Socioeconomic status (SES) during childhood is one of the strongest predictors of not only child health but also adult health. Child SES reflects a combination of family microeconomic conditions (e.g., household income, parental unemployment) and local macroeconomic conditions (e.g., recessions). Although the relationship between child health and family microeconomic conditions is well studied, the relationship between child health and local macroeconomic conditions is much less understood. Specifically, whether changes in local unemployment rates during recessions predict changes in child hospital utilization (the largest source of child health care expenditures) is unknown. It is also unknown whether local macroeconomic changes may have especially large effects on child hospital utilization for particular types of conditions (which we call ?Economy Sensitive Conditions?). Our study has two specific aims: (1) To examine associations between periods of local macroeconomic growth and recession and all-cause hospital utilization (measured as rates of hospitalizations, hospital days, and attributable costs) for all children and by quartiles of child household income; and (2) To identify specific conditions (?Economy Sensitive Conditions?) that exhibit especially large changes in hospital utilization for children (all and by quartiles of child household income) during periods of local macroeconomic growth and recession. In exploring possible Economy Sensitive Conditions (Aim 2), the investigators will examine 3 types of conditions: (1) conditions with high prescription, equipment, or service needs (e.g., complex chronic conditions); (2) conditions exacerbated by inadequate home or neighborhood environments (e.g., asthma, trauma); and (3) conditions triggered by family stress (e.g., non-accidental trauma, mental health and substance use disorders). To accomplish these aims, the investigators will conduct a retrospective study of approximately 161.8 million child-years and 13.6 million pediatric hospitalizations from 13 states from 1990- 2014, a 24-year period that spans the Great Recession (2007-09) and two minor recessions. The study will merge individual state-year datasets from AHRQ's State Inpatient Databases and will map each patient's home ZIP code to economic data from the Census Bureau's annual American Community Survey, allowing us to examine associations between hospital utilization and economic conditions. This research is innovative because, as with the analogous concept of Ambulatory Care Sensitive Conditions (conditions for which hospitalizations are often preventable through appropriate outpatient care), Economy Sensitive Conditions may be conditions for which hospitalizations are expected to increase during economic downturns. This research is significant because it creates a novel approach for determining which children are at risk for worsened health during economic downturns, thereby leading to general or condition-specific interventions and policies that anticipate and prevent these negative and costly outcomes.
The proposed research is relevant to public health because it seeks to identify pediatric conditions that worsen during economic recessions (what we have termed ?Economy Sensitive Conditions?). The project is relevant to the mission of the Eunice Kennedy Shriver National Institute of Child Health and Development because it helps to ensure that all children have the chance to achieve their full potential for healthy and productive lives even in times of economic recessions. This research supports the mission of the National Institutes of Health by creation of knowledge that will reduce illness and disability through the development of interventions and policies aimed to mitigate the negative influence of economic recessions on childhood health.
