HEALTH-CARE USE OF 3-YEAR-OLD LOW-BIRTH-WEIGHT PREMATURE CHILDREN - EFFECTS OF FAMILY AND NEIGHBORHOOD POVERTY

Objective: The objective of this study was to examine the effect of fa mily and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619). Design: A birth cohort was enrolled in a clinical randomized trial of early childhood educat ional and family services. Settings/participants: Infant Health and De velopment Program provided a sample of low birth weight premature infa nts stratified by clinical site, birth weight, and treatment group. Ma ternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth. Main outcome meas ures: Maternal reports of hospitalizations, doctor visits, and emergen cy department visits were used; data were averaged over the child's fi rst 3 years of life. Results: Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency depart ment visits than residence in affluent neighborhoods. Families in midd le-income neighborhoods reported more doctor visits than families in p oor or affluent neighborhoods. Conclusion: Neighborhood residence infl uences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.