Social inequalities and their impact on children's health: a current and global perspective

Rebouças, Poliana; Falcão, Ila Rocha; Barreto, Maurício Lima

doi:10.1016/j.jped.2021.11.004

Cited by 22 publications

(15 citation statements)

References 46 publications

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“…Johnson et al (19) reported a similar trend in children presenting to the ED with abdominal pain with NHW children being more likely to receive any pain medication and more likely to receive narcotic pain medication when compared to NHB children reporting the same pain severity. While implicit bias may be a contributing factor to the disparity we observed (20–22), given the lack of statistical significance seen after adjusting for a secondary diagnosis of CP, it is also possible that NHW children could have received more opioids than NHB children because they may already have used other non‐opioid analgesics at home without relief or may have received opioids during previous episodes of AP not captured during the study duration or may have a diagnosis of ARP or CP that was not included in their diagnostic codes.…”

Section: Discussionmentioning

confidence: 93%

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Dike

Lyden

Quirós-Tejeira

et al. 2022

J. pediatr. gastroenterol. nutr.

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Objectives: Racial or ethnic disparities in health care delivery and resource utilization have been reported in a variety of pediatric diseases. In acute pancreatitis (AP), there is an association between Black race and increased inpatient mortality. Data on the association of race and ethnicity and resource use for managing pediatric AP are lacking. The aim of this study is to investigate this potential association in pediatric AP. Methods: Retrospective study of children 0-18 years diagnosed with AP in the Pediatric Health Information System (PHIS) database from 2012 to 2018. Descriptive statistics were used to summarize cohort characteristics. Race/ ethnicity classifications included non-Hispanic Black (NHB), non-Hispanic White (NHW, used as reference), Hispanic, and "Other." Associations between patient characteristics and race/ethnicity were determined using χ 2 tests. Generalized linear mixed regression model was used to determine the association of race/ethnicity with odds of resource utilization, costs, and length of hospital stay after adjusting for covariates with a random intercept for site. Results: Five thousand nine hundred sixty-three patients from 50 hospitals were included. Adjusted analysis showed that NHB children hospitalized with AP were at lower odds of receiving opioids in the first 24 hours [adjusted odds ratio (aOR) = 0.82, 95% confidence interval (CI) = 0.70-0.98] and receiving intravenous fluids during the hospitalization (aOR = 0.64, 95% CI = 0.43-0.96) when compared with NHW children. Additionally, NHB and Hispanic children had a prolonged adjusted mean length of hospital stay and higher hospital costs when compared with NHW children. Although there was no significant association between race/ethnicity and diagnosis of pancreatic necrosis or sepsis, Hispanic and "Other" children were at higher odds of receiving antibiotics during hospitalization for AP (aOR = 1.33, 95% CI = 1.13-1.57 and aOR = 1.37, 95% CI = 1.09-1.73, respectively) than NHW children. Conclusions: Disparities exist in utilization of health care interventions for pediatric AP patients by race/ethnicity. Future studies should investigate why these disparities exist and if these disparities affect outcomes.

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Section: Discussionmentioning

confidence: 93%

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Dike

Lyden

Quirós-Tejeira

et al. 2022

J. pediatr. gastroenterol. nutr.

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“…The study also reveals negative associations of child disability and malnutrition with developmental outcomes, aligning with previous research emphasizing the detrimental impact of malnutrition and disabilities on cognitive and physical development [ 33 ]. Addressing these challenges through targeted interventions can be helpful for improving child’s developmental outcomes as previous research highlight the role of social protection programs in mitigating poverty-related adversities on child development [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic determinants of early childhood development: evidence from Pakistan

Akram,

Zahid,

Pervaiz

2024

J Health Popul Nutr

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This study investigates the socioeconomic determinants of early childhood development (ECD) in Pakistan by utilizing the data of sixth wave of the Multiple Indicator Cluster Survey (MICS) conducted in the four provinces of the country. The findings of the study reveal that mother’s education, father’s education, economic status of the household as measured by household’s wealth index quintile, region of residence (province), child’s gender, disability, nutrition and the practices used by the adult members of the household to discipline child are important determinants of ECD. The study highlights the crucial role of family background and importance of addressing the issue of malnutrition to foster child development.

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“…The difficulty of reducing birth weight–related outcomes indicates the need to intensify policies with this focus . Thus, there is a need to strengthen social, redistributive, and health policies that act on the negative consequences of inequalities, seeking to minimize their effects on health, striving for food and nutritional security, prenatal care, and assistance during labor …”

Section: Discussionmentioning

confidence: 99%

“…10 In low-and middle-income countries, socioeconomic factors, including education, income, selfreported race, and access to prenatal care, are associated with birth weight and SGA. [10][11][12][13][14][15][16][17][18][19] Conditional cash transfer (CCT) programs have emerged in Latin America beginning in the 1990s as a strategy for social protection and poverty reduction. 20,21 Complementary to unconditional cash transfer programs (UCTs), which provide only monetary transfers, CCTs incorporate the fulfillment of conditionalities (typically, adherence to a health and education agenda) as a requirement for continued receipt.…”

Section: Introductionmentioning

confidence: 99%

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Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight–Related Outcomes

Falcão,

Ribeiro-Silva,

Fiaccone

et al. 2023

JAMA Netw Open

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ImportanceThere is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.ObjectiveTo investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.Design, Setting, and ParticipantsThis cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.ExposureLive births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.Main Outcomes and MeasuresLow birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as “brown” and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.ResultsA total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).Conclusions and RelevanceThis study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight–related outcomes.

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Social inequalities and their impact on children's health: a current and global perspective

Cited by 22 publications

References 46 publications

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Socioeconomic determinants of early childhood development: evidence from Pakistan

Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight–Related Outcomes

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