Unequal Treatment for Young Children

1

• Unequal Treatment for Young Children?
• Racial and Ethnic Disparities in
• Early Childhood Health and Healthcare
• Glenn Flores, MD,1 Sandy Tomany, MS1
• and Lynn Olson, PhD2
• 1Department of Pediatrics,
• Medical College of Wisconsin and Childrens
  Hospital of Wisconsin
• 2Department of Practice Research, American
  Academy of Pediatrics
• Published in Pediatrics. 2005115e183-e193
• Funding Robert Wood Johnson Foundation, AHRQ,
  Gerber Foundation

2
Background

• US experiencing demographic surge in minority
  children, particularly among youngest age groups
• By 2030
• There will be more minority childrenthan
  non-Latino white children 0-18 years old
• Among 0-5 year olds, minorities will
  outnumbernon-Latino whites by 1.1 million
• One out of every four 0-5 year olds will be
  Latino
• As number and proportion of minority children
  grow, racial/ethnic disparities will take on even
  greater importance for healthcare providers

3
Background

• Recent reports by IOM and AHRQ called attention
  to tendency for US minorities to receive lower
  quality healthcare than whites, even after
  adjustmentfor access-related factors
• Although multiple studies document racial/ethnic
  disparities in adults, few studies have
  examinedsuch disparities in children
• For example, only 5 of 103 studies in IOMs
  extensive literature review specifically
  addresseddisparities in children
• In particular, little known about whether younger
  children experience racial/ethnic disparities in
  healthcare

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Study Aim

• To examine racial/ethnic disparities inearly
  childhood health and healthcareusing nationally
  representative sample

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Methods Data Source- National Survey of Early
Childhood Health (NSECH)

• Telephone survey in 2000 of national random
  sample of households with children 4-35 months
  old
• Oversampled households with blackand Hispanic
  children
• Parent or guardian most responsiblefor childs
  healthcare interviewed
• 2,068 interviews completed
• Interview completion rate 79
• Estimates based on sampling weights generalize to
  entire US population of children 4-35 months of
  age

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Methods Study Variables

• Variables examined included
• Selected sociodemographics
• Healthcare provider characteristics
• Use of health services
• Parental satisfaction with care
• Topics discussed with parents by providers
• Childrens race/ethnicity defined as white,
  black, or Hispanic by parental report ( black
  and Hispanic NSECH terms)
• Because of insufficient sample sizes, subjects
  from other racial/ethnic groups excluded

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Methods Statistical Analysis

• Multivariable analyses performed to examine
  racial/ethnic differences after adjustment for
• Insurance coverage
• Survey language chosen by parent(English vs.
  Spanish)
• Health status
• Poverty
• Childs age
• Parental educational attainment

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Characteristics 4-35 Month-Old US Children in
2000 (NSECH)
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Characteristics Well Child Care Providers for
4-35 Month-Old US Children
10
Parental Satisfaction and Interactions with Well
Child Care Providers 4-35 Month-Old US Children
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Topics Discussed with Parent by Well Child Care
Providers 4-35 Month-Old US Children
12
Use of Selected Health Services4-35 Month-Old
US Children
13
Multivariate Analyses Racial/Ethnic Disparities
for 4-35 Month-Old US Children
14
Multivariate Analyses Racial/Ethnic Disparities
for 4-35 Month-Old US Children
15
Multivariate Analyses Parent Survey Language
Disparities for 4-35 Month-Old US Children
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Conclusions

• Young minority children in US and those with
• Spanish-speaking parents experience
• multiple disparities in
• Insurance coverage
• Health status
• Parental satisfaction with well-child care
  providers
• Provider understanding of childs needsand
  parents childrearing preferences
• Provider discussion of violence
  andalcohol/illicit drug use
• Parents calls to doctors offices
• Specialty referrals

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Implications

• Greater insight needed about whysuch
  racial/ethnic disparities exist
• Study findings suggest priority areasfor
  monitoring, quality assurance, andprovider and
  system performance evaluationin health plans and
  systems providing healthcare to diverse pediatric
  populations
• Targeted educational interventions,such as
  cultural competency training,might help ensure
  equal treatmentfor all young children in
  pediatric visits