Urban Versus Rural Differences in the Effects of Providing Care to Children With Cerebral Palsy on Family Member's Employment

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Developmental Medicine & Child Neurology




Background and Objective(s): Context (urban vs rural) can mediate the impact on the family among other childhood populations with special healthcare needs. To date, few studies have examined the role of context in caring for a child with CP; therefore, we analyzed data from the National Survey of Children with Special Health Care Needs (NS-CSHCN).

Study Design: Cross-sectional.

Study Participants & Setting: Participants were parents of children (< 18y old) with CP. Children's mean age of rural respondents was 10.17 (SD=4.69), while 73% were white, 13.5% Hispanic, 11% black, and 2.5% other (non-Hispanic). Among rural families, 33.05% were living in households with incomes below the Federal Poverty Level (FPL). For those respondents living in urban areas, children's mean age was 9.74 (SD=4.50) and 63% were white, 13% Hispanic, 16% black, and 8% other (non-Hispanic). Overall 21.1% of urban families lived in households with incomes below the FPL.

Materials/Methods: The NS-CSHCN was designed to examine state- and national-level estimates of CSHCN. A national random-digit-dial sample of US households were screened for children with special healthcare needs aged 0–17 years. Households reporting a CSHCN participated in an interview for one randomly selected child with a special healthcare need. Of 40 242 completed interviews from 2009 to 2011, 744 reported as having a child with a diagnosis of CP and were included in the sample. We performed logistic regression analyses, in the context of multiply imputed data to address missing data concerns, modeling the probability that family member's employments were unaffected by the child's health.

Results: Our analysis indicated significant differences between families with children with CP living in an urban environment and those living in a rural setting concerning the impact that the child's health had on family member's work lives. There were six significant variables impacting the employment of family members for families living in an urban setting categories relating to missed school days, financial burden, and access to services (see Table 1). However, only a low financial burden and less time spent caring for the child were significant with regards to the impact on employment among rural families.

Conclusions/Significance: Despite a higher percentage of families living in poverty, urban families had more protective factors to prevent the diagnosis of a child from impacting the employment of the family.