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From Health Affairs:

Are Some Pediatric Hospitalizations Triggered by Recession?

Paul J. Chung, chair of Health Systems Science, co-authors study on interplay of economic conditions and child health

October 07, 2020

At a time of extreme market dislocation because of COVID-19, renewed public attention has been given to how those struggling with job and income loss are managing the potential health and financial crisis of contracting the virus. Could the fallout of negative market conditions affect the health of the nation’s most vulnerable family members?  

The answer, according to a new study with Dr. Paul J. Chung, MD, MS, chair of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine, is yes, though the severity varies widely by state.  

The study, “Economy Sensitive Conditions: Are Some Pediatric Hospitalizations Triggered by Economic Recessions?” published in Health Affairs, with lead author Dr. Jeffrey D. Colvin, associate professor in the Division of General Academic Pediatrics at Children’s Mercy Hospital in Kansas City, examines how county-level unemployment influenced pediatric hospitalizations in 14 states between 2002 to 2014. The time frame includes the global Great Recession, triggered by the subprime mortgage crisis.  

By focusing on how economic downturns affect hospitalizations - the most expensive aspect of children’s healthcare - the researchers were able to highlight the potential effect of recessions on both the health and healthcare of children.  

States examined in the study were Colorado, Florida, Iowa, Kentucky, Michigan, Nebraska, New Jersey, New York, North Carolina, Oregon, Rhode Island, Utah, Vermont, and Washington. 

After adjusting for state-specific effects of unemployment across all counties and years, the study found that even a minor uptick in unemployment was associated with increased pediatric hospitalizations for four potentially economy-sensitive conditions. A 1 percent increase in unemployment was associated with a 5 percent increase in hospitalizations for substance abuse, a 4 percent increase for diabetes mellitus, and a 2 percent increase in hospitalizations both for children with medical complexity and for poisoning and burns. Mean pediatric all-cause hospitalizations increased by 2 percent for every 1 percent rise in unemployment.  

While this increase may not sound dramatic, in absolute numbers it is considerable.  For instance, if the unemployment rate in 2011 (near the start of the slow recovery after the Great Recession) was as low as it was in 2005, there might have been 54,000 fewer hospitalizations that year among just the states the researchers studied. Whether the recession caused by COVID-19 will eventually show similar associations is unknown. Still, there may be lessons to draw from here.

“Increased pediatric hospitalizations might be anticipated during recessions, and appropriate planning by policy makers, public health officials, and healthcare leaders might be helpful,” said Chung. “Clinicians should pay special attention to the financial impact economic downturns have on their adult and pediatric patients, which can have serious health repercussions that go beyond the loss of employer-provided health insurance … Medical providers should be screening for unmet social needs, including food insecurity, and not just pre-existing health conditions, and take steps to connect their patients with community resources.” 

Read the entire article in Health Affairs .