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APHA Scientific Session and Event Listing

Recorded presentation

Jared M. Fixmer, BA¹, Emmanuel Ngui, DrPH, MSc², Sandra Tomany-Korman, MS², and Glenn Flores, MD². (1) Medical College of Wisconsin, 3863 N 75th St., Milwaukee, WI 53216, 414-731-1368, jfixmer@mcw.edu, (2) Department of Pediatrics, Medical College of Wisconsin, Center for the Advancement of Underserved Children, 8701 Watertown Plank Rd., Milwaukee, WI 53226

Objective: Immigrant children are rapidly increasing in the US. Not enough is known about their health and access to care. The study objectives were to: 1) identify disparities in insurance, health status, and barriers to care (BCs) for children of citizen parents (CPs) and non-citizen parents (NCPs), and 2) determine whether a gradient exists in these outcomes among NCP subgroups (legal permanent resident parents [LPRPs], temporary resident parents [TRPs], and undocumented immigrant parents [UIPs]).

Design: Cross-sectional survey of parents at community sites in Boston. Participants were asked 76 questions on insurance, BCs, and health services use.

Results: 1100 parents were interviewed; 40% were CPs and 60%, NCPs (29% LPRPs; 24%, UIPs; and 7%, TRPs). Compared to CP children, NCP children were significantly (P<.05) more likely to be in poor/fair/good health (40 vs. 47%), lack regular doctors (3 vs. 5%), and to be uninsured (7 vs. 23%), with LPRP (12%), TRP (27%), and UIP (37%) children more likely to be uninsured. NCP children were more likely than CP children to not be brought in for needed care due to uninsurance (17 vs. 9%), inability to afford care (14 vs. 7%), and language barriers (LBs; 9 vs. 4%).

In multivariate analyses, NCP children had higher odds of uninsurance than CP children (OR=2.7 [95% CI, 1.5-4.6]); a gradient existed among NCP children, with LPRP children at lowest risk (OR=1.6 [0.9-3.0]), and TRP (OR=3.9 [1.8-8.7]) and UIP children (OR=6.4 [3.3-12.3]) at highest risk. LPRPs had twice the odds (OR=2.1 [1.2-3.6]) of CPs of citing insurance difficulties as one of the three most important BC. NCPs were more likely than CPs to cite LBs (OR=3.8 [2.3-6.3]), with LPRPs (OR=4.4 [2.6-7.5]) and UIPs (OR=2.9 [1.6-5.4]) at highest risk. TRPs and LPRPs had greater odds of not bringing children in for needed care due to LBs (OR=4.1 [1.3-13.1]) and long provider waits (OR=1.5 [1.02-2.2]), respectively. LPRP children were less likely to be in poor/fair/good health (OR=0.6 [0.4-0.9]).

Conclusions: Uninsurance is a major problem and frequent BC for NCP children, with UIP and TRP children at highest risk. Uninsurance, LBs, and long provider waits prevent immigrant children from being seen for needed care, with LPRP children experiencing the least severe problems and UIP children the most severe. Results suggest the need to enhance insurance coverage, reduce BCs, and provide more efficient pediatric services for NCP children, particularly UIP children, who are most at risk for uninsurance and BCs.

Learning Objectives: At the conclusion of this session the participant ill be able to

• Recognize how parents’ immigration status can impact access to health care for children.
• Apply these data to help improve access to care for children with immigrant parents.

Keywords: Access Immigration, Children

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation