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Research Articles

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Louise E. Vaz, David V. Wagner, Katrina L. Ramsey, Celeste Jenisch, Jared P. Austin, Rebecca M. Jungbauer, Kimberly Felder, Raul Vega-Juarez, Mauricio Gomez, Natalie Koskela-Staples, Michael A. Harris and Katharine E. Zuckerman
Hospital Pediatrics January 2020, 10 (1) 20-28; DOI: https://doi.org/10.1542/hpeds.2019-0206
Louise E. Vaz
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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David V. Wagner
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Katrina L. Ramsey
bBiostatistics and Design Program, and
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Celeste Jenisch
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Jared P. Austin
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Rebecca M. Jungbauer
cPacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon;
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Kimberly Felder
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Raul Vega-Juarez
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
dBuild Exito Program, Portland State University, Portland, Oregon; and
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Mauricio Gomez
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Natalie Koskela-Staples
eDepartment of Clinical and Health Psychology, University of Florida, Gainsville, Florida
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Michael A. Harris
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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Katharine E. Zuckerman
aDepartment of Pediatrics, Doernbecher Children’s Hospital,
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    TABLE 1

    Child and Caregiver Demographics (N = 249)

    CharacteristicsFrequency, n (%)
    Child
     Age, y
      <1a79 (32)
      1–460 (24)
      5–941 (16)
      10–1439 (16)
      15–1830 (12)
     Sex, female119 (48)
     Race or ethnicity
      White203 (84)
      Black or African American5 (2)
      Asian American6 (2)
      Native Hawaiian or other Pacific Islander1 (<1)
      American Indian or Alaska Native3 (1)
      >1 race or other23 (10)
      Hispanic or Latino ethnicity51 (21)
     Public health insurance169 (68)
    Caregiver
     Median age in years, min–max35, 16–70
     Sex, female205 (82)
     Race or ethnicity
      White179 (75)
      Black or African American4 (2)
      Asian American9 (4)
      Native Hawaiian or Pacific Islander2 (1)
      American Indian or Alaska Native7 (3)
      >1 race or other33 (14)
      Hispanic or Latino ethnicity53 (22)
     Marriedb139 (56)
     Survey language, Spanish20 (8)
     Education
      Less than high school degree31 (13)
      High school or equivalent99 (40)
      Specialized training or associate’s degree59 (24)
      College degree or higher59 (24)
     Biological or adoptive parent238 (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).

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    TABLE 2

    Child Health Characteristics

    Health CharacteristicsOverall (N = 249)No Chronic Disease (n = 133)Noncomplex Chronic Disease (n = 44)Complex and Chronic Disease (n = 72)Pa
    General health status, n (%)<.001
     Not very good or poor44 (18)11 (8)10 (23)23 (32)
    Hospitalizations in previous 12 mo, n (%)<.001
     0129 (52)87 (66)24 (55)18 (25)
     167 (27)32 (24)14 (32)21 (29)
     2 or more52 (21)13 (10)6 (14)33 (46)
    Visits to ED in previous 12 mo, n (%)<.001
     0–1159 (64)101 (77)26 (59)32 (44)
     2–474 (30)27 (20)16 (36)31 (43)
     5 or more15 (6)4 (3)2 (5)9 (13)
    Hours per week providing or coordinating care, n (%)<.001
     <1 h per wk143 (58)112 (86)18 (41)13 (18)
     1–10 h per wk44 (18)11 (8)13 (30)20 (28)
     11 or more h per wk58 (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).

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    TABLE 3

    Prevalence of Socioeconomic Risk Factors

    Socioeconomic Risk FactorsOverall (N = 249)No Chronic Disease (n = 133)Noncomplex Chronic Disease (n = 44)Complex and Chronic Disease (n = 72)Pa
    Financial stress, any, n (%)85 (34)39 (29)19 (43)27 (38).19
     Having enough money for food66 (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 mortgage60 (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 bills54 (22)29 (22)10 (23)15 (21).98
     Issues paying other family members’ health care bills47 (19)23 (17)11 (25)13 (18).52
     Caregiver or household member without health insurance24 (10)14 (11)3 (7)7 (10).76
     Child without health insurance in past 12 mo18 (7)11 (8)3 (7)4 (6).76
     No regular doctor for child or other household member16 (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 child52 (21)19 (14)14 (32)19 (26).02
     Finding a job28 (11)15 (11)5 (11)8 (11).99
     Disability interfering with work24 (10)10 (8)8 (18)6 (8).10
     Unpaid wages, worker’s compensation, discrimination, etc11 (4)9 (7)1 (2)1 (1).15
    • ↵a P value from χ2 test of association between medical complexity and potential risk factor.

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    TABLE 4

    Prevalence of Household Risk Factors

    Household Risk FactorsOverall (N = 249)No Chronic Disease (n = 133)Noncomplex Chronic Disease (n = 44)Complex and Chronic Disease (n = 72)Pa
    No. children under age 18 in the home, n (%).21
     1–3204 (83)108 (84)33 (75)63 (88)
     4 or more41 (17)21 (16)11 (25)9 (13)
    No. additional children in household with a chronic condition, n (%)<.001
     0137 (56)92 (72)21 (49)24 (33)
     185 (35)30 (23)16 (37)39 (54)
     2 or more21 (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
     1–2154 (63)81 (63)29 (66)44 (61)
     3 or more91 (37)48 (37)15 (34)28 (39)
    Caregiver general health status, n (%).96
     Not very good or poor16 (6)8 (6)3 (7)5 (7)
    Caregiver behavioral or psychological concern, n (%)
     Anxiety and/or depression60 (25)31 (24)11 (26)18 (26).96
     ADD/ADHD, substance abuse, or other30 (13)16 (13)5 (12)9 (13).98
    Caregiver has social or emotional support present218 (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.

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    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)Pa
    n (%)n (%)n (%)n (%)
    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
    • ↵a P value from χ2 test of association between medical complexity and potential risk factor.

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Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children
Louise E. Vaz, David V. Wagner, Katrina L. Ramsey, Celeste Jenisch, Jared P. Austin, Rebecca M. Jungbauer, Kimberly Felder, Raul Vega-Juarez, Mauricio Gomez, Natalie Koskela-Staples, Michael A. Harris, Katharine E. Zuckerman
Hospital Pediatrics Jan 2020, 10 (1) 20-28; DOI: 10.1542/hpeds.2019-0206

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Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children
Louise E. Vaz, David V. Wagner, Katrina L. Ramsey, Celeste Jenisch, Jared P. Austin, Rebecca M. Jungbauer, Kimberly Felder, Raul Vega-Juarez, Mauricio Gomez, Natalie Koskela-Staples, Michael A. Harris, Katharine E. Zuckerman
Hospital Pediatrics Jan 2020, 10 (1) 20-28; DOI: 10.1542/hpeds.2019-0206
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