Assessing disparities on caregiver factors known to affect children's pain and outcomes

Abstract

Parental health, beliefs and behaviors influence pediatric pain experiences and treatment outcomes. There is increasing acknowledgment of pain disparities in underrepresented ethnic groups and growing understanding of social and economic factors (SEFs) that affect pain. Less is known about SEFs’ impact on caregivers and whether the presence of multiple SEFs increases risk of disparities. The present study assesses 1) disparities by ethnicity and insurance status in mental health (MH), physical health (PH), pain catastrophizing (PC) and protective behaviors (PB) of caregivers of children with pain, and 2) whether insurance status moderates ethnic disparities. 792 caregivers identifying as Hispanic (26%) and Non-Hispanic White (NHW; 74%) provided data before initial visit to an outpatient pediatric pain clinic. Measures included demographic information, insurance, PROMIS Global Health, the parent version of the Pain Catastrophizing Scale, and the Protect subscale of the Adult Responses to Children's Symptoms scale. Health-insurance was coded as private (73.4%) or public (25.5%). Hispanic caregivers were younger, had lower educational levels, and were more likely to have public insurance. Hispanic caregivers reported poorer PH and higher levels of PC and PB. Public insurance was associated with poorer PH and MH and with higher PC and PB. Two-way ANOVAs revealed main effects for ethnicity on PH, MH, and PB were no longer significant with insurance entered into model but remained significant for PC. Insurance main effects were significant for PH, PM, PC, and PB. None of the interaction terms were significant. Findings highlight disparities by ethnicity and insurance status in caregiver factors known to affect children's pain and treatment outcomes and underscore the role of insurance as a contributor to disparities. Results highlight the importance of assessing SEFs that may affect caregivers of children with pain to provide optimal support to families and maximize child treatment outcomes.