Survey of Child and Adolescent Well-Being from February 2008 to December 2012. This is a nationally representative dataset including children 0-17 years old referred to protective services for suspected abuse or neglect. Surveys were conducted at time of intake (baseline) then at 18- and 36- month follow-ups. We examined the association between baseline family poverty and caregiver report of the child’s overall health (poor/fair/good vs. very good/excellent), primary care visits in the previous 12 months, and emergency department (ED) visits in the previous 6 months using Pearson’s chi-squared test. Baseline family poverty level was determined from caregiver income and categorized as below the federal poverty level (FPL) or above the FPL. We conducted a set of multivariable logistic regression models for the 3 outcomes (measured at 18 and 36 months) as the dependent variables and baseline poverty level, race, gender, child home placement type (in-home or out-of-home), child age, and urbanicity as independent variables. Results: The sample represented an estimated 683,832 school-aged children nationally with 57% of children living below the FPL. At baseline, children living below the FPL had lower overall health with 30% of caregivers rating their child’s health as poor/fair/good compared to 18% of children above the FPL (p=0.02). At 36 months follow-up, 30% of children below the FPL also had lower health ratings compared to 13% of children above the FPL (p-value <0.01). In the multivariable analysis, baseline poverty was associated with increased odds for the child’s overall poorer health rating at 36 months follow-up (OR 2.89, 95% CI 1.63, 5.14). Poverty had no association with primary care visits. Poverty was associated with decreased odds of ED visits at 18 months (OR 0.48, 95% CI 0.29, 0.81), but not at 36 months. Conclusions: Overall health ratings were worse for children living below the FPL compared to children living above the FPL. Poverty was not consistently associated with increased primary care or ED visits. Interventions to improve child health in this vulnerable population should consider the role of child poverty in health outcomes.

Duke Scholars

Author Larissa Truschel Pediatrics, Emergency Medicine