The Impact of SES on Relationships between Children's Medical Impairments and Their Physical and Mental Health Status and School Attendance

Roger Avery, Brown University
Michael Msall, Brown University
Michelle L. Rogers, Brown University

Using data from four years of the National Health Interview Surveys (1997-2000), we investigate the relationships between medical impairments and three indicators of children's well-being, as a function of socioeconomic status. Our adverse outcomes are reported poor health status, school absences, and depression. As almost 50% of our sample of 38,245 children ages 5 to 17 are reported to have at least one medical impairment, we developed a scale to indicate the severity of these impairments: 13.3% minor, 20.6% moderate, and 12.0% complex. Of these children, 17.6% are reported to have sub-optimal health; 16.6% missed six or more days of school; and 3.7% are reported to have "always been unhappy, sad, or depressed" in the previous two months. We examine differentials in impairments by parental education, household poverty status, and whether the child lived in a single-parent household. We find few differences in impairments among these SES groups. However, when we examine differentials for these same SES variables for poor health status, days missed from school, and depression, we find substantial differences. We find that most of the explanation for these differences is due to the higher rate of negative outcomes for children with medical impairments and lower socioeconomic status. In our final analysis, we are examining the role of functional limitations, general medical service usage, and birthweight as instrumental variables in explaining these results. We measure functional limitations by combining responses concerning self-care, mobility, communication, and learning skills. Eight percent of children have at least one functional limitation; 2.2% have two or more. We divide birthweight into three categories: low birthweight-less than 2500 grams (6.5%), intermediate birthweight-2500-3000 grams (15.8%), and normal birthweight (70.6%). We look at three indicators of medical usage: whether the child has a regular source of care for both preventive and sick care, whether the child receives regular dental care, and whether the child has seen a doctor in the past year. Just over 10% of children lack either a place for sick or preventive care, 9.4% have infrequent dental care, and 22.5% have not seen a doctor in the past 12 months. Preliminary analyses suggest that children with functional limitations and low or intermediate birthweights are substantially more likely to experience adverse outcomes. However, we find the effects of medical usage to be significantly lower than anticipated.