Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence.
Am J Prev Med
; 66(6): 936-947, 2024 06.
Article
in En
| MEDLINE
| ID: mdl-38416088
ABSTRACT
INTRODUCTION:
Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied.METHODS:
This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health.RESULTS:
Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of â¼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373).CONCLUSIONS:
In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.
Full text:
1
Database:
MEDLINE
Main subject:
Residence Characteristics
/
Health Services Accessibility
Limits:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Am J Prev Med
Journal subject:
SAUDE PUBLICA
Year:
2024
Type:
Article