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

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.