Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

New evidence suggests that children with chronic conditions may be predisposed to overweight and obesity. This study provides prevalence estimate of obesity for children and adolescents with select chronic conditions. We analyzed reported height and weight and the corresponding BMI from 46,707 subjects aged 10–17 years collected by the National Survey of Children's Health (NSCH‐2003). Our main outcome measure was the prevalence of obesity (defined as ≥95th percentile of the sex‐specific BMI for age growth charts), adjusted for underlying demographic and socioeconomic factors. We found that the prevalence of obesity among children 10–17 years of age without a chronic condition was 12.2% (95% confidence interval (CI) 11.5–13.0); the prevalence of obesity for children with asthma was 19.7% (19.5–19.9); with a hearing/vision condition was 18.4% (18.2–18.5); with learning disability was 19.3% (19.2–19.4); with autism was 23.4% (23.2–23.6); and with attention‐deficit/hyperactivity disorder was 18.9% (18.7–19.0). Our findings suggest that children 10–17 years of age with select chronic conditions were at increased risk for obesity compared to their counterparts without a chronic condition.

BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients' primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30‐day readmission or 30‐day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non‐English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non‐English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0‐1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2‐2.3 and OR, 1.5; 95% CI, 1.0‐2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non‐English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post‐hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.