Economic Stability of Children, a Key Social Determinant of Health, in the United States: Differences by Rurality

PURPOSE: This study aims to examine rural-urban differences in the prevalence of three measures of one domain of social determinants of heath, economic security, in a national sample of children. METHODS: This was a cross-sectional study (2022-2023) of the National Survey of Children's Health. Primary exposures included rurality and child and caregiver characteristics. Three economic stability outcomes were whether a child experienced housing instability, food insecurity, and/or income inadequacy (having a hard time getting by on family income). We used bivariate analyses and multivariable regressions analyses to examine the association between rurality and measures of economic stability. All analyses were weighted with survey sampling to generate nationally representative estimates. FINDINGS: In the weighted multivariable regression analysis, adjusting for child and caregiver characteristics, rural children had higher odds of housing instability (aOR 1.20; 95% CI 1.07-1.34), food insecurity (aOR 1.47; 95% CI 1.22-1.78), and income inadequacy (aOR 1.32; 95% CI 1.18-1.48), compared to urban children. CONCLUSIONS: Rural children and their families are experiencing everyday challenges in housing, food access, and the ability to get by on their income, which are all shown to have ramifications on their health. Child advocates, policymakers, and program developers must consider these factors when developing programs and policies for families residing in rural America.