Inequities exist in disease burden, health care and access for minority children

Minority children in the U.S. face a pervasive gap in the quality and extent of health care received compared to Caucasians, according to a report from the American Academy of Pediatrics written by a UT Southwestern Medical Center physician.

The country's 31.4 million minority children face higher overall death rates than Caucasians, and certain groups face greater violence and higher incidence of HIV/AIDS, sexually transmitted diseases, asthma, ADHD and certain types of cancers, according to the report.

The report, appearing in the April issue of Pediatrics, was compiled on behalf of the American Academy of Pediatrics' Committee on Pediatric Research. It is the first comprehensive review of racial/ethnic disparities in pediatric care, using the findings of more than 50 years of studies with regard to racial/ethnic disparities in children's health and health care.

The report defines disparities as population-specific differences in the presence of disease, in health outcomes or in access to care.

Other common disparities for minority children included higher rates of obesity and lower rates of breastfeeding, immunizations, and proper nutrition. Compared with Caucasians, minority children also faced less insurance coverage, less access to adequate health care, less time with doctors, fewer screenings and longer times for diagnosis for some conditions.

"To see those disparities is very disconcerting," said Dr. Glenn Flores, author of the report and professor of pediatrics at UT Southwestern. "We need to figure out why there are such stark differences when there really shouldn't be in a country that prides itself on equity and justice."

Dr. Flores said possible actions for addressing children's disparities include:

• Clinics, hospitals and health systems should routinely collect data on race/ethnicity, the primary language spoken at home and English proficiency;
  
• Children's health and health care disparities should be monitored and publicly disclosed annually at the federal, state, local, health-plan and institutional levels;
  
• All children should have access to continuous health insurance coverage;
  
• Insurers should cover medical interpreter services;
  
• Medical, dental, osteopathic, nursing and other health professions schools should increase diversity training; and
  
• More funding and research is needed to identify and address disparities in children, including creating health care empowerment zones that provide resources and programs in communities with the greatest disparities for children.

"There's never been a piece of research like this where we say, 'Let's just look at all the disparities, and see what they are, how pervasive they are and which domains they fall into'," he said. "The severity, the extent and the pervasiveness were not known. I think there's a lack of recognition of the problem, and hopefully we'll fill that gap with this report."

According to the study, the 31.4 million minority children in the U.S. account for 43 percent of all children. Conservative estimates project that minorities will comprise half of children in America by 2040. Latinos are the largest minority group, accounting for 20 percent of all children. African-Americans account for 15 percent, Asian/Pacific Islanders for 4 percent and American Indian/Native Alaskans for about 1 percent.

The review examined 781 studies, but found only 111 that provided specific information that could be used to identify disparities, signaling a need for better data collection methods, Dr. Flores said. For example, many studies simply lump all non-Caucasian populations together. Some studies do not distinguish between data for adults and for children, or do not factor out race/ethnicity from economic or other factors, Dr. Flores noted.

"Part of the goal of our paper is to bring these issues to the surface and to increase awareness that there are some pretty serious disparities that we can do something about and that we ought to be doing something about," Dr. Flores said.