Correlates of Physician Visits Among Children and Adolescents in West Texas: Effects Of Hyperglycemia Symptoms Ahmed A. Arif, MD, PhD; Girikumar Venati, MD, MS; Tyrone F. Borders, PhD; and James E. Rohrer, PhD ABSTRACT: Purpose: The health care services use by children vary tremendously. ?1 This cross-sectional study examines correlates of physician visits among children and adolescents living in west Texas. Methods: A telephone survey was administered in 2002 to a random sample of households in 106 counties of West Texas. The sample included 5,462 respondents with children aged between 3 and 18 years. Proportional odds ordered logistic regression analysis was used to determine correlates of physician visits in the previous 12 months. Findings: Hispanic children were less likely than non-Hispanic whites to have a recent physician visit; there were no significant rural- urban differences. Children with insurance (adjusted odds ratio ¼ 2.21, 95% CI ¼ 1.89–2.59) were more likely to visit physicians. Almost 16% of children in this study did not have any health insurance coverage. Children reporting 3 or more hyperglycemia symptoms and those with a family history of diabetes had 1.81 times and 1.20 times the odds of visiting the physician. Conclusions: Presence of health insurance and increasing symptoms of diabetes were found to influence the utilization of physician services. Since most of the cases of diabetes that have recently been diagnosed among Texas youth are type 2 diabetes, it is important that adolescents and their parents are educated about the risk factors and how to recognize them. T he use of health care services by children varies tremendously. Research has shown that approximately 1 in 8 children can be classified as high users of health care, and there is a similar number of low users. 1 Since physicians play a pivotal role in the delivery of health care services, physician visits are commonly used as an indicator of access to care. 2 Not only do children with chronic health conditions and disabilities use a high volume of health care, 3 but the cost of care is also more than for healthy children. 4,5 Previous studies have linked sociodemographic and other factors, including parents’ socioeconomic status, race/ethnicity, and health insurance status, with high or low volumes of pediatric health care use. 6-11 Diabetes, particularly type 2, among children is increasing at an alarming rate in Texas. No reliable estimates are available for type 2 diabetes among children and adolescents in Texas, but recent studies show that type 2 diabetes is becoming more common among Hispanic and Latino, Native American, and African American children and adolescents. 12 This study focuses on the identification of barriers to access to medical care by evaluating correlates of physician visits among children with and without symptoms of hyperglycemia and to determine ethnic and urban/rural disparities in access to physician services to children and adolescents living in rural areas in West Texas. Methods The data used for the present study were collected by the Department of Health Services Research at the Texas Tech University Health Sciences Center (TTUHSC) as part of the Childhood Health and Diabetes Survey (CHDS) conducted in 2002. Detailed description of the survey is provided elsewhere. 13 CHDS is a random-digit-dialed population-based survey of 5,933 households with children aged between Department of Family and Community Medicine, Division of Health Services Research, Texas Tech University Health Sciences Center, Lubbock, Tex. This work was supported by the grant from the Centers for Disease Control and Prevention. Grant No. 75/CCH620020-01. For further information, contact: Ahmed A. Arif, Texas Tech University Health Sciences Center, Department of Family and Community Medicine, Division of Health Services Research, 3601 4th St, STOP 8161, Lubbock, TX 79430; e-mail ahmed.arif@ttuhsc.edu. ..... Vulnerable Populations: Children ..... The Journal of Rural Health Vol. 20, No. 3