Unmet Health Care Need in US Adolescents and Adult Health Outcomes.
BACKGROUND
Adolescence is a formative period when health care services have a unique opportunity to influence later health outcomes. Unmet health care need in adolescence is known to be associated with poor contemporaneous health outcomes; it is unknown whether it predicts poor adult health outcomes.


METHODS
We used nationally representative data from 14 800 subjects who participated in Wave I (mean age: 15.9 years [1994/1995]) and Wave IV (mean age: 29.6 years [2008]) of the National Longitudinal Study of Adolescent to Adult Health. Logistic regression models were used to estimate the association between unmet health care need in adolescence and 5 self-reported measures of adult health (fair/poor general health, functional impairment, time off work/school, depressive symptoms, and suicidal ideation). Models were adjusted for baseline health, insurance category, age, gender, race/ethnicity, household income, and parental education.


RESULTS
Unmet health care need was reported by 19.2% of adolescents and predicted worse adult health: fair/poor general health (adjusted odds ratio [aOR]: 1.27 [95% confidence interval (CI): 1.00-1.60]); functional impairment (aOR: 1.52 [95% CI: 1.23-1.87]); depressive symptoms (aOR: 1.36 [95% CI: 1.13-1.64]); and suicidal ideation (aOR: 1.30 [95% CI: 1.03-1.68]). There was no significant association between unmet health care need and time off work/school (aOR: 1.13 [95% CI: 0.93-1.36]). Cost barriers accounted for only 14.8% of unmet health care need. The reason for unmet need was not significantly related to the likelihood of poor adult health outcomes.


CONCLUSIONS
Reported unmet health care need in adolescence is common and is an independent predictor of poor adult health. Strategies to reduce unmet adolescent need should address health engagement and care quality, as well as cost barriers to accessing services.
Division of General Pediatrics, Department of Medicine, and Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom; dougal.hargreaves@childrens.harvard.edu.
Dougal S
DS
Hargreaves
RAND Corporation, Santa Monica, California; and.
Marc N
MN
Elliott
Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom;
Russell M
RM
Viner
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts;
Tracy K
TK
Richmond
Division of General Pediatrics, Department of Medicine, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Mark A
MA
Schuster
D000041:Absenteeism; D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D003863:Depression / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage; D008137:Longitudinal Studies; D015995:Prevalence; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D014481:United States / Q000453:epidemiology; D055815:Young Adult