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

Abstract

BACKGROUND. Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care. OBJECTIVE. 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. METHODS. The National Survey of Children's Health was a telephone survey in 2003–2004 of a national random sample of parents and guardians of 102353 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. RESULTS. 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 ≥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.

Late Preterm Infants and Neurodevelopmental Outcomes at Kindergarten

“…LPIs have higher odds of severe impairment, and those who [22][23][24][25][26][27] Non-Englishspeaking families also tend to have reduced access to and utilization of high-quality pediatric health care, which identifies and helps with the effects of adverse physical and environmental exposures. 28,29 Our results expand on the current literature in several ways. With this cohort, we were able to follow participants from infancy to school age and find deficiencies in LPIs compared with FTIs at 2 time points.…”

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

“…A study in adult mental health care found a greater disparity in racial and ethnic minorities' access to psychiatrists compared with other providers, 38 and pediatric studies have concluded that disadvantaged groups less frequently see specialists or use prescription medications. 25,[39][40][41][42][43][44] This study has some limitations. Likewise, the extent of management by providers and the depth of discussion at PCP visits could not be determined.…”

Health Equity and Children's Rights

“…9 Disparities in the well-being of children in the United States are growing. [10][11][12][13] These racial, ethnic, gender, and class-based disparities have profound implications for the welfare of children in the United States and for the adults they will become. [14][15][16][17][18][19] The sources of these disparities are deeply rooted in inequities in social and environmental determinants of health (eg, poverty, income inequality, maldistribution of educational and other resources, racism, and environmental injustice) and the failure of public policies to address them.…”