The aim of this study was to evaluate the relationship between sociodemographic/socioeconomic factors and learning disability in preterm children. Findings from this study showed health insurance, federal poverty level, food situation at home, and sex to be significantly associated with learning disability in children. Children who are not currently and adequately insured had greater odds of having learning disability compared to those with current and adequate health insurance. This finding is consistent with the literature as studies have shown extremely low health care utilization in children with special needs, despite being the category that needs healthcare the most, given associated health issues [7, 25,26,27,28]. This finding highlights a gap in health care access for families with children living with learning disabilities (CLWLD) in terms of obtaining health care consultation for their children as well as obtaining coverage for necessary medications, potentially placing CLWLD at risk of severe health complications.
Previous studies have documented an increasing amount of emergency care visits and hospitalizations for children with special care needs due to a lack of adequate health insurance [27, 28]. Although several health insurance plans are available for children under the Affordable Care Act, especially for families of low-income including Medicaid, Children’s Health Insurance Program (CHIP), and qualified health plans (QHPs) [ 27, 28], however, several issues such as cost-sharing between families and insurance companies as well as high out of pocket costs still present as limiting factors for health care utilization [27, 28].
Findings from this study also showed that children living in households that cannot afford nutritious meals were more likely to have learning disability compared to children living in households that can afford nutritious meals. From a clinical perspective, proper and adequate nutrition is necessary for neurodevelopment, body growth, and functioning of the organ system. Similar findings have been reported in other studies as poor nutrition has been shown to cause less participation in school activities, poor concentration during classes, tardiness, and in some cases can result in socially unacceptable behaviors like stealing from peers [29]. Such action can cause this group of children to be treated differently and isolated from their peers, giving rise to issues such as low self-esteem, anxiety, aggression, and stress, all of which can severely affect child learning and behavior [ 27, 29]. Additional studies have linked poor nutrition in childhood to the development of permanent structural brain damage along with the development of chronic illness such as obesity, heart diseases, and diabetes, later in life [27, 29, 30].
Another important finding is that families of children in the lowest income level were more likely to have children with learning disability compared to those in the highest income level. Data from previous studies show that in 2013, about 40% of CLWLD in the United States were found to live in households within the lowest income category of 100–200% FPL [26, 27]. Additional studies have highlighted the restrictive effect of poverty in the ability of families to access special services for their CLWLD, [26, 31, 32] along with differences in terms of race or ethnicity, as African American or Black CLWLD were less likely to access special services in relation to their White peers [22, 27]. This disproportionality cuts across socioeconomic factors and the availability of resources for minority populations. The importance of this finding can be viewed as poverty being the root cause of subsequent socioeconomic effects affecting CLWLD, as it directly impacts both food situation at home as well as access to adequate health insurance.
While substantial strides have been made by the government in addressing the issue of poverty especially for low-income families, in the manner of provision of food stamps, cash or voucher programs- supplement security income [26], a lot more still needs to be done given prevailing conditions of families with CLWLD in the low-income category.
Consistent with other studies where gender differences have been shown to exist with respect to learning disability cases [7, 21], our study found that male children had a higher likelihood of having learning disability compared to females. The etiology of these differences remains unclear [21].
In model 2, findings from the interaction analysis between adult education and health insurance for CLWLD weres statistically significant. Similar interaction analysis has been examined in a previous study [24]. Learning disability was associated with educational status in the uninsured but was not significant in the insured group. Compared to parents with some college or higher, parents with less than high school or high school education who were uninsured had a higher odds of learning disability in their children. This finding underscores the protective effect of health insurance in the association between learning disability and parental education, suggesting that the presence or absence of health insurance could be a major moderator of socioeconomic factors like parental educational status on outcomes like learning disability, although more longitudinal analyses are needed to clarify this effect. Given the critical state of health insurance in the United States, as the U. S Census Bureau’s Health insurance coverage report stated that in 2018, more than 4 million children had no health insurance coverage [33], it is highly imperative that attention is placed on CLWLD without current and adequate health insurance.
The presence of a learning disability in a child is associated with numerous health and social consequences including repetition of grades, dropping out of high school, peer rejection, anxiety, as well as behavioral and conduct problems [ 16–18, 34, 35]. In addition, a study has shown a particular form of learning disability in children, nonverbal type to be associated with depression and suicide [36]. Additionally, families of CLWLD experience various range of effects such as poor mental health due to associated stress, marital issues, interruption of work and career plans [26, 29, 30, 37], and on their siblings can cause relationship and behavioral issues as they perceive lack of attention from parents [38, 39]. Given the consequences associated with learning disability irrespective of socioeconomic status, the magnitude of these consequences arise in a dose-response fashion for families in the low socioeconomic category with increasing stress on the family which ultimately affects CLWLD in such families.
The future expectations of most youths includes graduating from school, getting a job, and being financially dependent irrespective of disabilities, however, CLWLD tends to have slower progress in achieving these goals, and this progress is increasingly impeded for CLWLD from families with low socioeconomic status [40]. Therefore, efforts aimed at addressing the root causes of learning disability, particularly socioeconomic factors, in order to close the gaps in accessing special services for CLWLD as well as providing resources for families in managing CLWLD would prove invaluable in mitigating these adverse health and social consequences as well as protect and promote the health and future success of children with disabilities.
Findings from this study highlights the important role sociodemographic and socioeconomic factors play as determinants of progression of learning disability in preterm children and provide an avenue for solutions to be developed to address these factors. Possible recommendations for tackling this issue will involve collaboration between public health professionals, health care providers, community leaders, government, families, special services, and education programs school staff team and includes: Promoting school’s commitment to active communication with families of CLWLD to foster proper understanding of demands, opportunities as it relates to their children’s educational needs, provision of healthier and more nutritious food options at home and in schools, development, and implementation of policies by the government that addresses the imbalance in access to special services for CLWLD, developing community-based supports groups to help engage families with CLWLD to enable them to cope with challenges and stress as well as providing mental health services and support to families with CLWLD [41,42,43].
Also, intervention efforts targeting parental education, especially maternal education will be instrumental in effecting a more lasting impact on the prevalence of preterm births and subsequently, learning disability. Efforts aimed at addressing these socioeconomic effects will help promote child education, engagement, and student success in line with the 2004 Individuals with Disabilities Education Act (IDEA) that advocates for the educational advancement of children living with disabilities to prepare them for future opportunities [44].
Data from the National Survey of Children’s Health (NSCH), a nationally representative data source, was used for this study. Various limitations exist for this study and include the cross-sectional nature of the study, therefore making it difficult to ascertain the direction of causality. Furthermore, the data collected was based on self-report and could be prone to recall and social desirability bias. In addition, certain putative confounders like genetic diseases that predispose a child to learning disabilities were not controlled for in this analysis due to unavailability in the dataset. Given the large variation in outcomes for preterm children according to gestational age, it would have been important to include gestational age in the model, however, this was not available in the dataset. While this current study focused on sociodemographic and socioeconomic factors, future studies exploring social relationships such as teacher to student, peer to peer, as it relates to learning disability as well as maternal mental health as it relates to birth outcomes and child-rearing might be warranted to gain deeper insight in improving the health outcomes of children with learning disabilities.