Poster #127 - 50 States, Many Outcomes: State-Level Trends and Socioeconomic Disparities in Child Wellbeing, 2016–2024

• In Event: Saturday Poster Luncheon

Abstract

Following the APPAM conference theme of "50 States, 50 Systems: State Policy Variation and Impacts," this paper examines state-level trends in child wellbeing among children aged zero to five, focusing on incidence of language disorders, lack of health insurance, and food insufficiency from 2016 through 2024.Employing nationally- and state-representative data from the National Survey of Children's Health (NSCH), we use both descriptive statistics and regression analyses to document both worsening outcomes and widening socioeconomic disparities across multiple dimensions of early childhood wellbeing. The NSCH consists of repeated cross-sections in which different households are sampled each year; our analyses pool nine waves (2016–2024) to estimate income-group-specific trends nationally and within states.

Nationally, rates of food insufficiency among low-income children (below 200% of the FPL) declined modestly from 49.2% in 2016 to a trough of 46.4% in 2019, likely reflecting pre-pandemic economic expansion, before rising sharply to 52.6% by 2024, which exceeded pre-pandemic levels. Among higher-income children, food insufficiency also rose over the same period, from 19.2% to 23.6%, suggesting broad deterioration in food security following the withdrawal of pandemic-era social supports. The income gap in food insufficiency has remained large and persistent throughout, hovering near 30 percentage points.Lack of health insurance coverage increased steadily for both income groups over the period, with low-income children's uninsured rate rising from 7.4% in 2016 to 10.9% in 2024, compared to a more modest increase from 2.8% to 4.2% among higher-income children. The gap between groups has thus widened over time, pointing to erosion of coverage particularly among economically vulnerable families.Language disorder rates also increased among both groups, rising from 8.9% to 9.8% among low-income children and from 5.3% to 7.5% among higher-income children between 2016 and 2024. The persistent and growing gap (approximately 2~3 percentage points throughout) raises concerns about differential access to early intervention and developmental services.

Considerable state-specific variation underlies these national trends. State-level models reveal that while all examined states show upward trends in uninsured rates and language disorders, the pace and magnitude differ substantially. For instance, Indiana exhibits the highest predicted probability of lacking insurance among low-income children, reaching approximately 13.5% by 2024, while Rhode Island shows the lowest. Similarly, Georgia leads among the examined states in predicted language disorder rates for low-income children (~12.4% by 2024), whereas Ohio and Iowa show lower but still rising rates. For food insufficiency, Kentucky's low-income children face predicted rates approaching 66% by 2024, which roughly double those in Illinois.These patterns suggest that state policy environments meaningfully shape child wellbeing trajectories, even after accounting for income. The existence of widening disparities within and across states, particularly following the contraction of pandemic-era social spending, underscores the importance of targeted federal and state policy responses to protect the most economically vulnerable young children. This work is part of a larger project examining how changes in the social safety net post-Covid have affected early childhood wellbeing and how children's outcomes vary by state of residence.

Author

• Judy A Temple, University of Minnesota
  Presenting Author