American Academy of Pediatrics Committee on Pediatric Research technical report highlights
Noteworthy African-American disparities:
- Overall childhood mortality rates were found to be consistently higher; national data for a 43-year period revealed marked crude mortality disparities in young children 1-4 years old (twice that of Caucasian children) and older children 5-14 years old, and increases in the mortality disparity ratio in the most recent 10-year period.
- Higher risks of death due to swimming pool drowning, and especially in public pools, with the drowning rate in hotel/motel pools disproportionately higher.
- Significant disease-specific mortality disparities were identified for acute lymphoblastic leukemia, median age at death for Down syndrome children, congenital heart defects (both in terms of the fatality rate and a lower average age at death), and in-hospital death after congenital heart surgery.
- Reduced access to care includes higher rates than Caucasians of unmet health care needs; lower rates of access to primary care providers (including race being more strongly associated with this outcome than income); a higher likelihood of having no usual source of care; greater odds of not being referred to a specialist by the health care provider; higher hospitalization rates for ambulatory-care-sensitive conditions; and higher odds of appendix rupture.
- Differences in breastfeeding and immunization rates, injuries, obesity, physical activity and nutrition.
- Female adolescents have higher risks than Caucasians of skipping breakfast, of obesity, lacking health insurance, needing but not getting medical care, contracting any STD, perpetrating violence and being a victim of violence.
- Male adolescents have a higher risk of perpetrating violence and being a victim of violence.
- Children have the highest asthma prevalence of any racial/ethnic group, and this disparity compared to rates in Caucasians has widened over time. Compared with Caucasians, African-Americans also experience substantially higher rates of asthma mortality, hospitalizations, emergency room and office visits, and disparities in asthma mortality and hospitalizations have widened over time.
- HIV/AIDS disparities are substantial. They include the largest percentages and numbers of new diagnoses in every age group of children and adolescents and via perinatal transmission, and longer adjusted length-of-stays for those hospitalized.
- Underdiagnosis, undertreatment and other disparities for ADHD were found in several studies, including lower adjusted odds of evaluation, receiving a diagnosis, and receiving medication or treatment, and higher proportions of parents with negative expectations about treatment helpfulness.
- Children also were found to receive a diagnosis of autism 1.4 years later than Caucasians, and to be in mental health treatment an average of 13 months longer than Caucasians before receiving the autism diagnosis.
- Numerous differences were identified in quality of care, including lower adjusted odds compared with Caucasians for meeting the recommended number of well-child visits and receiving any counseling or screening during well-child visits.
- Lower adjusted scores were observed for timeliness of care, health insurance plan service, getting needed medical care, primary care comprehensiveness, primary care provider strength of affiliation and primary care provider interpersonal relationships.
- Among children with end-stage renal disease, African-Americans are substantially less likely than Caucasians to be activated on the kidney transplant waiting list, but significantly more likely to receive hemodialysis rather than peritoneal dialysis, and to receive an inadequate hemodialysis dose.
- Children also are less likely to receive preemptive kidney transplants, and receive fewer living transplants and more cadaveric transplants.
- Compared with Caucasians, heart transplant patients have double the odds of graft failure, lower graft survival rates, a median graft survival time that is six years lower, a median age at heart transplant that is five years greater, and a higher likelihood of HLA mismatch.
Noteworthy American Indian/Alaska Natives disparities:
- Higher age-specific crude mortality rate compared with Caucasians.
- Higher adjusted risk of death for children with acute lymphoblastic leukemia.
- Firearm injury rate that is more than seven times higher than that of Caucasian children.
- Higher adjusted odds of being overweight and of obesity.
- Female teens have higher risks than their Caucasian counterparts of needing but not getting medical care, and perpetrating violence.
- Male adolescents have a higher risk than their Caucasian counterparts of skipping breakfast, having poor/fair health status, and perpetrating violence.
- Teen birth rate is two to three times higher than that of Caucasians.
- Higher adjusted odds than Caucasian children of being in poor or fair health, and the highest prevalence of these suboptimal health ratings of any racial/ethnic group.
- Within six months of a new episode of depression, children have lower adjusted odds than Caucasian children of any mental health visit or antidepressant prescription being filled.
- Parents gave lower adjusted scores for their child’s health care timeliness, health care provider communication and health insurance plan service, and lower adjusted ratings for their child’s personal doctor and health plan.
Noteworthy Asian/Pacific-Islander disparities:
- Native Hawaiian children have a higher crude mortality rate than Caucasians.
- Greater adjusted odds of having no usual source of care, having made no visit to a physician or other health care provider in the past year, and going more than one year since the last physician visit, as well as a lower adjusted number of physician visits in the past year.
- Among children with cancer, Pacific Islanders had significantly greater odds of death, untimely treatment, not completing treatment as recommended, and loss to follow up.
- Differences were identified in rates of injuries, lead intoxication, obesity and nutrition.
- Adolescents were found to have lower adjusted odds of seatbelt use, sunscreen use and weekly physical activity, and greater adjusted daily hours of television/video game screen time.
- Several studies document disparities in primary care quality, including lower overall quality of primary care scores, lower primary care provider interpersonal relationship scores, and lower scores for specific primary care services available to the child.
Noteworthy Latino disparities:
- A higher drowning rate in neighborhood pools, along with higher swimming pool drowning rates in general for adolescent males.
- Higher adjusted risks of death exist compared to Caucasians among those with acute lymphoblastic leukemia and after congenital heart surgery.
- Multiple studies document a wide range of disparities in access to care and use of services for children in comparison with Caucasian children, including greater adjusted odds of being uninsured, having no usual source of care or health care provider, having gone a year or more since the last physician visit, making fewer physician visits in the past year, not being referred to a specialist, having a perforated appendix and never/sometimes getting medical care without long waits.
- Differences were identified in rates of breastfeeding, injuries, obesity, physical activity and nutrition.
- Adolescents have a higher risk than Caucasian teens of having no health insurance, perpetrating violence and being a victim of violence.
- Disparities for male adolescents include a higher risk of having no health insurance, going more than two years since the last physical exam and being a victim of violence.
- Adolescents (15-19 years old) have a crude birth rate three times higher than their Caucasian counterparts and the highest of any racial/ethnic group.
- Adolescents also have lower adjusted odds of bicycle helmet and sunscreen use.
- Compared with Caucasians, Latinos have twice the percentage of new HIV/AIDS diagnoses among children younger than 13 years of age, in perinatal transmission and among other pediatric cases.
- Several studies document a particularly high asthma prevalence among Puerto Ricans. Other asthma disparities include higher adjusted odds of asthma emergency room visits, hospitalizations, activity limitations and the need for urgent care in the past 12 months.
- Eleven studies documented disparities in mental health care and behavioral/developmental issues. Included were significantly higher unmet need for mental health care, and lower odds of any mental health visit, outpatient visits, antidepressant prescriptions, and receiving treatment from a mental health specialist for any condition, behavior problems or depression.
- Children have a shorter average well-child visit duration, lower adjusted odds of receiving any counseling during well-child visits, and greater adjusted odds of the parent not being very likely to recommend the child’s health care provider.