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Table 3 Associations of Healthcare Access with Adverse Family Impact among U.S. Children Born Prematurely (VLBW and LBW/PTB combined), ages 0–5 years

From: Healthcare access and adverse family impact among U.S. children ages 0–5 years by prematurity status

  Adverse Family Impact
≥$1000 Out-of-Pocket Expenses Parent Cut-Back or Stopped Work Parental Aggravation Maternal Health Not Excellent Paternal Health Not Excellent
Healthcare Access
 Adequate Health Insurance
  RR (95% CI) 0.21 (0.12–0.36) 0.38 (0.22–0.66) 0.37 (0.19–0.71) 0.96 (0.84–1.08) 0.97 (0.86–1.09)
p-value <.001 0.001 0.003 0.48 0.62
  aRR (95% CI) 0.25 (0.15–0.42) 0.26 (0.16–0.44) 0.44 (0.26–0.74) 0.92 (0.83–1.02) 0.95 (0.85–1.07)
p-value <.001 <.001 0.002 0.13 0.39
 Medical Home
  RR (95% CI) 0.48 (0.22–1.08) 0.22 (0.09–0.55) 0.27 (0.10–0.73) 1.12 (0.98–1.29) 1.13 (0.96–1.34)
p-value 0.08 0.001 0.010 0.09 0.14
  aRR (95% CI) 0.54 (0.38–0.76) 0.34 (0.17–0.70) 0.32 (0.17–0.60) 1.04 (0.95–1.13) 1.01 (0.92–1.12)
p-value <.001 0.004 <.001 0.41 0.78
 Developmental Screening
  RR (95% CI) 1.00 (0.48–2.09) 2.29 (0.80–6.51) 1.26 (0.27–5.85) 1.08 (0.84–1.38) 1.12 (0.88–1.43)
p-value 0.997 0.12 0.77 0.56 0.37
  aRR (95% CI) 0.66 (0.39–1.11) 1.13 (0.52–2.43) 0.69 (0.28–1.66) 1.04 (0.87–1.23) 1.20 (0.99–1.46)
p-value 0.12 0.76 0.40 0.70 0.056
  1. Note. Propensity score weighting was used to estimate average treatment effect of adequate health insurance, access to medical home, or developmental screening receipt on each adverse family impact. Models included the following covariates: child age, sex, race and ethnicity, family structure, insurance status/type, region, VLBW status, CSHCN status, comorbid condition(s), ACEs, family resilience, parent nativity, household language, and household income. Family structure was omitted from maternal and paternal health models due to possible collinearity with the dependent variable. For these models, the Bonferroni-adjusted significance threshold = 0.003
  2. Data source: 2016 & 2017 National Survey of Children’s Health
  3. Abbreviations: aRR adjusted relative risk, CI confidence interval, LBW low birthweight, PTB preterm birth, RR relative risk, U.S. United States, VLBW very low birthweight