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Beyond income: material hardship and the health and healthcare of premature children

Abstract

Objectives

To estimate national prevalence of household hardships (food insufficiency, financial hardship, and difficulty paying medical bills) among children born term and preterm; and examine associations of household hardships with preterm children’s outcomes (health status, emergency room visits, and unmet healthcare needs).

Methods

We studied 24,026 children aged 0–3 years born term, preterm with moderately low birth weight (1501–2499 grams) and preterm with very low birth weight (VLBW; ≤1500 grams). Using propensity score matching to control for correlates of poverty, we examined associations of hardships and child outcomes.

Results

Compared with term, households with preterm VLBW children had >2-fold higher odds of financial hardship (aOR:2.63; 95% CI: 1.26–5.46) and >5-fold higher odds of difficulty paying bills (aOR:5.60; 95% CI: 2.35–10.35). Matching for sociodemographics, special healthcare needs, income and receipt of public benefits, hardships were independently associated with adverse preterm children’s outcomes.

Conclusions

Addressing household hardships is needed to optimize preterm child outcomes.

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Data availability

Dataset and codebooks for the National Survey of Children’s Health are publicly available in the Data Resource Center for Child & Adolescent Health at https://www.childhealthdata.org/.

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Funding

This work was supported by the Evans Center for Implementation and Improvement Sciences (Department of Medicine, Boston University School of Medicine). EGCR is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through BU-CTSI Grant Number 1KL2TR001411. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Contributions

ECR and MGP contributed to conceptualization and design, analysis, and drafted and edited the manuscript. YT contribute to design and data analysis. AB, AG and YT contributed to data interpretation, and reviewed and edited the manuscript. All authors approved the final manuscript.

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Correspondence to Erika G. Cordova-Ramos.

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Cordova-Ramos, E.G., Brochier, A., Tripodis, Y. et al. Beyond income: material hardship and the health and healthcare of premature children. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01560-w

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