Cumulative social disadvantage and child health.
BACKGROUND
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.


METHODS
We analyzed data on 57,553 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.
Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York, USA. bauman@aecom.yu.edu
Laurie J
LJ
Bauman
Ellen J
EJ
Silver
Ruth E K
RE
Stein
D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002669:Child Welfare; D002908:Chronic Disease; D004522:Educational Status; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008913:Minority Groups; D010290:Parents; D011203:Poverty; D012307:Risk Factors; D020954:Single-Parent Family; D014481:United States; D035862:Vulnerable Populations