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Background: Children with special health care needs (CSHCN) are those who: (1) have or are at increased risk for a chronic medical condition and (2) require more health care than children generally. Because the CSHCN designation is intended to improve access to care, including securing a medical home and public programs that address the health needs of CSHCN, an important policy issue is whether childhood overweight meets both criteria that define CSHCN. Methods: This is a cross-sectional analysis of two nationally representative data sources, the 2001-2002 National Health and Nutrition Examination Survey (NHANES) and the 2002 Medical Expenditure Panel Survey (MEPS). Both surveys are used to examine the relationship between overweight and health status. NHANES is used to examine the relationship between overweight and three chronic conditions: dyslipidemia, dysglycemia, and hypertension. MEPS is used to examine the relationship between overweight, health care use and expenditures, and a medical home. Results: Overweight children, compared to healthy-weight children, have significantly increased risk for high total cholesterol, high or borderline LDL cholesterol, low HDL cholesterol, high triglycerides, high fasting glucose, high glycohemoglobin, and high systolic blood pressure. Overweight children report worse health status than healthy-weight children. Compared to healthy weight children, overweight children are less likely to have any health care expenditure; this difference does not remain after adjusting for socioeconomic status. Having a medical home tends to be associated with greater health care use and expenditures, though not consistently. Conclusions: These findings suggest that overweight children may meet the definition of CSHCN. They are clearly at increased risk for chronic health conditions that require more health care than that needed by healthy-weight children. Including overweight children under the umbrella of CSHCN is one potential strategy for improving access to care and enhancing health care resources available to overweight children. Such strategies to address overweight during childhood are critical to prevent chronic conditions, improve health status, and reduce health care expenditures, both during childhood and into adulthood. |
