Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Article Figures & Data

TABLE 1

Child and Caregiver Demographics (N = 249)

Characteristics	Frequency, n (%)
Child
Age, y
<1^a	79 (32)
1–4	60 (24)
5–9	41 (16)
10–14	39 (16)
15–18	30 (12)
Sex, female	119 (48)
Race or ethnicity
White	203 (84)
Black or African American	5 (2)
Asian American	6 (2)
Native Hawaiian or other Pacific Islander	1 (<1)
American Indian or Alaska Native	3 (1)
>1 race or other	23 (10)
Hispanic or Latino ethnicity	51 (21)
Public health insurance	169 (68)
Caregiver
Median age in years, min–max	35, 16–70
Sex, female	205 (82)
Race or ethnicity
White	179 (75)
Black or African American	4 (2)
Asian American	9 (4)
Native Hawaiian or Pacific Islander	2 (1)
American Indian or Alaska Native	7 (3)
>1 race or other	33 (14)
Hispanic or Latino ethnicity	53 (22)
Married^b	139 (56)
Survey language, Spanish	20 (8)
Education
Less than high school degree	31 (13)
High school or equivalent	99 (40)
Specialized training or associate’s degree	59 (24)
College degree or higher	59 (24)
Biological or adoptive parent	238 (96)

Demographics were otherwise evenly distributed among children with or without chronic disease.
↵a Children younger than age 1 were more likely to not have any chronic disease (P < .001).
↵b Caregivers of children with chronic diseases were more likely to be separated, divorced, or widowed compared with those without chronic disease (P = .004).

TABLE 2

Child Health Characteristics

Health Characteristics	Overall (N = 249)	No Chronic Disease (n = 133)	Noncomplex Chronic Disease (n = 44)	Complex and Chronic Disease (n = 72)	P^a
General health status, n (%)					<.001
Not very good or poor	44 (18)	11 (8)	10 (23)	23 (32)
Hospitalizations in previous 12 mo, n (%)					<.001
0	129 (52)	87 (66)	24 (55)	18 (25)
1	67 (27)	32 (24)	14 (32)	21 (29)
2 or more	52 (21)	13 (10)	6 (14)	33 (46)
Visits to ED in previous 12 mo, n (%)					<.001
0–1	159 (64)	101 (77)	26 (59)	32 (44)
2–4	74 (30)	27 (20)	16 (36)	31 (43)
5 or more	15 (6)	4 (3)	2 (5)	9 (13)
Hours per week providing or coordinating care, n (%)					<.001
<1 h per wk	143 (58)	112 (86)	18 (41)	13 (18)
1–10 h per wk	44 (18)	11 (8)	13 (30)	20 (28)
11 or more h per wk	58 (24)	7 (5)	13 (30)	38 (54)
History or current concern for anxiety and/or depression, n (%)	30 (12)	10 (8)	12 (28)	8 (11)	.002

↵a P value from χ² test of association between medical complexity and potential risk factor. Cell counts may not sum to column totals in cases of excluded nonresponse (n = 0–4, except child or caregiver histories of behavioral or psychological concern, with 8 and10 nonresponses, respectively).

TABLE 3

Prevalence of Socioeconomic Risk Factors

Socioeconomic Risk Factors	Overall (N = 249)	No Chronic Disease (n = 133)	Noncomplex Chronic Disease (n = 44)	Complex and Chronic Disease (n = 72)	P^a
Financial stress, any, n (%)	85 (34)	39 (29)	19 (43)	27 (38)	.19
Having enough money for food	66 (27)	29 (22)	16 (36)	21 (29)	.14
Paying for utilities and services (gas, water, etc)	64 (26)	28 (21)	14 (32)	22 (31)	.20
Paying rent or mortgage	60 (24)	25 (19)	16 (36)	19 (26)	.05
Working appliances (stove, refrigerator, etc)	47 (19)	25 (19)	9 (20)	13 (18)	.95
Housing concerns, n (%)
Infestation problems (ie, mold, insects, rats or mice)	19 (8)	9 (7)	5 (11)	5 (7)	.59
Unstable housing (ie, eviction, foreclosure, homelessness)	13 (5)	6 (5)	4 (9)	3 (4)	.44
Medical bills and insurance stress, any, n (%)	91 (37)	44 (33)	20 (45)	27 (38)	.33
Problems paying child’s health care bills	54 (22)	29 (22)	10 (23)	15 (21)	.98
Issues paying other family members’ health care bills	47 (19)	23 (17)	11 (25)	13 (18)	.52
Caregiver or household member without health insurance	24 (10)	14 (11)	3 (7)	7 (10)	.76
Child without health insurance in past 12 mo	18 (7)	11 (8)	3 (7)	4 (6)	.76
No regular doctor for child or other household member	16 (6)	7 (5)	8 (18)	1 (1)	.001
Employment concerns, any, n (%)	83 (33)	39 (29)	20 (45)	24 (33)	.14
Time off or changing responsibilities to care for a child	52 (21)	19 (14)	14 (32)	19 (26)	.02
Finding a job	28 (11)	15 (11)	5 (11)	8 (11)	.99
Disability interfering with work	24 (10)	10 (8)	8 (18)	6 (8)	.10
Unpaid wages, worker’s compensation, discrimination, etc	11 (4)	9 (7)	1 (2)	1 (1)	.15

↵a P value from χ² test of association between medical complexity and potential risk factor.

TABLE 4

Prevalence of Household Risk Factors

Household Risk Factors	Overall (N = 249)	No Chronic Disease (n = 133)	Noncomplex Chronic Disease (n = 44)	Complex and Chronic Disease (n = 72)	P^a
No. children under age 18 in the home, n (%)					.21
1–3	204 (83)	108 (84)	33 (75)	63 (88)
4 or more	41 (17)	21 (16)	11 (25)	9 (13)
No. additional children in household with a chronic condition, n (%)					<.001
0	137 (56)	92 (72)	21 (49)	24 (33)
1	85 (35)	30 (23)	16 (37)	39 (54)
2 or more	21 (9)	6 (5)	6 (14)	9 (13)
School-aged child missed 10 or more d of school in past year, n (%)	55 (53)	17 (40)	10 (42)	28 (76)	.003
No. people age 18 and older in the home, n (%)					.87
1–2	154 (63)	81 (63)	29 (66)	44 (61)
3 or more	91 (37)	48 (37)	15 (34)	28 (39)
Caregiver general health status, n (%)					.96
Not very good or poor	16 (6)	8 (6)	3 (7)	5 (7)
Caregiver behavioral or psychological concern, n (%)
Anxiety and/or depression	60 (25)	31 (24)	11 (26)	18 (26)	.96
ADD/ADHD, substance abuse, or other	30 (13)	16 (13)	5 (12)	9 (13)	.98
Caregiver has social or emotional support present	218 (88)	115 (86)	41 (93)	62 (86)	.46
Concerns caring for pet while child is ill, n (%)	23 (9)	13 (10)	3 (7)	7 (10)	.82
General issues with transportation, eg, work, grocery store, etc, n (%)	20 (8)	12 (9)	3 (7)	5 (7)	.80
Transportation is 100% reliable, n (%)	219 (88)	117 (88)	38 (86)	64 (89)	.91

ADD, attention-deficit disorder; ADHD, attention-deficit hyperactivity disorder; —, not applicable.
↵a P value from χ² test of association between medical complexity and potential risk factor.

TABLE 5

Prevalence of Trauma or ACEs

Trauma or ACEs (No. who declined to respond)	Overall (N = 249)	No Chronic Disease (n = 133)	Noncomplex Chronic Disease (n = 44)	Complex and Chronic Disease (n = 72)	P^a
Trauma or ACEs (No. who declined to respond)	n (%)	n (%)	n (%)	n (%)	P^a
Any ACEs reported (4)	92 (38)	38 (29)	21 (48)	33 (46)	.017
4 or more ACEs reported (4)	22 (9)	10 (8)	5 (11)	7 (10)	.70
Parent or guardian divorced or separated (6)	58 (24)	21 (16)	14 (32)	23 (32)	.016
Been involved with Child Protective Services (11)	31 (13)	15 (12)	5 (12)	11 (16)	.73
Lived with anyone who had a problem with alcohol or drugs (7)	27 (11)	13 (10)	7 (16)	7 (10)	.54
Lived with anyone who was mentally ill, suicidal, or severely depressed (6)	25 (10)	12 (9)	7 (16)	6 (8)	.39
Parent or guardian served time in jail (5)	20 (8)	8 (6)	6 (14)	6 (8)	.30
Was a victim of violence or witnesses violence in neighborhood (4)	19 (8)	6 (5)	4 (9)	9 (13)	.12
Saw or heard parents or adults slap, kick, or punch one another (6)	16 (7)	5 (4)	2 (5)	9 (13)	.048
Parent or guardian died (5)	10 (4)	3 (2)	1 (2)	6 (8)	.09
Been involved in the juvenile justice system (6)	10 (4)	5 (4)	2 (5)	3 (4)	.98
Treated or judged unfairly because of his or her race or ethnic group (4)	8 (3)	5 (4)	0 (0)	3 (4)	.40