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Children with medical complexity (CMC) have complex chronic conditions and increased acute care utilization, impacting health-related quality of life (HRQOL). Families of CMC are more likely to have low income and food insecurity. Other measures of socioeconomic status (SES) and household material hardship (HMH) have not been examined in families of CMC, nor has the relationship of SES and HMH with acute care utilization and HRQOL.


Examine SES and HMH in CMC and its relationship with HRQOL and acute care utilization. Examine predictors of family financial difficulty related to the child’s health conditions.


250 parents of CMC completed surveys containing items related to SES, HMH, and HRQOL. Predictors were SES and HMH. SES was measured as income, wealth (car/home ownership), and parental education. HMH was measured as food, housing, or utilities insecurity. Outcomes were child HRQOL, acute care utilization, and family financial difficulty. HRQOL was measured using validated CP-QOL and Functional Status II instruments; total HRQOL was converted into a Z score. Acute care utilization was measured as annual ED visits, hospitalizations, and costs. Utilization data were collected from hospital administrative data. We examined bivariate associations with the X2 test. For bivariate associations with p<0.10, we performed generalized linear and logistic models, adjusting for demographic and clinical characteristics. We performed a classification and regression tree (CART) analysis.


Table 1 describes the study population characteristics and association with outcomes. 60.4% of families reported income below the FPL, and 69% completed education less than a college degree. 40% reported at least one HMH. SES and HMH were not associated with HRQOL. Education was associated with acute care utilization. HMH was not associated with utilization. In adjusted analyses, education was not associated with costs, but was associated with ED visits: parents with advanced degrees had 8 more ED visits/year than parents with high school degrees (7.9 [95%CI: 4.3, 14.7], p<0.01). HMH was associated with family financial problems, with odds of financial problems increasing with number of hardships (6.9 [95%CI: 2.3, 20.2], p<0.001). By variance importance factor and cross-validation of CART analysis, HMH remained a strong predictor of family financial difficulty.


HMH were common in this study population. Higher parental education was associated with more ED visits, but there was no association between other facets of SES or HMH and HRQOL or acute care utilization. HMH was associated with increased odds of family financial difficulties related to the child’s health conditions, regardless of SES.

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Socioeconomic Status And Household Material Hardship In Children With Medical Complexity