title: State-level income inequality and family burden of U.S. families raising children with special health care needs.
abstract: Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.
authors.affiliation: Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, USA. Electronic address: slp@brandeis.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Parish
authors.affiliation: Carolina Institute for Public Policy, Department of Public Policy, University of North Carolina at Chapel Hill, USA.
authors.forename: Roderick A
authors.initials: RA
authors.lastname: Rose
authors.affiliation: School of Social Work, University of North Carolina at Chapel Hill, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dababnah
authors.affiliation: Department of Social Welfare, Seoul National University, South Korea.
authors.forename: Joan
authors.initials: J
authors.lastname: Yoo
authors.affiliation: Department of Sociology, Anthropology, and Social Work, University of Dayton, USA.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Cassiman
mesh_terms: D000293:Adolescent; D002648:Child; D002668:Child Rearing; D002671:Child, Exceptional; D002675:Child, Preschool; D017281:Cost of Illness; D019988:Children with Disabilities; D005190:Family; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D012959:Socioeconomic Factors; D014481:United States