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Brief ReportBrief Report

Children’s Special Health Care Needs and Caregivers’ Well-Being During the COVID-19 Pandemic

Melisa Pasli and Dmitry Tumin
The Journal of the American Board of Family Medicine October 2023, 36 (5) 731-738; DOI: https://doi.org/10.3122/jabfm.2022.220406R2
Melisa Pasli
From the Brody School of Medicine at East Carolina University, Greenville NC (MP), Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville NC (DT).
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Dmitry Tumin
From the Brody School of Medicine at East Carolina University, Greenville NC (MP), Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville NC (DT).
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Article Figures & Data

Tables

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    Table 1.

    Weighted Means or Proportions with 95% Confidence Intervals of Study Variables, Stratified by Era and Child Special Health Care Needs (SHCN) Status (n = 147,487)

    VariableFamilies without CSHCNFamilies with CSHCN
    Pre-Pandemic (n = 44,345)Pandemic Era (n = 69,160)PPre-Pandemic (n = 13,582)Pandemic Era (n = 20,400)P
    Caregiver physical health
     Excellent0.23 (0.22, 0.23)0.22 (0.21, 0.23)0.5060.13 (0.12, 0.14)0.12 (0.11, 0.13)0.328
     Very good0.40 (0.39, 0.41)0.40 (0.39, 0.41)0.6780.34 (0.32, 0.36)0.33 (0.32, 0.35)0.408
     Good0.29 (0.29, 0.30)0.30 (0.29, 0.31)0.7070.35 (0.34, 0.37)0.36 (0.35, 0.37)0.624
     Fair0.07 (0.06, 0.07)0.07 (0.07, 0.07)0.7640.14 (0.12, 0.15)0.14 (0.12, 0.16)0.357
     Poor0.01 (0.01, 0.02)0.01 (0.01, 0.01)0.2550.04 (0.03, 0.05)0.04 (0.03, 0.05)0.632
    Caregiver mental health
     Excellent0.34 (0.33, 0.35)0.31 (0.30, 0.31)<0.0010.21 (0.20, 0.22)0.18 (0.16, 0.19)<0.001
     Very good0.38 (0.37, 0.39)0.38 (0.37, 0.39)0.8840.35 (0.34, 0.37)0.33 (0.32, 0.35)0.089
     Good0.22 (0.21, 0.23)0.24 (0.23, 0.25)<0.0010.31 (0.29, 0.33)0.33 (0.32, 0.35)0.036
     Fair0.05 (0.05, 0.06)0.06 (0.06, 0.07)0.0010.11 (0.10, 0.12)0.13 (0.12, 0.14)0.001
     Poor0.01 (0.01, 0.01)0.01 (0.01, 0.01)0.0460.02 (0.02, 0.03)0.03 (0.02, 0.03)0.736
    Caregiver age (years)41.1 (40.9, 41.3)41.1 (41.0, 41.3)0.73643.3 (43.0, 43.6)43.5 (43.2, 43.7)0.369
    Caregiver born outside US0.30 (0.29, 0.31)0.30 (0.29, 0.31)0.4670.18 (0.16, 0.19)0.19 (0.18, 0.21)0.241
    Caregiver education
     High school or less0.23 (0.22, 0.24)0.24 (0.23, 0.24)0.5780.21 (0.20, 0.23)0.20 (0.19, 0.22)0.404
     Some college0.26 (0.25, 0.27)0.24 (0.23, 0.25)0.0010.30 (0.29, 0.32)0.29 (0.28, 0.31)0.513
     Four-year college degree0.51 (0.50, 0.52)0.52 (0.52, 0.53)0.0310.49 (0.47, 0.50)0.50 (0.49, 0.52)0.155
    Household language
     English0.84 (0.83, 0.85)0.84 (0.83, 0.84)0.2170.93 (0.92, 0.94)0.91 (0.90, 0.92)0.031
     Any other language0.16 (0.15, 0.17)0.16 (0.16, 0.17)0.2170.07 (0.06, 0.08)0.09 (0.08, 0.10)0.031
    Household structure
     Two parents0.75 (0.74, 0.76)0.74 (0.73, 0.74)0.0260.64 (0.62, 0.66)0.66 (0.64, 0.67)0.250
     Single mother0.16 (0.15, 0.17)0.17 (0.16, 0.18)0.0210.24 (0.22, 0.26)0.23 (0.21, 0.24)0.216
     Any other0.09 (0.09, 0.10)0.09 (0.09, 0.10)0.7010.12 (0.11, 0.13)0.12 (0.11, 0.13)0.984
    Child age (years)8.3 (8.2, 8.4)8.2 (8.2, 8.3)0.79010.3 (10.2, 10.5)10.4 (10.3, 10.6)0.508
    Child sex
     Female0.51 (0.50, 0.52)0.50 (0.50, 0.51)0.9550.43 (0.41, 0.44)0.43 (0.41, 0.44)0.924
     Male0.49 (0.48, 0.50)0.50 (0.49, 0.50)0.9550.57 (0.56, 0.59)0.57 (0.56, 0.59)0.924
    Child race and ethnicity
     Non-Hispanic White0.51 (0.50, 0.52)0.51 (0.50, 0.51)0.8690.54 (0.52, 0.56)0.52 (0.51, 0.54)0.117
     Non-Hispanic Black0.12 (0.12, 0.13)0.12 (0.12, 0.13)0.9750.16 (0.15, 0.17)0.15 (0.14, 0.17)0.518
     Hispanic or Latino0.26 (0.25, 0.27)0.26 (0.25, 0.27)0.8700.20 (0.18, 0.22)0.23 (0.21, 0.25)0.014
     None of the above0.11 (0.11, 0.12)0.11 (0.11, 0.12)0.5440.10 (0.09, 0.11)0.09 (0.08, 0.10)0.335
    Child health insurance
     Private0.62 (0.61, 0.63)0.62 (0.61, 0.63)0.8870.56 (0.54, 0.57)0.56 (0.54, 0.57)0.886
     Public0.27 (0.26, 0.28)0.27 (0.26, 0.28)0.6820.37 (0.36, 0.39)0.37 (0.35, 0.38)0.646
     Other0.04 (0.03, 0.04)0.04 (0.03, 0.04)0.5020.03 (0.03, 0.04)0.03 (0.03, 0.04)0.851
     None0.07 (0.07, 0.08)0.07 (0.07, 0.08)0.3770.04 (0.03, 0.05)0,04 (0,03, 0.05)0.567
    Child health condition limits age-typical  activities
     Nevera0.95 (0.95, 0.96)0.97 (0.96, 0.97)<0.0010.48 (0.47, 0.50)0.51 (0.50, 0.53)0.024
     Sometimes0.04 (0.04, 0.05)0.03 (0.03, 0.04)<0.0010.38 (0.36, 0.39)0.37 (0.36, 0.39)0.621
     Often0.00 (0.00, 0.00)0.00 (0.00, 0.00)0.1930.08 (0.07, 0.10)0.07 (0.06, 0.07)0.007
     Always0.00 (0.00, 0.00)0.00 (0.00, 0.00)0.7930.05 (0.05, 0.06)0.05 (0.04, 0.06)0.644
    Child overall health
     Excellent0.73 (0.72, 0.74)0.74 (0.73, 0.74)0.7830.36 (0.35, 0.38)0.37 (0.35, 0.38)0.914
     Very good0.21 (0.20, 0.22)0.21 (0.20, 0.22)0.6280.36 (0.35, 0.38)0.36 (0.35, 0.38)0.993
     Good0.05 (0.04, 0.05)0.05 (0.04, 0.05)0.9830.21 (0.20, 0.23)0.21 (0.20, 0.22)0.759
     Fair0.00 (0.00, 0.01)0.00 (0.00, 0.01)0.6600.05 (0.04, 0.06)0.06 (0.05, 0.07)0.511
     Poor0.00 (0.00, 0.00)0.00 (0.00, 0.00)0.1430.01 (0.01, 0.01)0.01 (0.00, 0.01)0.278
    Family income (% FPL)
     <1000.18 (0.17, 0.19)0.18 (0.17, 0.18)0.6750.22 (0.20, 0.24)0.19 (0.17, 0.21)0.040
     100 to 1990.22 (0.20, 0.23)0.20 (0.20, 0.21)0.1380.22 (0.21, 0.24)0.22 (0.21, 0.24)0.885
     200 to 3990.29 (0.28, 0.30)0.29 (0.29, 0.30)0.2600.26 (0.24, 0.27)0.29 (0.27, 0.30)0.007
     400 or greater0.32 (0.31, 0.33)0.33 (0.32, 0.33)0.2920.30 (0.28, 0.31)0.30 (0.28, 0.31)0.704
    • a Includes children with no health conditions.

    • Abbreviations: CSHCN, children with special health care needs; FPL, Federal poverty level; US, United States.

    • View popup
    Table 2.

    Multivariable Ordinal Logistic Regression Model of Caregiver Physical Health, with Higher Values Indicating Worse Health (n = 147,487)

    VariableOR95% CIP
    Child special health care needs
     Family without CSHCNRef.
     Family with CSHCN1.691.57, 1.83<0.001
    Era
     Pre-pandemicRef.
     Pandemic1.030.98, 1.080.323
    CSHCN x pandemic era interaction1.070.96, 1.190.205
    Caregiver age (years)1.031.02, 1.03<0.001
    Caregiver born outside US0.710.66, 0.76<0.001
    Caregiver education
     High school or lessRef.
     Some college0.990.91, 1.070.746
     Four-year college degree0.630.58, 0.68<0.001
    Household language
     EnglishRef.
     Any other language0.770.70, 0.86<0.001
    Household structure
     Two parentsRef.
     Single mother0.920.85, 0.980.017
     Any other0.750.68, 0.82<0.001
    Child age (years)1.011.002, 1.01<0.001
    Child sex
     FemaleRef.
     Male0.970.93, 1.020.197
    Child race and ethnicity
     Non-Hispanic WhiteRef.
     Non-Hispanic Black1.040.96, 1.120.298
     Hispanic or Latino1.261.16, 1.36<0.001
     None of the above1.251.17, 1.33<0.001
    Child health insurance
     PrivateRef.
     Public1.381.28, 1.48<0.001
     Other0.980.86, 1.120.755
     None0.920.82, 1.040.171
    Family income (% FPL)
     <100Ref.
     100 to 1990.850.77, 0.930.001
     200 to 3990.790.72, 0.86<0.001
     400 or greater0.550.50, 0.67<0.001
    • Abbreviations: CI, confidence interval; CSHCN, children with special health care needs; FPL, Federal poverty level; OR, odds ratio; Ref, reference; US, United States.

    • View popup
    Table 3.

    Multivariable Ordinal Logistic Regression Model of Caregiver Mental Health, with Higher Values Indicating Worse Health (n = 147,487)

    VariableOR95% CIP
    Child special health care needs
     Family without CSHCNRef.
     Family with CSHCN1.881.74, 2.03<0.001
    Era
     Pre-pandemicRef.
     Pandemic1.201.15, 1.26<0.001
    CSHCN x pandemic era interaction1.050.95, 1.160.341
    Caregiver age (years)1.001.00, 1.000.735
    Caregiver born outside US0.690.65, 0.75<0.001
    Caregiver education
     High school or lessRef.
     Some college1.091.00, 1.180.042
     Four-year college degree0.920.85, 0.990.048
    Household language
     EnglishRef.
     Any other language0.670.60, 0.75<0.001
    Household structure
     Two parentsRef.
     Single mother1.060.99, 1.140.101
     Any other0.710.65, 0.78<0.001
    Child age (years)1.001.00, 1.010.216
    Child sex
     FemaleRef.
     Male0.950.91, 0.990.012
    Child race and ethnicity
     Non-Hispanic WhiteRef.
     Non-Hispanic Black0.750.69, 0.81<0.001
     Hispanic or Latino1.030.96, 1.110.418
     None of the above1.191.11, 1.27<0.001
    Child health insurance
     PrivateRef.
     Public1.221.14, 1.31<0.001
     Other0.960.84, 1.090.534
     None0.960.85, 1.070.459
    Family income (% FPL)
     <100Ref.
     100 to 1990.910.83, 1.010.068
     200 to 3990.900.82, 0.980.018
     400 or greater0.690.62, 0.75<0.001
    • Abbreviations: CI, confidence interval; CSHCN, children with special health care needs; FPL, Federal poverty level; OR, odds ratio; Ref, reference; US, United States.

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The Journal of the American Board of Family     Medicine: 36 (5)
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September-October 2023
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Children’s Special Health Care Needs and Caregivers’ Well-Being During the COVID-19 Pandemic
Melisa Pasli, Dmitry Tumin
The Journal of the American Board of Family Medicine Oct 2023, 36 (5) 731-738; DOI: 10.3122/jabfm.2022.220406R2

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Children’s Special Health Care Needs and Caregivers’ Well-Being During the COVID-19 Pandemic
Melisa Pasli, Dmitry Tumin
The Journal of the American Board of Family Medicine Oct 2023, 36 (5) 731-738; DOI: 10.3122/jabfm.2022.220406R2
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