AMBULATORY PEDIATRICS

VOLUME 6, NUMBER 5

EMBARGOED UNTIL September 21, 2006

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US Children’s Health Care Insurance Coverage, Health Service Use, and Expenditures by County Level of Urban Influence

Ambulatory Pediatrics publishes in this issue of the Journal its annualreview of health care trends for children. This comprehensive report uses two national databases to describe health service indicators in 2002 for children by how urban or rural their county of residence is. This work uses Urban Influence Codes, new categories to describe the “urbanicity,” relative urban/rural characteristics of counties. The specific categories are: (1) “large metropolitan” for counties with a population of 1 million or more; (2) “small metropolitan” for counties with fewer than 1 million residents; (3) “micropolitan” counties with one or more towns of at least 10,000 residents; and (4) “noncore” counties that lack any towns of 10,000 people. Selected findings are highlighted here. For additional information, contact Frances Chevarley, PhD, 301-427-1473.

Health care insurance coverage
  • Black, non Hispanic children and Hispanic children residing in micropolitan counties were less likely to have private insurance than their respective peers in large metropolitan areas. However, in general, the proportion of children who were uninsured had public insurance or private insurance did not vary by urbanicity of residence.
Use of Health Care
  • For uninsured children, differences in visits to the doctor by geography were substantial: children in small metro counties had 4.2 annual doctors’ visits compared with 2.6 visits for children in large metro counties. For all children, regardless of insurance status, mean number of annual office visits was lower in large metro counties (3.8) than in small metro counties (4.5 visits) and in micropolitan counties (4.3 visits).
  • The use or probability of use of many services generally increased with increasing rural character of the county. Number of prescription medications rose with increasing “ruralization” from 4.3 for large metro, 4.9 for small metro, 5.0 for micro, and 5.5 for noncore. The likelihood of hospitalization -- 2.4%, 2.9%, 3.7%, and 4.3 – and the likelihood of an emergency department visit – 12.0%, 13.7%, 19%, and 17.5% – generally increased respectively for large metropolitan, small metropolitan, micropolitan, and noncore.
  • The proportion of children with at least one dental visit was higher in small metro counties (47.2%) compared with both large metro (42.6%) and noncore (40.4%) counties.
Expenditures
  • Regardless of poverty status, children in large metro counties were less likely to have any expenditure than children in small metro counties (74.3% and 81.5% respectively for children < 200% federal poverty limit [FPL]; 88.8% and 91.4% respectively for children ≥ 200% FPL).

Middle Ear Effusion in Young Children Is Not Associated with

School Achievement at Age 7

Conventional wisdom suggests that young children with early persistent middle ear effusion i.e., otitis media with effusion or serous otitis media are at risk for poorer academic performance in school. To test this assumption, researchers recruited 698 newborns and monitored them for middle ear effusion every 2-4 weeks until age 3. They then sought school records of these children’s performance and obtained data for 226 children at age 7 years. Overall, after controlling for gender, socioeconomic status, the home environment and ethnicity, statistical analyses found no relationship between middle ear effusion in the first 3 years of life and school achievement at age 7 years as measured by 11 standard tests. This study contributes to resolving the long-standing controversy about the effects of middle ear effusion in youngsters on their later performance in school. (Contact David McCormick, MD, 409-772-1444.)

Predicting Children’s Blood Lead Levels from Exposure to School Drinking Water

Lead exposure through drinking water is of increasing interest although little is known about its potential impact on children’s health. In 2004, testing of school drinking water in Seattle found that lead levels exceeded national guidelines. As a result, researchers estimated potential blood lead levels (BLLs) in elementary school aged children to better understand the risks of these exposures. Using US Environmental Protection Agency (EPA) modeling, they estimated typical-case and worst-case scenarios for children in 71 elementary schools. The estimated BLLs for typical-case schools ranged between 1.6-2.5 μ/dL and worst-case scenarios predicted BLLs between 1.7 to 5.0 μ/dL. These predicted BLLs are well below the Centers for Disease Control and Prevention (CDC) public health goal of <10 μ/dL. The modeling suggests that drinking water lead exposure up to 10-15 times the EPA guidelines are unlikely to result in BLLs exceeding CDC’s recommendations. Further characterization of drinking water is indicated only if children are drinking more water or if water lead concentrations are higher than those in this study. (Contact Sheela Sathyanarayana, MD, 206-616-5928.)

Relationship of Childhood Behavior Disorders to Weight Gain

from Childhood to Adulthood

Obesity and behavior disorders are important conditions that affect the health of children and adolescents. The relationship between them has not been studied longitudinally. Researchers investigated childhood to adult weight change associated with attention deficit and disruptive behavior disorders. Females with disruptive disorders were estimated at all ages to have average standardized BMI scores 0.23 units (95% confidence interval [CI] 0.03-0.44) higher than females without disruptive conduct. Similarly, males at all ages with disruptive disorders had average standardized BMI score 0.20 units (95% CI 0.00-0.39) higher than males without such disorders. These standardized BMI scores translate into weight differences in adulthood of approximately 5 to 15 pounds depending on height. Disruptive disorders were associated with heavier weight that was maintained from childhood into adulthood. (Contact Sarah Anderson, PhD, 617-636-2403.)

The official journal of the Ambulatory Pediatric Association (APA), Ambulatory Pediatrics provides a much-needed forum for cutting-edge work in general pediatrics. The journal focuses on areas including child health services research, emergency medicine, research methodology, complementary and alternative medicine, child health policy, and adolescent medicine. Ambulatory Pediatrics is indexed in Index Medicus.

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