TABLE 1

Disparities in the Health and Health Care of AA Children

Disparity (vs White Children)Study DesignSample Size(s)NotesRef No.
Access to care
    Lower accessibility to pediatric primary care providersAnalysis of spatial accessibility to pediatric primary care providers in Washington, DCUS Census data on all children and American Medical Association/American Osteopathic Association data on concentration of all pediatric primary care providers in Washington, DCNot adjusted for covariates27
    Neighborhood AA race more strongly associated with access to pediatric primary care providers than neighborhood income
    Double the adjusted odds of having no usual source of careAnalysis of household component of 1996 and 2000 MEPSAA: n = 2189; Latino: n =4091; Asian: n = 325; white: n = 6362Adjusted for 8 covariates; double theadjusted odds of dissatisfaction with quality of care in 1996 but not 200028
    Double the adjusted odds of no health professional/doctor visit in past year
    Higher adjusted odds of appendicitis ruptureCross-sectional analysis of full-year samples of hospital discharge records for acute appendicitis from California and New York children 4–18 y of ageCalifornia: AA, n = 297; Latino, n = 4304; API, n = 459; white, n = 4017; New York: AA, n = 342; Latino, n = 444; API, n = 80; white, n = 2379Adjusted for 7 covariates29
    Higher adjusted proportion in fair or poor health among new SCHIP enrollees in FloridaAnalysis of CHIRI data on new SCHIP enrollees in 4 states (<18 y old in Alabama, Kansas, and New York, and 11.5–17.9 y old in Florida)Total sample: n = 8975bAdjusted for 10 covariates30
    Lower adjusted proportion had usual source of care before SCHIP among new SCHIP enrollees in New York
    Before enrollment in SCHIPInterviews of parents in New York State at the time of SCHIP enrollment of their child (baseline) and 1 y after enrollmentTotal sample: N = 2644b (baseline) and N = 2290 (1-y follow-up)Adjusted for 12 covariates; 1 unadjusted quality-of-care disparity was noted but not adjusted for31
        Lower adjusted rate of having usual source of care
        Higher adjusted rate of having unmet needs for health care
    Greater adjusted odds of not being referred to specialist by health care providerAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates32
Adolescents
    Higher likelihood of fair to poor health among adolescents recently enrolled in SCHIPAnalysis of CHIRI telephone interview data of adolescents newly enrolled in SCHIP in Florida and New York (and their parents)Total sample: N = 2036bNo multivariable adjustments performed33
    Less likely to use doctor's offices as their usual source of care among adolescents recently enrolled in SCHIP
    Significantly lower adjusted odds of use of substance abuse services among adolescentsAnalysis of 5 y of Tennessee Medicaid (TennCare) enrollment, encounter, and claims data for substance abuse services use by adolescents 12–17 y of ageAA: n = 60 104; white: n = 110 552Adjusted for 4 covariates34
    Significantly older age at first use of substance abuse services
    AA girls at particular risk of underuse of substance abuse services, with only 1 in 25 AA female teenaged substance abusers accessing substance abuse services
    Female adolescents: higher risk of skipping breakfast, obesity, lacking health insurance, needing but not getting medical care, any sexually transmitted disease, perpetrating violence, and being a victim of violenceAnalysis of Add Health (waves 1 and 2), a nationally representative school-based study of youths in grades 7–12, with follow-up into adulthoodAA: n = 3038; Latino: n = 2340; API: n = 1021; AI/AN: n = 136; white: n = 7728Prevalence in published tables was not adjusted; authors stated that adjustments for income and parental education had minimal influence on findings; significant disparities were identified by using 95% CIs that did not overlap with measure for white children; no formal statistical evaluation of disparities were provided in article35
    Male adolescents: higher risk of perpetrating violence and being victim of violence
    Live birth rate for 15- to 17 y-old girls was >3 times higher1990–1998 natality files from the National Vital Statistics systemNot providedExpressed as rates per 1000; rates were not adjusted for any covariates36
    Birth rate for 15- to 17 y-old girls was 4–5 times higherAnalysis of vital records from the Illinois and Chicago departments of public healthNot providedNot adjusted for covariates37
    AA/white disparity ratio worsened by 23% between 1990 and 1998
    Birth rate for 15- to 19-y-old girls more than twice as highBirth certificate data reported to CDC National Center for Health StatisticsNot providedNot adjusted for covariates; no P values or 95% CIs38
    Greater adjusted odds of alcohol testing among female adolescents admitted to EDs for traumatic injuryAnalysis of data from the National Trauma Data Bank (includes 64 US institutions) on adolescents 12–17 y of age admitted to EDs with traumatic injuryAA: n = 1760; Latino: n = 396; white: n = 5584Adjusted for 7 covariates39
Asthma and allergies
    Highest asthma prevalence of any racial/ethnic group (26% higher vs white children)Trends in asthma over time for children 0–17 y of age using data from 5 National Center for Health Statistics sources: National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, and mortality component of the National Vital Statistics systemNot providedNo statistical comparisons performed or 95% CIs provided; only unadjusted rates were presented40
    Highest asthma-attack prevalence of any racial/ethnic group (44% higher vs white children)
    Disparity vs white children has widened progressively over 16-y period, from 15% higher prevalence to 26% higher prevalence vs white children
    Higher asthma office-visit rate
    Triple the rate of asthma ED visits
    Triple the rate of hospital outpatient visits for asthma
    Ambulatory asthma-visit rate (all outpatient visit types) 1.6 times higher
    Hospitalization rate 3.6 times higher
    Hospitalization rate increased at more than double the rate of white children
    Highest asthma mortality rate of any racial/ethnic group, 4.6 times higher than that of white children
    Asthma mortality rate increased over 19 y (vs remained the same in white children)
    Greater likelihood of current asthmaNational database (NHIS)AA: n = 14 487; white: n = 49 042Adjusted for 8 covariates41
    Greater likelihood of ED visit for asthma in past year
    Greater adjusted odds (adjusted odds ratio, 2.5 [95% CI: 1.3–4.8]) of physician-diagnosed asthma, even after adjustment for family incomeRhode Island Health Interview SurveyAA: n = 142; Latino: n = 353; white: n = 1274Adjusted for 7 covariates42
    Higher adjusted odds of asthmaSecondary analysis of 2 y of MEPS data on children 2–18 y of ageTotal 1996 MEPS sample size: children 2–18 y of age sample size: N = 5933Adjusted for 6–8 covariates; in 1 children 2–18 y of age significantly lower adjusted odds of ED visits and internalizing and externalizing behavioral conditions43
    Lower adjusted odds of ambulatory visits
    Lower adjusted odds of prescriptions filled
    Higher asthma mortality rate, both for underlying cause and any mentionAnalysis of 12 y of data from the multiple cause-of-death files from the National Center for Health StatisticsTotal sample: N = 4091a,bUnadjusted rates, not adjusted for SES or insurance coverage; asthma mortality rate also higher than that of Latino and API children44
    Higher adjusted odds of an asthma ED visit or hospitalizationAnalysis of data from parent-response questionnaires administered in 26 randomly selected New York City public elementary schoolsTotal sample: N = 5250bAdjusted for 4 covariates45
    Higher diagnosed asthma prevalence (18%)Cross-sectional analysis of parent-report questionnaire data from 14 low-income, diverse Chicago public elementary schoolsAA: n = 2938; Latino: n = 6002; white: n = 1560Not adjusted for covariates46
    Higher total potential asthma burden (diagnosed plus possible but undiagnosed asthma)
    More than double the adjusted odds of having a current asthma diagnosisAnalysis of NHANES III on children 1–16 y of ageTotal sample: N = 11 181bAdjusted for 14 covariates; sample size of those with asthma was not provided47
    Worse asthma physical health scoresCross-sectional study using parental telephone interviews and electronic records for Medicaid-insured children 2–16 y of age with asthma in 5 managed care organizations in California, Washington, and MassachusettsAA: n = 636; Latino: n = 313; white: n = 512Adjusted for SES, health status, age, gender, and other sociodemographic variables48
    Lower adjusted odds of daily anti-inflammatory use for asthma
    Higher adjusted odds of cockroach allergen sensitivityCross-sectional analysis of children 6–16 y of age who participated in allergen testing in the NHANES IIIAA: n = 1502; Mexican American: n = 1546; white: n = 1116Adjusted for 8 covariates49
    Higher adjusted odds of dust mite allergen sensitivity
    Higher adjusted odds of mold allergen sensitivity
    Higher adjusted odds of asthmaAnalysis of data from the Los Angeles County Health Survey on children <18 y of ageAA: n = 566; Latino: n = 3675; API: n = 361; white: n = 1278Adjusted for 8 covariates50
    Higher adjusted odds of need for urgent medical care for asthma in past 12 mo
    Lower adjusted odds of use of β2-agonistsAnalysis of data from the Childhood Asthma Severity Study, which used a 12-mo, retrospective, parent-reported questionnaire on asthma in a community sample of children <13 y of age and residing in Connecticut and MassachusettsAA: n = 139; Latino: n = 255; white: n = 549Adjusted for 9 covariates51
    Lower adjusted odds of use of inhaled steroids
    Higher adjusted prevalence of asthma overallAnalysis of NHIS data on children 0–17 y of ageAdjusted for 8 covariates; stratified analyses suggested disparities only for poorest children, but sample sizes for other strata may not have been adequate (and not indicated in study)52
    Among children with family income less than half the federal poverty level, higher prevalence of asthma
Breastfeeding
    Lower proportion of children ever breastfedAnalysis of breastfeeding data on children 12–71 mo of age in the NHANES III (1988–1994)AA: n = 1845; Mexican American: n = 2118; white: n = 1869Not adjusted for any covariates53
    Lower proportion of children who received any human milk at 6 mo of age
    Lower proportion of children exclusively breastfed at 4 mo of age
Cardiovascular and hypertension
    Higher relative risk of all strokesAnalyses of databases of the Office of Statewide Health Planning and Development of California for 10 y on all admissions to nonfederal hospitals in CaliforniaNot providedNot adjusted for covariates (except sickle cell disease)54
    Higher relative risk of intracerebral hemorrhage
    Higher relative risk of subarachnoid hemorrhage
    Higher relative risk of ischemic stroke after exclusion of sickle cell disease
Health status
    Lower adjusted odds of being in excellent/very good healthAnalysis of cross-sectional data on children 0–19 y of age from the California Health Interview SurveyTotal sample: N = 19 485bAdjusted for 4 covariates; higher adjusted odds of making a physician visit in the previous year55
    Higher adjusted likelihood of fair or poor healthAnalysis of NHIS dataAA: n = 5776; API: n = 1088; Latino: n = 4785; white: n = 20 717Not adjusted for family income or health insurance coverage (adjusted only for age, gender, and parental education); lower adjusted likelihood of acute respiratory illness and injuries; interactions noted between race/ethnicity and parental education for selected outcomes in selected groups56
    Higher adjusted likelihood of activity limitations
    Higher adjusted likelihood of school limitations
    Greater adjusted scores of global stress in previous month among adolescentsCohort of adolescents in grades 7–12 in 1 suburban Midwestern public school districtAA: n = 550; white: n = 659Adjusted for 7 covariates; interaction noted between race and college education; stress related to racism not examined57
    Higher adjusted odds of poor, fair, or good health status (vs excellent/very good)Analysis of data from National Survey of Early Childhood Health on children 4–35 mo of ageTotal sample: N = 2068bAdjusted for 8 covariates58
    Greater adjusted odds of not being in excellent or very good healthAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates32
HIV/AIDS
    Represent largest percentages of new HIV/AIDS diagnoses in every age group of children and adolescents and in perinatal transmissionDiagnoses of HIV/AIDS reported to the CDC in 2001–2004 by 33 states that used confidential, name-based reporting of HIV/AIDS cases for at least 4 yAA: n = 11 554; Latino: n = 3249; white: n = 3707aNo 95% CIs or P values presented; not adjusted for SES or other covariates59
    Number of new HIV/AIDS diagnoses in every age group of children and adolescents and in perinatal transmission exceed those of all other racial/ethnic groups combined
    Among females, percentages of new pediatric HIV/AIDS diagnoses are 4–9 times that for white females
    Among males, percentages of new pediatric HIV/AIDS diagnoses are 2–7 times that for white males
    Longer adjusted length of hospital stay for HIV-infected childrenCohort study of pediatric patients with HIV at 4 sites specializing in the care of pediatric HIV-infected patientsAA: n = 390; Latino: n = 112; white: n = 66Adjusted for 8 covariates; inpatient length-of-stay data available on only 79 patients60
Hospitalizations
    Higher hospitalization rates for ACSCsAnalysis of 6 y of data on children 1–14 y of age from National Hospital Discharge Surveys, US Census, and the NHISAA: n = 17 599; white: n = 66 270Not adjusted for covariates; only examined 6 ACSCs61
    Higher proportion of all hospital discharges attributable to ACSCs
    Asthma comprised much higher proportion of all ACSCsWhite race category included all those with missing race
Immunization
    For children <48 mo old, lowest rate of being up-to-date on 4:3:1:3:3 immunization seriesRetrospective cohort study based on Chicago public schools' computerized immunization database on all children completing kindergarten in a 2-y periodTotal sample: N = 66 556bNot adjusted for covariates62
    Substantially greater delay and later mean age for all immunization categories and doses
Infectious diseases (other than HIV/AIDS)
    Higher rate ratio of invasive pneumococcal disease among all 3 age groups analyzed (<2, 2–4, and 5–17 y of age)Analysis of age- and race-specific pneumococcal disease incidence rates from the Active Bacterial Core Surveillance/Emerging Infections Program Network, an active, population-based surveillance system in 7 states, using data from between January 1, 1998, and December 31, 2002Not stated for childrenNot adjusted for covariates63
    Higher incidence rate of tuberculosisAnalysis of 8 y of data on children <15 y of age from the North Carolina Tuberculosis Information Management System databaseAA: n = 114; Latino: n = 33; API: n = 12; white: n = 21Not adjusted for any covariates64
Injuries
    Firearm injury rate >13 times higherAnalysis of data from Minnesota Department of Health's Minnesota Trauma Data Bank on firearm injuries in children 0–19 y of ageTotal sample: N = 175bNot adjusted for covariates65
    Higher adjusted odds of not putting up stair gateAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates66
    Higher adjusted odds of not installing safety latches or locks on cabinets
    Higher adjusted odds of not turning down hot-water thermostat setting
Mental health and behavioral/developmental issues
    Lower adjusted odds of receiving treatment for depression from a mental health specialistAnalysis of National Longitudinal Survey of Youth and the Child/Young Adult supplement, a nationally representative sample of 7- to 14-y-old childrenTotal sample: N = 2482bAdjusted for 28 covariates; no differences for any visit or behavior problem visit67
    Lower adjusted odd of being diagnosed with ADHD without a learning disabilityAnalysis of 5 y of the NHISAA: n = 3562; Latino: n = 5552; white: n = 11 287Adjusted for birth weight, income, and health insurance coverage68
    Lower adjusted odd of being diagnosed with ADHD with a learning disability
    Lower adjusted odds among those with ADHD of receiving any prescription medication
    Lower adjusted odds of any mental health service useAnalysis of outcomes for a random sample of 6- to 18-y-old youths receiving services in ≥1 of 5 San Diego County public sectors of care (alcohol and drug abuse, child welfare, juvenile justice, mental health, and public school education services) over a 1.5-y periodAA: n = 282; Latino: n = 332; API: n = 88; white: n = 554Parents and children with limited English proficiency were excluded; adjustment for 12 covariates69
    Lower adjusted odds of outpatient mental health service use
    Lower adjusted odds of informal mental health service use (self-help groups, peer counseling, clergy counseling, or alternative healers)
    Among those with autism, receive diagnosis 1.4 y later than white children (after adjustment)Analysis of 7 y of Philadelphia County Medicaid claims data for children and adolescents with autismAA: n = 242; Latino: n = 33; white: n = 118Adjusted for 3 covariates; Latino children did not significantly differ from AA children for any finding, but no direct Latino-white comparison made70
    Among those with autism, in mental health treatment an average of 13 mo longer than white children before receiving diagnosis of autism (after adjustment)
    Higher proportion of parents with children with ADHD had negative expectations about ADHD treatment (ie, thought treatment could not help)District-wide stratified random sample of 1615 elementary-school children (kindergarten through 5th grade) in north central Florida public school; included telephone contacts, home visits, and teacher symptom-screening questionnaireAA: n = 201; white: n = 188Adjusted for 8 covariates, except parent-reported barriers, which were unadjusted71
    Among those with ADHD or at high risk for ADHD
        Lower adjusted odds of receiving professional evaluation for ADHD
        Lower adjusted odds receiving ADHD diagnosis
        Lower adjusted odds of currently receiving treatment for ADHD
    Higher adjusted odds of use of state-funded mental health servicesAnalysis of New York City data on receipt of services from state-funded mental health care facilitiesTotal sample: N = 78 085 (including adults)bAdjusted for 7 covariates72
    Higher adjusted odds of developmental delays (based on parental concerns)Analysis of data from National Survey of Early Childhood Health on children 4–35 mo of ageTotal sample: N = 2068bAdjusted for 8 covariates58
    Lower adjusted odds of use of specialty mental health services among children for whom an investigation of abuse or neglect had been opened by the child welfare systemAnalysis of data from the National Survey of Child and Adolescent Well-being on use of specialty mental health services for 1 y after contact with child welfare among a cohort of children 2–14 y of ageAA: n = 899; Latino: n = 487; white: n = 1208Adjusted for 11 covariates and 2 interaction terms73
    Lower adjusted odds of receipt of psychotropic medicationsCross-sectional analysis of computerized claims for children 2–19 y of age continuously enrolled in a mid-Atlantic state Medicaid program for 1 yAA: n = 112 488; white: n = 56 858 Medicaid eligibility (SCHIP,Adjusted for 3 covariates; disparities persisted across 4 categories of Temporary Assistance to Needy Families [TANF], foster care, and Supplemental Security Income [SSI])74
    Lower adjusted odds of receipt of stimulant medications
    Lower adjusted odds of receipt of antidepressants
    Lower adjusted odds of receipt of neuroleptics
    Higher adjusted odds of child's meals not being at the same time dailyAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates66
    Higher adjusted odds of family eating lunch or dinner together less often than every day
    Higher adjusted odds of family never eating lunch or dinner together
    Watch an adjusted mean of 45 min more of television daily
    Higher adjusted odds of reading to child less often than every day
    Lower adjusted mean number of children's books in home
Mortality
    Higher adjusted rates of drowning in a swimming poolAnalysis of 4 y of national data from the Consumer Products Safety Commission on drowning deaths of children 5–24 y of age from death certificates, medical examiner reports, and newspaper clippingsAA: n = 316; Latino: n = 81; AI/AN: n = 18; white: n = 222Adjusted for income; values expressed as rate ratios and 95% CIs, but no P values provided75
    Higher adjusted rates of drowning in public pools, especially hotel/motel pools
    Higher adjusted child mortality rate among boys in the Detroit tri-county areaCombined death-certificate and census data on childhood mortality in 3 major metropolitan areas: Chicago, Detroit, and New YorkAA: n = 13 744; white: n = 54 846Adjusted for age, gender, and census tract income; no consistent adjusted disparities observed for other 2 cities analyzed (New York and Chicago)76
    Higher adjusted child mortality rate among 10- to 19-y-old girls in the Detroit tri-county area
    Median age at death for those with Down syndrome substantially lower (25 vs 50 y among white individuals)Analysis of data from multiple-cause mortality files on all deaths with a diagnostic code for Down syndromeNot indicatedNot adjusted for covariates; included in this analysis because Down syndrome customarily viewed as primarily a pediatric entity77
    Substantially lower average increase in median age at death for those with Down syndrome between 1968 and 1997 (0.7 vs 1.9 in white individuals)
    Mortality from congenital heart defects 19% higher and declined more slowly over 18-y periodAnalysis of data from multiple-cause mortality files compiled by the National Center for Health Statistics from all death certificates filed in the United States with any mention of a congenital heart defectNot indicatedNot adjusted for covariates; small sample sizes for children 1–4 y78
    Infant mortality rate for ventricular septal defect higher and persistently higher over 18-y period
    Lower increase of average age at death from congenital heart defects over time
    Average age at death from congenital heart defects 3–6 times lower
    About half the average age at death vs white individuals for 5 specific congenital heart defects: transposition of the great arteries, tetralogy of Fallot, ventricular septal defect, pulmonary valve anomalies, and single ventricle
    Almost twice the mortality rate for children 1–4 y of age between 1950 and 1993Analysis of 43 y of data on children 5–14 y of age from the National Vital Statistics System, the National Longitudinal Mortality Study, and the Area Resource FileNot indicated (except for two 3-y intervals)Not adjusted for covariates; presented only as population rates; no statistical comparisons or 95% CIs79
    Black/white disparity ratio in mortality rate for children 1–4 y of age increased somewhat during the most recent 10-y period examined
    Approximately 50% higher mortality rate for children 5–14 y of age between 1950 and 1993
    Black/white disparity ratio in mortality rate for children 5–14 y of age increased somewhat during most recent 10-y period examined
    Higher adjusted relative risk of death among children without congenital anomaliesRetrospective cohort study of linked birth and death files for state of Michigan over 6-y periodTotal mortality sample: N = 8362bAdjusted for 4 covariates; no mortality disparities among children with congenital anomalies80
    Higher adjusted risk of death among those with ALLAnalysis of 9 population-based registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results programAA: n = 356; Latino: n = 504; NA: n = 61; API: n = 410; white: n = 3621Adjusted for 3 covariates; did not adjust for SES or insurance coverage81
    Higher adjusted odds of in-hospital death after congenital heart surgeryAnalysis of data from the KID 2000 of the HCUP, limited to 19 states with adequate race/ethnicity dataAA: n = 860; Latino: n = 1835; white: n = 4134Adjusted for 8 covariates82
Nephrology
    Among those with end-stage renal disease, 2.4 times more likely to be on hemodialysis rather than peritoneal dialysisAnalysis of data from Medicare End-Stage Renal Disease registry on all Medicare-eligible children 0–19 y of age undergoing renal replacement therapy in the United StatesAA: n = 368; white: n = 870Adjusted for 10 covariates83
    Lower adjusted hemodialysis doseChildren and adolescents <18 y old within the North American Pediatric Renal Transplant Cooperative Study registry who began maintenance hemodialysis during a 6.5-y period and who received at least 6 consecutive mo of hemodialysisAA: n = 65; white: n = 46Adjusted for 6 covariates84
    Four to 5 times greater adjusted likelihood of inadequate hemodialysis dose
    Among children with end-stage renal disease, lower adjusted likelihood to be activated on the kidney transplant waiting listNational longitudinal cohort study using data from US Renal Data System on children 0–18 y of age with end-stage renal diseaseAA: n = 1122; white: n = 2162Adjusted for 5 covariates; stratified Kaplan-Meier analyses suggested that racial disparities may vary by SES, with significant differences in lowest but not highest SES quartile85
Obesity, physical activity, and nutrition
    Select larger body size for ideal adult body size and ideal opposite-gender adult body sizeCross-sectional survey of random sample of all 4th- and 6th-graders in South Carolina public schoolsAA: n = 749; white: n = 848Adjusted for 2–3 covariates86
    Less personal and family/peer concern about weight
    Significantly fewer trying to lose weight
    Lower adjusted aerobic fitness levelProgressive treadmill protocol evaluation of aerobic fitness (V̇o2peak) of Los Angeles children 7–14 y of age, adjusting for gender, maturational stage, and body compositionAA: n = 19; Latino: n = 36; white: n = 18Adjusted for 3 covariates but did not include SES87
    Higher adjusted odds of overweightAnalysis of height and weight data collected during 3 mo of physical fitness testing of students in grades 5, 7, and 9 in the Los Angeles County public school systemTotal sample: N = 281 630bAdjusted for 4 covariates88
    Higher adjusted likelihood of insulin resistance (cross-sectional assessment)Analysis of 3 y of longitudinal data from the Princeton School District Study of 5th- to 12th-graders in 1 suburban Midwestern public school districtAA: n = 542; white: n = 625Adjusted for 9 covariates; no significant association with change in insulin resistance over time89
    Higher prevalence of overweight in boys among 8th-graders (35%) and 10th-graders (35%)Analysis of 10–17 y of data from Monitoring the Future, a nationally representative sample of students in the 8th, 10th, and 12th gradesTotal sample: N = 4800–17 074 per study interval, depending on grade and yearaNot adjusted for covariates90
    Higher prevalence of overweight in girls among 8th-graders (32%), 10th-graders (34%), and 12th-graders (28%) (highest prevalence among all racial/ethnic groups studied)
    Lower likelihood of eating breakfast regularly
    Less likely to regularly exercise vigorously among girls
    Higher number of hours of television-viewing on average weekday
    Higher prevalence of overweight and obesity among girls (highest of any racial/ethnic group)Cross-sectional survey of adolescents 11–18 y of age in 31 public schools in the Minneapolis, St Paul, and Osseo school districts of MinnesotaTotal sample: N = 4746bNot adjusted for covariates, but the authors stated that stratified analyses adjusting for grade and SES were performed but not reported, because they generally showed patterns similar to those of unadjusted analyses91
    More likely to consume >30% of calories as fat and >10% of calories as saturated fat (highest of any racial/ethnic group)
    Lower calcium intake
    Higher mean BMICross-sectional survey and weight and height measurements of all children in 5th grade in 2 middle schools in Scott County, MississippiAA: n = 121; Latino: n = 70; white: n = 12Not adjusted for covariates; unclear what proportion of potential participants refused to participate92
    Higher BMI percentile
    Lower mean consumption of fiber per 1000 kcal
    Lower mean scores on self-administered health knowledge questionnaire
    Higher prevalence of overweight Analysis of NHANES data on children 2–19 y of age from 1999–2000 and 2001–2002AA: n = 1274; Latino: n = 1475; white: n = 1094Not adjusted for covariates93
    Higher prevalence of overweight among 6- to 11-y-olds
    Higher prevalence of overweight among 12- to 19-y-olds
    Higher prevalence of overweight among girls
    Higher prevalence of overweight among 6- to 11-y-old girls
    Higher prevalence of overweight among 12- to 19-y-old girls
    Higher prevalence of at risk of overweight or overweight
    Higher prevalence of at risk of overweight or overweight among 12- to 19-y-olds
    Higher prevalence of at risk of overweight or overweight among girls
    Higher prevalence of at risk of overweight or overweight among 12- to 19-y-old girls
    Higher adjusted odds of overweightCross-sectional sample of California public school 5th, 7th, and 9th-graders (10–15 y of age)AA: n = 58 491; Latino: n = 330 758; Asian: n = 63 292; Pacific Islanders: n = 7977; Filipino: n = 22 598; NA: n = 7977; white: 275 722Adjusted for 2 covariates and stratified according to age94
    Slower adjusted 1-mile run/walk time
Ophthalmology
    Lower adjusted odds of being diagnosed with any eye or vision conditionAnalysis of 6 y of data for children 0–17 y of age in the MEPSTotal sample: N = 2813bAdjusted for 13 covariates; the authors concluded that disparities indicate possible underdiagnosis, undertreatment, or both95
    Lower adjusted odds of being diagnosed with an eye or vision condition other than conjunctivitis
Orthopedic issues
    For treatment of supracondylar humerus fractures, more likely to undergo closed reduction with internal fixation (percutaneous pinning)Retrospective examination of selected pediatric fractures in the KID of the HCUPAA: n = 207; Latino: n = 659; white: n = 1478Not adjusted for covariates; no disparities for femur or forearm fractures96
Quality
    Lower adjusted odds of receiving any counseling during well-child visitsCross-sectional analysis of 10 y of data on children 0–18 y of age from the National Ambulatory Medical Care SurveyTotal sample: N = 2892bAdjusted for 7 covariates97
    Lower adjusted odds of receiving any screening during well-child visits
    Lower adjusted likelihood of meeting recommended number of well-child visitsAnalysis of 3 y of data for children 0–17 y of age in the MEPSAA: n = 5137; API: n = 890; Latino: n = 9392; white: n = 14 041Adjusted for 10 covariates98
    Children with cardiovascular disease had bidirectional Glenn surgery at significantly older median age (11 vs 6 mo of age among white infants)Review of surgical database at Duke University Medical Center of all children who underwent bidirectional Glenn or Fontan stages of single-ventricle palliation over a 4-y periodAA: n = 20; white: n = 47Although not adjusted for covariates, no significant differences found between AA and white children in median family income for either measure99
    Children with cardiovascular disease had Fontan procedure at significantly older median age (60 vs 36 mo of age among white children)
    Lower primary care provider strength-of-affiliation scores (unadjusted and adjusted)Telephone survey of parents of random sample of 413 children attending elementary school in 3 suburban communities in San Bernardino County, CaliforniaAA: n = 100; API: n = 91; Latino: n = 84; white: n = 102Adjusted for 11 covariates100
    Lower primary care provider interpersonal relationship scores (unadjusted and adjusted [if required by managed care organization to stay in network])
    Lower adjusted scores for timeliness of careAnalysis of parental survey data on children 0–17 y of age from the national CAHPS Benchmarking Database 1.0 administered by Medicaid sponsors comprising 33 health maintenance organizations from Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and WashingtonAA: n = 1344; Latino: n = 842; API: n = 291; AI/AN: n = 330; white: n = 6328Adjusted for 4 covariates101
    Lower adjusted scores for health insurance plan service
    Lower adjusted scores for getting needed medical care
    Lower adjusted scores for comprehensiveness of primary careCross-sectional survey of parents of children in 228 classes, from kindergarten through 6th grade, at 18 elementary schools in a large urban school district in CaliforniaAA: n = 458; API: n = 1158; Latino: n = 1292; white: n = 479Adjusted for 5 covariates102
    Greater adjusted odds of child being assigned to health care providerAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates32
    Greater adjusted odds of health care provider never/only sometimes understanding how parent prefers to rear child
    Greater adjusted odds of discussing violence in the community, smoking in the household, use of alcohol or drugs in household, trouble paying for child's needs, and spouse/partner supportive of parenting efforts
Special health care needs
    Lower adjusted odds of receiving adequate time and information from child's health care provider, among children with special health care needsAnalysis of National Survey of Children With Special Health Care NeedsTotal sample: N = 38 866bAdjusted for 6 covariates; no disparities in any unmet need or problem with specialty referral103
    Among children with special health care needsAnalysis of data on children 0–17 y of age with special health care needs in the NHIS on disabilityAA: n = 1762; Latino: n = 1777; white: n = 6365Adjusted for 9–10 covariates104
        Higher adjusted odds of not identifying a regular clinician
        Lower adjusted odds of usual source of care being doctor's private office or health maintenance organization
        Average 2 fewer doctor visits per year
    Among children with special health care needsAnalysis of data on children 0–17 y of age from National Survey of Children with Special Health Care NeedsNot indicatedAdjusted for 6 covariates105
        Higher adjusted odds of child having no physician or nurse
        Higher adjusted odds of dissatisfaction with care
    Among children with special needsAnalysis of data on special needs children 0–17 y of age from the National Survey of Children With Special Health Care NeedsAA: n = 3820; Latino: n = 3210; white: n = 28 916Adjusted for 13 covariates106
        Greater adjusted odds of problems with ease of using health care services
Surgery
    For those hospitalized for appendicitisAnalysis of data on children 1–17 y of age with appendicitis from the Nationwide Inpatient Sample and the KIDTotal sample: N = 428 463bNot adjusted for covariates for time to operation, length of stay, or hospital charges; other outcomes include adjustment for 6 covariates107
        Longer time to operation (regardless of disease severity)
        Longer length of stay (regardless of disease severity)
        Higher hospital charges (regardless of disease severity)
        Higher adjusted odds of perforation or other complicating factors
        Lower adjusted odds of a laparoscopic procedure
Transplantation
    Lower proportion (0%) received preemptive transplantsRetrospective analysis of transplant database at Cincinnati Children's HospitalAA: n = 37; white: n = 192Relatively small sample size of AA children; not adjusted for covariates108
    Fewer living transplants and more cadaveric transplants in most recent time period
    Cause of end-stage renal disease more likely to be acquired and less likely to be congenital or metabolic
    Approximately double the adjusted odds of heart transplantation graft failureAnalysis of 18 y of data from the United Network for Organ Sharing, including annual follow-up of transplant recipientsAA: n = 717; white: n = 3510Adjustment for 13 covariates109
    Lower 5-y heart transplant graft survival rate
    Median heart transplant graft survival rate (5.3 y) ∼6 y lower than that for white children (11.0)
    Median age at heart transplant (8 y) 5 y older than that for white children (3 y)
    More likely to have HLA mismatch
Use of health services
    Reduced physician visits under mandatory enrollment in managed care among those with MedicaidDifference-in-difference analysis of pre/post impact of mandatory enrollment in managed care for Medicaid beneficiaries in 2 unnamed counties in an unnamed Midwestern stateAA: n = 4891; white: n = 4460Adjusted for 3 covariates (all subjects enrolled in Medicaid, so no SES adjustment); no differences observed in hospitalizations or ED use110
    Higher adjusted likelihood of medically unnecessary EMS transportsAnalysis of linked EMS and ED billing records for all EMS-to-hospital transports of children 0–17 y old originating in 3 counties in South Carolina over 27 moAA: n = 4331; Latino: n = 75; other: n = 48; white: n = 1239Adjusted for 4 covariates111
    Greater adjusted odds of ≥1 y since last physician visitAnalysis of 3 y of NHIS data on children 0–17 y oldAA: n = 17 324; Latino: n = 12 765; API: n = 2516; AI/AN: n = 1067; white: n = 62 572Adjusted for 4 covariates112
    Lower adjusted number of physician visits in previous 12 mo
    Double the odds of suboptimal health status
    Among those hospitalized for pneumoniaAnalysis of 3 y of data on children 0–17 y of age hospitalized for pneumonia from the National Inpatient Sample of the HCUPAA: n = 17 095; Latino: n = 15 152; API: n = 2050; white: n = 43 180Adjusted for 6–7 covariates113
        Higher adjusted risk ratio of admission through EDs
        Lower adjusted odds of bronchoscopy
        Lower adjusted odds of mechanical ventilation
        Shorter adjusted length of stay
        Higher adjusted charges
    Among Medicaid-covered childrenAnalysis of data on North Carolina Medicaid-covered children 1–4 y of age from linked Medicaid, WIC service, and birth certificate dataAA: n = 9288; white: n = 11 351cAdjusted for 8–9 covariates114
        Lower adjusted odds of well-child care visit in previous year (at 1, 2, and 4 y of age)
        Lower adjusted odds of diagnosis and treatment for otitis media
        Lower adjusted odds of diagnosis and treatment for upper respiratory infections
        Lower adjusted odds of diagnosis and treatment for lower respiratory infections
        Lower adjusted odds of diagnosis and treatment for gastroenteritis
        Higher adjusted odds of diagnosis and treatment for asthma
        Lower adjusted outpatient Medicaid expenditures
        Lower adjusted ED Medicaid expenditures (for 3- and 4-y-olds)
        Lower adjusted prescription drug Medicaid expenditures
        Lower adjusted mean number of calls to doctor's office in past yearAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthAA: n = 477; Latino: n = 817; white: n = 718Adjusted for 9 covariates32
        Greater adjusted odds of at least 1 ED visit in previous year
  • MEPS indicates Medical Expenditure Panel Survey; CHIRI, Child Health Insurance Research Initiative; Add Health, National Longitudinal Study of Adolescent Health; NHIS, National Health Interview Survey; NHANES, National Health and Nutrition Examination Survey; ACSC, ambulatory-care–sensitive condition; 4:3:1:3:3, combined series composed of ≥4 doses of diphtheria and tetanus toxoids and pertussis/diphtheria and tetanus toxoids/diphtheria and tetanus toxoids and acellular pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine; V̇o2, oxygen consumption per unit time; KID, Kid's Inpatient Database; HCUP, Healthcare Cost and Utilization Project; CAHPS, Consumer Assessment of Health Plans Study; EMS, Emergency Medical Services; WIC, Supplemental Nutrition Program for Women, Infants, and Children.

  • a Sample sizes include those 0 to 24 y of age, because those 15 to 24 y of age were grouped together.

  • b Sample sizes were not disaggregated in article according to race/ethnicity.

  • c Sample sizes for initial cohort (1-y-olds)