Poster #220 - The Pain of Poverty: the Relation Between Poverty and Healthcare use in Early Childhood

• In Event: 3-053 - Poster Session 10
  In Poster Session: PS 10 Section - Social Policy

Integrative Statement

One of the most detrimental factors during development is growing up in poverty. According to the World Health Organization, extreme poverty is the leading cause of mortality and morbidity worldwide (1995). Poor perinatal outcomes are more often observed in impoverished neighborhoods, with both more perinatal mortality and morbidity (prematurity and small for gestational age) in these neighborhoods (PRN, 2011). Additionally, growing up in families with a lower socio-economic status exposes children to more unsafe environments (Scott et al., 2017; Wen, Browning & Cagney, 2007) making them more at risk for behavioral problems, addiction, mental illnesses and deficits in cognitive development (Barker, 1997; Murali & Oyebode, 2004; Turner, Wheaton & Lloyd, 1995). Additionally, their parents are also exposed to these harsh environments, resulting in continuously high levels of stress, reducing their emotional availability towards their children, while also increasing the risk of harsh parenting behavior (Murali & Oyebode, 2004; Steptoe & Feldman, 2001). In sum, children growing up in poverty have an increased risk of unfavorable perinatal outcomes in combination with a multidimensional unforgiving environment, resulting in a poor health status and a higher healthcare consumption. As a consequence, we assume that this poor health status is reflected in higher healthcare expenses. Additionally, we expect that this effect is mediated by their higher risk of perinatal morbidity, influencing lifelong health (Godfrey & Barker, 2011; McCormick, Litt, Smith & Zupanic, 2011). This inequity is particularly detrimental, since the gap between poor and rich is widening, not only regarding income disparity, but also in the case of health inequality.
In our cross-sectional study, we included data from all children born in 2013 (N = 141,977) in the Netherlands utilizing data from different national registries. Healthcare expenses included all expenses covered by obligatory health insurance in their first year of life. Poverty was studied using monthly household incomes per 1000 euro’s. Perinatal morbidity was defined as prematurity (<37 weeks of gestation), small for gestational age (below 10th percentile), or both. Since healthcare expenses and household income originate from different distributions, z-scores were calculated. The results of our mediation analysis are shown in Figure 1.

This research shows that children growing up with a higher household income have lower healthcare expenses in the first life. In other words, growing up in poverty is associated with higher healthcare expenses, supporting our assumption that children growing up in poverty have a poorer health status, already during their first year of life. Furthermore, the relation between household income and healthcare expenses can be partially explained by perinatal morbidity. This research shows that perinatal morbidity is more common in families with lower household income and is associated with higher healthcare expenses. Together, this sheds light on how income and adverse birth outcomes contribute to disparities and inequalities in children’s healthcare expenses, already in early life. More attention should be focused on impoverished populations in order to break through the perpetuating cycle of adversity and poor health.

Authors

• Marije van der Hulst, Erasmus MC
  Presenting Author

• Rianne Kok, Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam
  Non-Presenting Author

• Loes Bertens, Erasmus MC
  Non-Presenting Author