Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status.
OBJECTIVE
To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status.


METHODS
We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes <200% of the federal poverty level. We examined 3 immigration status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care.


RESULTS
All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P < .01), and an 11 percentage point greater increase in having no unmet medical need (P < .01). Immigrant children had significantly lower health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P < .01) and a 26 percentage point greater increase in having no unmet medical need (P < .01) relative to citizen children with nonimmigrant parents.


CONCLUSIONS
Some disparities in access to care related to family immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care.
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pa. Electronic address: marian.jarlenski@pitt.edu.
Marian
M
Jarlenski
Mathematica Policy Research, Washington DC.
Julia
J
Baller
Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pa; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa.
Sonya
S
Borrero
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
Wendy L
WL
Bennett
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010290:Parents; D011203:Poverty / Q000706:statistics & numerical data*; D014481:United States
access to care; disparities; health insurance; immigrant