Association between child behavior problems and frequent physician visits
B. Zuckerman, K. A. Moore and D. Glei
Department of Pediatrics, Boston University School of Medicine, Mass., USA.
OBJECTIVE: To determine the association between parent-reported behavior
problems and health care utilization, especially among physically healthy
children. DESIGN: Analysis of data from the 1988 National Health Interviews
Survey--Child Health Supplement. The sample for analysis consisted of
11,840 children aged 5 to 17 years. The independent measure of primary
interest are behavior problems as measured by the Behavior Problems Index.
For the bivariate analysis, children in the lowest quartile, highest
quartile and middle half were compared. For the multivariate analysis,
children in the highest quartile with behavior problems were compared with
all other children. MAIN OUTCOME MEASURES: The number of reported physician
visits in the past year and the past 2 weeks, Two common behavior
syndromes--antisocial and depressed or anxious--were analyzed separately to
determine whether a specific type of behavior problem was associated with
frequent health care utilization. RESULTS: Eighteen percent of the children
aged 5 to 17 years had four or more health visits during the past year, and
2% had two or more visits during the past 2 weeks. Children in the top
quartile for parent-reported behavior problems were more likely to have
four or more physician visits than children in the middle half and bottom
quartile. Children reported to be in "excellent," "very good," or "good"
health who were in the top quartile of behavior problems were more likely
to report four or more physician visits during the past year, but no
statistically significant differences were seen among children reported to
be in "fair" or "poor" health. Controlling for confounding variables,
children in the top quartile of the Behavior Problems Index are
significantly more likely to report four or more visits during the past
year and two or more visits during the past 2 weeks compared with other
children. Anxious or depressed and antisocial subscales of the Behavior
Problems Index showed independent and significant associations with four or
more physician visits in the past year. CONCLUSION: Children with
parent-reported behavior problems are likely to have more frequent
physician visits compared with children without behavior problems, even
when confounding sociodemographic and health status variables are
controlled. The association is concentrated among physically healthy
children.
