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Unequal Treatment for Young Children? Racial and Ethnic Disparities in

Unequal Treatment for Young Children? Racial and Ethnic Disparities in Early Childhood Health and Healthcare Glenn Flores, MD, 1 Sandy Tomany, MS 1 and Lynn Olson, PhD 2 1 Department of Pediatrics, Medical College of Wisconsin and Children’s Hospital of Wisconsin;

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Unequal Treatment for Young Children? Racial and Ethnic Disparities in

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  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 Children’s Hospital of Wisconsin; 2Department of Practice & Research, American Academy of Pediatrics 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-Hispanic white children 0-18 years old • Among 0-5 year olds, minorities will outnumber non-Hispanic whites by 1.1 million • As number and proportion of minority children grow, racial/ethnic disparities will take on even greater importance for pediatric 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 IOM’s extensive literature review specifically addresseddisparities in children • In particular, little known about whether younger children experience racial/ethnic disparities in healthcare

  4. Study Aim • To examine racial/ethnic disparities inearly childhood health and healthcareusing nationally representative sample

  5. 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 child’s 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

  6. 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 • Children’s 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

  7. 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 • Child’s age • Parental educational attainment

  8. Characteristics: 4-35 Month-Old US Children in 2000 (NSECH)

  9. 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

  11. Topics Discussed with Parent by Well Child Care Providers: 4-35 Month-Old US Children

  12. Use of Selected Health Services:4-35 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

  16. 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 child’s needsand parents’ childrearing preferences • Provider discussion of violence andalcohol/illicit drug use • Parents’ calls to doctors’ offices • Specialty referrals

  17. 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

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