Racial and Ethnic Disparities in Medical and Dental Health, Access to Care, Use of Services in US Children

Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2008; 121(2):e286-98. DOI: 10.1542/peds.2007-1243
Source: PubMed


Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care.
The purpose of this work was to examine racial/ethnic disparities in medical and oral health, access to care, and use of services in a national sample.
The National Survey of Children's Health was a telephone survey in 2003-2004 of a national random sample of parents and guardians of 102,353 children 0 to 17 years old. Disparities in selected medical and oral health and health care measures were examined for white, African American, Latino, Asian/Pacific Islander, Native American, and multiracial children. Multivariate analyses were performed to adjust for primary language at home, age, insurance coverage, income, parental education and employment, and number of children and adults in the household. Forty measures of medical and oral health status, access to care, and use of services were analyzed.
Many significant disparities were noted; for example, uninsurance rates were 6% for whites, 21% for Latinos, 15% for Native Americans, 7% for African Americans, and 4% for Asians or Pacific Islanders, and the proportions with a usual source of care were as follows: whites, 90%; Native Americans, 61%; Latinos, 68%; African Americans, 77%; and Asians or Pacific Islanders, 87%. Many disparities persisted for > or = 1 minority group in multivariate analyses, including increased odds of suboptimal health status, overweight, asthma, activity limitations, behavioral and speech problems, emotional difficulties, uninsurance, suboptimal dental health, no usual source of care, unmet medical and dental needs, transportation barriers to care, problems getting specialty care, no medical or dental visit in the past year, emergency department visits, not receiving mental health care, and not receiving prescription medications. Certain disparities were particularly marked for specific racial/ethnic groups: for Latinos, suboptimal health status and teeth condition, uninsurance, and problems getting specialty care; for African Americans, asthma, behavior problems, skin allergies, speech problems, and unmet prescription needs; for Native Americans, hearing or vision problems, no usual source of care, emergency department visits, and unmet medical and dental needs; and for Asians or Pacific Islanders, problems getting specialty care and not seeing a doctor in the past year. Multiracial children also experienced many disparities. CONCLUSIONS; Minority children experience multiple disparities in medical and oral health, access to care, and use of services. Certain disparities are particularly marked for specific racial/ethnic groups, and multiracial children experience many disparities.

  • Source
    • "Although the prevalence of diagnosable mental disorders, such as major depression and dysthymia, has not always been found to be higher in minorities compared to non-minorities, certain studies have documented elevated depressive symptoms rates and higher risk of persistent mental health disorders among minorities (see Anderson and Mayes 2010; Breslau et al. 2006; Kessler et al. 2005, 2012). Disparities for these groups also include poorer access, utilization, and quality of mental health services (Alexandre et al. 2010; Flores and Tomany-Korman 2008). Differential suicide rates, such as higher rates among Native Americans, also suggest mental health disparities (Karch et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Certain subgroups of youth are at high risk for depression and elevated depressive symptoms, and experience limited access to quality mental health care. Examples are socioeconomically disadvantaged, racial/ ethnic minority, and sexual minority youth. Research shows that there are efficacious interventions to prevent youth depression and depressive symptoms. These preventive interventions have the potential to play a key role in addressing these mental health disparities by reducing youth risk factors and enhancing protective factors. However, there are comparatively few preventive interventions directed specifically to these vulnerable subgroups, and sample sizes of diverse subgroups in general prevention trials are often too low to assess whether preventive interventions work equally well for vulnerable youth compared to other youth. In this paper, we describe the importance and need for "scientific equity," or equality and fairness in the amount of scientific knowledge produced to understand the potential solutions to such health disparities. We highlight possible strategies for promoting scientific equity, including the following: increasing the number of prevention research participants from vulnerable subgroups, conducting more data synthesis analyses and implementation science research, disseminating preventive interventions that are efficacious for vulnerable youth, and increasing the diversity of the prevention science research workforce. These strategies can increase the availability of research evidence to determine the degree to which preventive interventions can help address mental health disparities. Although this paper utilizes the prevention of youth depression as an illustrative case example, the concepts are applicable to other health outcomes for which there are disparities, such as substance use and obesity.
    Full-text · Article · Oct 2014 · Prevention Science
  • Source
    • "Concerns about racial discrimination, genetic discrimination (Peters et al. 2004), and misuses of genetic testing (Bates et al. 2005; Zimmerman et al. 2006) are prevalent in minority populations, potentially impacting the use of clinical genetic services (Armstrong et al. 2003) and participation in genetics research (Bussey-Jones et al. 2010; Corbie-Smith et al. 1999). Distrust from minority populations likely stems from a combination of past mistreatment of minorities by the medical community (Gamble 1997) as well as continuing feelings of underlying racism (Gamble 1997; Jacobs et al. 2006) and limited access to healthcare services (Flores and Tomany- Korman 2008; Joshi et al. 2012; Mahmoudi and Jensen 2012). Despite the lower level of trust reported by participants in the online arm, these participants would still prefer to review results online for future testing, but with the option to speak with a healthcare professional if needed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patient trust in personal medical information is critical to increasing adherence to physician recommendations and medications. One of the anticipated benefits of learning of one's genomic risk for common diseases is the increased adoption of screening, preventive care and lifestyle changes. However, the equivocal results thus far reported of the positive impact of knowledge of genomic risk on behavior change may be due to lack of patients' trust in the results. As part of a clinical study to compare two methods of communication of genomic risk results for Type 2 diabetes mellitus (T2DM), we assessed patients' trust and preferred methods of delivery of genomic risk information. A total of 300 participants recruited from the general public in Durham, NC were randomized to receive their genomic risk for T2DM in-person from a genetic counselor or online through the testing company's web-site. Participants completed a baseline survey and three follow-up surveys after receiving results. Overall, participants reported high levels of trust in the test results. Participants who received their results in-person from the genetic counselor were significantly more likely to trust their results than those who reviewed their results on-line (p = 0.005). There was not a statistically significant difference in levels of trust among participants with increased genetic risk, as compared to other those with decreased or same as population risk (p = 0.1154). In the event they undergo genomic risk testing again, 55 % of participants overall indicated they would prefer to receive their results online compared to 28 % that would prefer to receive future results in-person. Of those participants preferring to receive results online, 77 % indicated they would prefer to have the option to speak to someone if they had questions with the online results (compared to accessing results online without the option of professional consultation). This is the first study to assess satisfaction with genomic risk testing by the method of delivery of the test result. The higher rate of trust in results delivered in-person suggests that online access reports may not result in serious consideration of results and lack of adoption of recommended preventive recommendations.
    Full-text · Article · Jun 2013 · Journal of Genetic Counseling
  • Source
    • "Specific outcome measures included 22 for medical and oral health status (including developmental delays/problems and special healthcare-needs conditions), nine for access to medical and dental care, and three for use of medical and dental services. Bonferroni adjustments were not made, consistent with published guidelines [11] and prior NSCH disparities analyses [2,3], because a specific a priori hypothesis was tested for each dependent variable. Although one NSCH question addressed interpreter availability, only bivariate analyses could be performed for this outcome, due to limited sample sizes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction The 2010 Census revealed the population of Latino and Asian children grew by 5.5 million, while the population of white children declined by 4.3 million from 2000-2010, and minority children will outnumber white children by 2020. No prior analyses, however, have examined time trends in racial/ethnic disparities in children’s health and healthcare. The study objectives were to identify racial/ethnic disparities in medical and oral health, access to care, and use of services in US children, and determine whether these disparities have changed over time. Methods The 2003 and 2007 National Surveys of Children’s Health were nationally representative telephone surveys of parents of 193,995 children 0-17 years old (N = 102,353 in 2003 and N = 91,642 in 2007). Thirty-four disparities indicators were examined for white, African-American, Latino, Asian/Pacific-Islander, American Indian/Alaskan Native, and multiracial children. Multivariable analyses were performed to adjust for nine relevant covariates, and Z-scores to examine time trends. Results Eighteen disparities occurred in 2007 for ≥1 minority group. The number of indicators for which at least one racial/ethnic group experienced disparities did not significantly change between 2003-2007, nor did the total number of specific disparities (46 in 2007). The disparities for one subcategory (use of services), however, did decrease (by 82%). Although 15 disparities decreased over time, two worsened, and 10 new disparities arose. Conclusions Minority children continue to experience multiple disparities in medical and oral health and healthcare. Most disparities persisted over time. Although disparities in use of services decreased, 10 new disparities arose in 2007. Study findings suggest that urgent policy solutions are needed to eliminate these disparities, including collecting racial/ethnic and language data on all patients, monitoring and publicly disclosing disparities data annually, providing health-insurance coverage and medical and dental homes for all children, making disparities part of the national healthcare quality discussion, ensuring all children receive needed pediatric specialty care, and more research and innovative solutions.
    Full-text · Article · Jan 2013 · International Journal for Equity in Health
Show more