Double Jeopardy: What Social Risk Adds to Biomedical Risk in Understanding Child Health and Health Care Utilization

  • Ruth E.K. Stein
    Address correspondence to Ruth E. K. Stein, MD, Department of Pediatrics, Albert Einstein College of Medicine, Van Etten 6B27, 1300 Morris Park Avenue, Bronx, New York 10461.
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein and Dr Bauman); and Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University, New Brunswick, NJ (Dr Siegel)
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  • Michele J. Siegel
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein and Dr Bauman); and Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University, New Brunswick, NJ (Dr Siegel)
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  • Laurie J. Bauman
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein and Dr Bauman); and Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University, New Brunswick, NJ (Dr Siegel)
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      The aim of this study was to test the hypothesis that children with both social and biomedical risk factors are more likely to be in poorer health and utilize more health services than those with either type of risk alone.


      Variables were identified using the 1998 National Health Interview Survey and tested here on 2002 data. Dependent variables were health (poorer health rating) and service use (hospitalization or greater than 2 emergency services). High social risk was defined as greater than 2 risk factors (parental education less than high school, family income <200% of federal poverty level, and non–2-parent family). High biomedical risk was defined as having a chronic condition or birth weight <2500 grams.


      Children with either high social or biomedical risk were significantly more likely to be in poorer health (odds ratio [OR] 3.1–3.4) and to have higher utilization (OR 1.7–2.1) than children at low risk on both dimensions. Children with high risk on both dimensions were significantly more likely to be in poorer health (OR 7.8–7.9) and have higher utilization (OR 3.5–3.7) on both social and biomedical risks and those children rated high risk on either dimension alone. Overall, social risk was as powerful as biomedical risk in these models and added substantially to biomedical risk. Findings were stable using different cut points for social risk and health ratings, and different definitions of chronic condition.


      These findings have implications for health care planners and insurers in estimating the burdens on clinicians and potential costs of delivering care to those with high social risks.

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