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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Household income determines access to specialized pediatric chronic pain treatment in Germany

Authors: Ann-Kristin Ruhe, Julia Wager, Gerrit Hirschfeld, Boris Zernikow

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain.

Methods

Families presenting to a specialized pain center (N = 1,001) provided information on ‘household income, ‘parental education’ and ‘occupation’ to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75 % catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area.

Results

The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75 % catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. ‘Household income’ predicted travel distance (OR 1.32 (1.12–1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area.

Conclusions

In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.
Appendix
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Literature
1.
Apouey B, Geoffard PY. Family income and child health in the UK. J Health Econ. 2013;32(4):715–27.CrossRefPubMed
2.
3.
4.
Yantzi N, Rosenberg MW, Burke SO, Harrison MB. The impacts of distance to hospital on families with a child with a chronic condition. Soc Sci Med. 2001;52(12):1777–91.CrossRefPubMed
5.
Wager J, Ruhe A, Hirschfeld G, Wamsler C, Dobe M, Hechler T, Zernikow B. Influence of parental occupation on access to specialised treatment for paediatric chronic pain: A retrospective study. Schmerz. 2013;27(3):305–11.CrossRefPubMed
6.
Valenzuela JM, Seid M, Waitzfelder B, Anderson AM, Beavers DP, Dabelea DM, Dolan LM, Imperatore G, Marcovina S, Reynolds K. Prevalence of and Disparities in Barriers to Care Experienced by Youth with Type 1 Diabetes. J Pediatr. 2014;164(6):1369–75.CrossRefPubMedPubMedCentral
7.
Kamtsiuris P, Bergmann E, Rattay P, Schlaud M. [Use of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5–6):836–50.CrossRefPubMed
8.
Larson K, Halfon N. Family income gradients in the health and health care access of US children. Matern Child Health J. 2010;14(3):332–42.CrossRefPubMed
9.
Kuhlthau K, Nyman RM, Ferris TG, Beal AC, Perrin JM. Correlates of use of specialty care. Pediatr. 2004;113(3):e249–55.CrossRef
10.
Amone-P’Olak K, Ormel J, Oldehinkel AJ, Reijneveld SA, Verhulst FC, Burger H. Socioeconomic position predicts specialty mental health service use independent of clinical severity: The TRAILS study. J Am Acad Child Adolesc Psychiatry. 2010;49(7):647–55.PubMed
11.
Kemper KJ, Gardiner P, Birdee GS. Use of Complementary and Alternative Medical Therapies Among Youth With Mental Health Concerns. Acad Ped. 2013;13(6):540–5.CrossRef
12.
Simon M. Das Gesundheitssystem in Deutschland. Eine Einführung in Struktur und Funktionsweise, Vol. 4. Bern: Hans Huber; 2008.
13.
Reiss F. Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med. 2013;90:24–31.CrossRefPubMed
14.
Howe LD, Lawlor DA, Propper C. Trajectories of socioeconomic inequalities in health, behaviours and academic achievement across childhood and adolescence. J Epidemiol Community Health. 2013;67:358–64.CrossRefPubMedPubMedCentral
15.
Jarrin DC, McGrath JJ, Quon EC. Objective and subjective socioeconomic gradients exist for sleep in children and adolescents. Health Psychol. 2014;33(3):301–5.CrossRefPubMed
16.
Schechter MS, McColley SA, Silva S, Haselkorn T, Konstan MW, Wagener JS. Association of socioeconomic status with the use of chronic therapies and healthcare utilization in children with cystic fibrosis. J Pediatr. 2009;155(5):634–9.CrossRefPubMedPubMedCentral
17.
Koivusilta LK, Rimpel AH, Kautiainen SM. Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position? BMC Public Health. 2006;6(1):110–22.CrossRefPubMed
18.
Toliver-Sokol M, Murray CB, Wilson AC, Lewandowski A, Palermo TM. Patterns and predictors of health service utilization in adolescents with pain: Comparison between a community and a clinical pain sample. J Pain. 2011;12(7):747–55.CrossRefPubMedPubMedCentral
19.
Wichstrom L, Belsky J, Jozefiak T, Sourander A, Berg-Nielsen TS. Predicting Service Use for Mental Health Problems Among Young Children. Pediatr. 2014;133(6):1054–60.CrossRef
20.
King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011;152(12):2729–38.CrossRefPubMed
21.
Hechler T, Ruhe A-K, Schmidt P, Hirsch J, Wager J, Dobe M, Krummenauer F, Zernikow B. Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects. Pain. 2014;155(1):118–28.CrossRefPubMed
22.
Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, Meyer A, Hübner-Möhler B, Wamsler C, Blankenburg M. Characteristics of highly impaired children with severe chronic pain: A 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr. 2012;16(12):54–65.
23.
Azevedo LF, Costa-Pereira A, Mendonca L, Dias CC, Castro-Lopes J. Chronic Pain and Health Services Utilization: Is There Overuse of Diagnostic Tests and Inequalities in Nonpharmacologic Treatment Methods Utilization? Med Care. 2013;51(10):859–69.CrossRefPubMed
24.
Rahman MM, Kopec JA, Sayre EC, Greidanus NV, Aghajanian J, Anis AH, Cibere J, Jordan JM, Badley EM. Effect of sociodemographic factors on surgical consultations and hip or knee replacements among patients with osteoarthritis in British Columbia, Canada. J Rheumatol. 2011;38(3):503–9.CrossRefPubMed
25.
Lampert T, Schenk L, Stolzenberg H. [Conceptualization and operationalization of social inequality in The Child and Adolescent Health Survey]. Gesundheitsw. 2002;64:48–52.CrossRef
26.
Lampert T, Kroll LE. Die Messung des sozioökonomischen Status in sozialepidemiologischen Studien. In: Gesundheitliche Ungleichheit. edn.: VS Verlag für Sozialwissenschaften; 2009: 309–334.
27.
Hölling H, Schlack R, Kamtsiuris P, Butschalowsky H, Schlaud M, Kurth BM. [The KiGGS study. Nationwide representative longitudinal and cross-sectional study on the health of children and adolescents within the framework of health monitoring at the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012;55(6–7):836–42.CrossRefPubMed
28.
Kurth BM, Bergmann KE, Hölling H, Kahl H, Kamtsiuris P, Thefeld W. The National Child and Adolescent Health Survey. The complete concept. Gesundheitswesen. 2002;64:3–11.CrossRef
29.
Ellert U, Neuhauser H, Roth-Isigkeit A. [Pain in children and adolescents in Germany: the prevalence and usage of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5–6):711–7.CrossRefPubMed
30.
Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T. [Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50:578–89.CrossRefPubMed
31.
Dobe M, Damschen U, Reiffer-Wiesel B, Sauer C, Zernikow B. Three-week multimodal inpatient treatment of children with chronic pain. First results of the long-term follow-up. Schmerz. 2006;20(1):51–60.CrossRefPubMed
32.
Hechler T, Dobe M, Kosfelder J, Damschen U, Hübner B, Blankenburg M, Sauer C, Zernikow B. Effectiveness of a three-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: Statistical and clinical significance. Clin J Pain. 2009;25(2):156–66.CrossRefPubMed
33.
Zernikow B, Dobe M, Hirschfeld G, Blankenburg M, Reuther M, Maier C. [Please don’t hurt me!: a plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)]. Schmerz. 2012;26(4):389–95.CrossRefPubMed
34.
Chou SY, Deily ME, Li S. Hospital Report Cards, Patients’ Travel Distance, and Health Outcomes. 2009.
35.
Cohen J. Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Earlbaum Associates; 1988.
36.
Gelman A. Scaling regression inputs by dividing by two standard deviations. Stat Med. 2008;27(15):2865–73.CrossRefPubMed
37.
Simpson L, Owens PL, Zodet MW, Chevarley FM, Dougherty D, Elixhauser A, McCormick MC. Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income. Ambul Pediatr. 2005;5(1):6–e20.CrossRefPubMed
38.
Hechler T, Kosfelder J, Vocks S, Mönninger T, Blankenburg M, Dobe M, Gerlach AL, Denecke H, Zernikow B. Changes in pain-related coping strategies and their importance for treatment outcome following multimodal inpatient treatment: Does sex matter? J Pain. 2010;11(5):472–83.CrossRefPubMed
39.
Peng P, Choiniere M, Dion D, Intrater H, LeFort S, Lynch M, Ong M, Rashiq S, Tkachuk G, Veillette Y, et al. Challenges in accessing multidisciplinary pain treatment facilities in Canada. Can J Anaesth. 2007;54(12):985–91.CrossRefPubMed
40.
Federal Statistical O. [Information on Health Insurance (Results of the Microcencus]. In., vol. Fachserie 13, Reihe 1.1. Wiesbaden 2012; 2012.
41.
42.
Du Y, Knopf H, Zhuang W, Ellert U. Pain perceived in a national community sample of German children and adolescents. Eur J Pain. 2010;15(6):649–57.PubMed
43.
Gonzalez A, Boyle MH, Kyu HH, Georgiades K, Duncan L, MacMillan HL. Childhood and family influences on depression, chronic physical conditions, and their comorbidity: findings from the Ontario Child Health Study. Psychiatry Res. 2012;46(11):1475–82.CrossRef
44.
Hoftun GB, Romundstad P, Rygg M. Association of parental chronic pain with chronic pain in the adolescent and young adult. JAMA pediatr. 2013;167(1):61–9.CrossRefPubMed
45.
Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19(2):69–79.CrossRefPubMed
46.
Leung YW, Brual J, Macpherson A, Grace SL. Geographic issues in cardiac rehabilitation utilization: A narrative review. Health Place. 2010;16:1196–205.CrossRefPubMedPubMedCentral
47.
48.
Hradil S. Social inequality in Germany, vol. 8. Wiesbaden: VS Verlag für Sozialwissenschaften; 2001.
49.
Allin S, Stabile M. Socioeconomic status and child health: What is the role of health care, health conditions, injuries and maternal health? Health Economics. Policy Law. 2012;7(02):227–42.
50.
Carlisle CE, Mamdani M, Schachar R, To T. Predictors of psychiatric aftercare among formerly hospitalized adolescents. Can J PsychiatryRev Can Psychol. 2012;57(11):666–76.
51.
52.
Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy RK. Access to care for chronic pain: racial and ethnic differences. J Pain. 2005;6(5):301–14.CrossRefPubMed
Metadata
Title
Household income determines access to specialized pediatric chronic pain treatment in Germany
Authors
Ann-Kristin Ruhe
Julia Wager
Gerrit Hirschfeld
Boris Zernikow
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1403-9

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