Access to Care for Children of Migratory Agricultural Workers: Factors Associated With Unmet Need for Medical Care

Abstract

Objective. To assess the correlates of unmet need for medical care among migrant children. Design and Setting. A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina. Participants. Three hundred adult caretakers of 1 (per household) randomly selected child <13 years old. Results. Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.16–0.61) and less than high school caretaker education (OR: 0.62; 95% CI: 0.39–0.98) and was associated directly with 1) having bed-days due to illness (OR: 2.46; 95% CI: 1.42–4.26), 2) lacking an annual well examination (OR:1.89; 95% CI: 1.12–3.20), 3) transportation dependence (OR:1.97; 95% CI: 1.24–3.13), 4) female gender (OR: 1.69; 95% CI: 1.07–2.67), 5) preschool age (OR: 2.24; 95% CI: 1.28–3.92), and 6) very high caretaker work pressure (OR: 5.01; 95% CI: 2.98–8.42). Adjustment using multiple logistic regression reveals unmet medical need to be independently associated with preschool age (OR: 2.08; 95% CI: 1.05–4.13) and very high caretaker pressure to work (OR: 5.93; 95% CI: 3.24–10.85). Of sampled children, 27% were preschool aged, and 40% had caretakers categorized with high work pressure. Conclusions. Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications.