Health Inequity in Children and Youth With Chronic Health Conditions

Abstract

BACKGROUND: Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them. OBJECTIVES: To describe health inequities experienced by children with chronic health conditions. METHODS: We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words “incidence,” “prevalence,” “survival,” “mortality,” or “disparity” in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury. RESULTS: Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children. CONCLUSIONS: Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

“…1 These inequities are especially troubling in children with type 1 diabetes whose anticipated long duration of disease places them at risk for acute and chronic complications, particularly in the presence of suboptimal care. 2 Previous studies of children with type 1 diabetes have found that nonHispanic black (black) children tend to have poorer glycemic control than non-Hispanic white (white) children as evidenced by higher hemoglobin A1c (HbA1c) values; many studies suggest that glycemic control in Hispanic children is intermediate (ie, between that of white and black subjects).…”

“…2 Previous studies of children with type 1 diabetes have found that nonHispanic black (black) children tend to have poorer glycemic control than non-Hispanic white (white) children as evidenced by higher hemoglobin A1c (HbA1c) values; many studies suggest that glycemic control in Hispanic children is intermediate (ie, between that of white and black subjects). 1,[3][4][5][6][7][8][9][10] Poor glycemic control has been associated with a ninefold higher mortality rate among black subjects compared with white subjects with type 1 diabetes aged ,25 years, primarily due to an increased incidence of diabetic ketoacidosis (DKA) in black subjects. 11 Racial/ethnic disparities have also been reported in treatment regimens used in pediatric patients with type 1 diabetes.…”

Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making

“…21 Significant and pervasive racial and ethnic health and health care inequities persist among children with chronic health conditions, such as attentiondeficit/hyperactivity disorder, asthma, autism spectrum disorder, Down syndrome, cerebral palsy, cystic fibrosis, diabetes, sickle cell anemia, obesity, traumatic brain injury, and HIV/AIDS. 22 Black and Hispanic parents of children with special health care needs report higher dissatisfaction with care and more difficulties navigating services for their children compared with their white counterparts. 23 Although Healthy People 2020 has listed "cultural sensitivity in health care provision" as 1 of 7 key determinants of health under the heading of health disparities, 18 addressing disparities in cultural attributes and attitudes between physicians and their patients, patients' families, and/or guardians requires educational interventions to ensure that pediatricians and other health care professionals are able to provide CEHC to a diverse patient population.…”

Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake

“…[1][2][3][4][5][6][7] The prevalence appears to be increasing, likely as a reflection of medical advances reducing mortality and a rise in conditions such as human immunodeficiency virus (HIV) infection, diabetes mellitus, and mental health disorders. 8 Challenges with interpreting epidemiological studies exist, primarily as a result of using different age cutoffs for defining adolescence and variable classification of CMCs.…”