Access to care for children of migratory agricultural workers: factors associated with unmet need for medical care

Pediatrics. 2004 Apr;113(4):e276-82. doi: 10.1542/peds.113.4.e276.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Agriculture*
  • Caregivers
  • Child
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Cross-Sectional Studies
  • Educational Status
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Medically Uninsured / ethnology
  • Medically Uninsured / statistics & numerical data
  • North Carolina
  • Sampling Studies
  • Surveys and Questionnaires
  • Transients and Migrants / statistics & numerical data*