Unequal Treatment for Young Children? Racial and Ethnic Disparities in Early Childhood Health and Healthcare

G. Flores, L. Olson, S. Tomany.;  Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI; Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.

 

BACKGROUND: Racial/ethnic disparities in health recently have received much national attention, but few studies have focused on disparities in children.

 

OBJECTIVE: To examine disparities in early childhood health and healthcare in a nationally representative sample.

 

DESIGN/METHODS: The 2000 National Survey of Early Childhood Health is a phone survey of a national sample of parents of 2,608 children aged 4 to 35 months. Differences in selected healthcare measures were examined for white (W), African-American (AA) & Latino (L) children. STATA was used to obtain odds ratios (ORs) in multivariate analyses adjusting for insurance, health status, income, age, parental education, and interview language (English/Spanish).

 

RESULTS: L & AA children are significantly (P<.05) less likely than Ws to be in excellent/very good health (72% vs 79% vs 90%), but more likely to be uninsured (31% vs 18% vs 9%), have no regular healthcare provider, & have an assigned provider. L parents most often report the child?s provider didn't spend enough time with the child in the visit. Only 60% of L parents and 77% of AAs would recommend their child?s provider to others, vs 84% of Ws. L & AA parents less often report receiving family-centered care and more often are asked about violence, smoking, drinking & drug use. Providers less often refer L & AA children to specialists (Ws: 22%; AAs, 17%; Ls: 11%). Some disparities disappeared in multivariate analyses, but those persisting were: L children are more likely to be uninsured (OR=2.1 [1.3-3.4]), L parents are twice as likely to not recommend their child?s provider and to report providers sometimes/never understand the child?s needs; AA children have twice the odds of no regular provider and not being in excellent/very good health; L & AA parents feel providers sometimes/never respect parents' expertise or understand their preferences, L & AAs are asked more often about violence, household smoking, drinking and drug use, and L & AA children are twice as likely to not get specialty referrals.

 

CONCLUSIONS: Minority children experience multiple disparities in health status, having a regular provider, being uninsured, the content of pediatric visits, parents feeling respected and understood, parental satisfaction, and referrals to specialists. Greater insight is needed about why such disparities exist, and targeted educational interventions might help ensure equal treatment for all children in pediatric visits.