Parents of seriously ill children appear at increased risk for unemployment

Parents of children with serious health problems appear less likely to be employed, according to a study from the Center for Child and Adolescent Health Policy at MassGeneral Hospital for Children.

The study, which appears in the December 2001 issue of Archives of Pediatric and Adolescent Medicine, draws on a more comprehensive study population than have earlier investigations. It also is the first to look at employment patterns for fathers as well as mothers.

"The number of children being cared for at home for serious health problems has significantly increased in recent years," says Karen Kuhlthau, PhD, the study?s first author. "But there is still a lot we don?t know about what that means for the families of those children and for the health care system in general. We need to find data to support the assumptions that have been made about illness?s impact on these families."

The study's authors cite several factors underlying the situation. New medical treatments and technologies have led to more infants and children surviving serious diseases, injuries and problems like premature birth; many of those children have resulting chronic health problems.

In addition, illnesses like AIDS and asthma are affecting larger numbers of children. In parallel trends, more services are available to support families caring for children at home, while insurers and care providers are striving to reduce hospital stays and institutional care.

At the same time, far greater numbers of women with young children are entering the workforce, and increased rates of divorce and out of wedlock births have led to more single-parent families.

The current study analyzed data from the 1994 National Health Interview Survey on Disability, conducted by the U.S. Bureau of the Census and designed to include a broad representative sampling of the U.S. population. The survey includes information on children?s overall health status, limitations in their activity, the presence of any chronic conditions, and any recent hospitalizations. Participants are asked whether or not they worked during the two weeks before completing the survey.

The study's results showed that, for both mothers and fathers, having a child with poor health was significantly associated with not being employed. For mothers, lack of employment was most strongly associated with limitations in a child?s activities; for fathers, the strongest association was with hospitalization, differences that could reflect specific parental caregiving responsibilities.

"While we?re not yet able to say that having a seriously ill child causes a drop in parental employment, the implication is that this is a serious issue for these families," says James Perrin, MD, director of the Center for Child and Adolescent Health Policy, the study?s senior author.

He continues, "In considering how to meet the needs of chronically ill children, it is important to think in the context of the whole family. These families have a wide array of increased costs that range from medications to transportation and special equipment. Reductions in parents? income could lead to a worsening of the child?s health problems."

The study was partially funded by a grant from the Maternal and Child Health Bureau, U.S. Health Resources and Services Administration.

MassGeneral Hospital for Children is the pediatric service of Massachusetts General Hospital. Established in 1811, MGH is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, the neurosciences, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women?s Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.