TABLE 3

Disparities in the Health and Health Care of Latino Children

Disparity (vs White Children)Study DesignSample Size(s)NotesRef No.
Access to care
    Triple the adjusted odds of having no usual source of careAnalysis of Household Component of 1996 and 2000 MEPSLatino: n = 4091; AA: n = 2189; Asian: n = 325; white: n = 6362Adjusted for 8 covariates; double the adjusted odds of dissatisfaction with quality of care in 1996 but not 200028
    Double the adjusted odds of no health professional/doctor visit in previous year
    Lower adjusted odds of having a regular source of careAnalysis of cross-sectional data on children 0–19 y of age from the California Health Interview SurveyTotal sample: N = 19 485Adjusted for 7 covariates55
    Lower adjusted odds of surety of accessing health care among adolescents
    Lower adjusted odds of being in excellent/very good health
    Among Mexican American childrenCross-sectional, population-based, random-digit-dialing survey of parents/guardians of children 3–18 y of age residing in 111 counties in west Texas using 4 items from the CAHPSMexican American: n = 2052; white: n = 2655Adjusted for 17 covariates; same finding when Mexican American children stratified by language spoken at home121
        Lower adjusted odds of always/usually obtaining appointment for regular or routine care
        Lower adjusted odds of always/usually obtaining care for illness or injury
        Lower adjusted odds of always/usually obtaining advice/help over telephone
        Higher adjusted odds of always/usually having a long wait in doctor's office
    Higher adjusted odds of appendicitis rupture in CaliforniaCross-sectional analysis of full-year samples of hospital discharge records for acute appendicitis from California and New York children 4–18 y of ageCalifornia: Latino, n = 4304; API, n = 459; AA, n = 297; white, n = 4017; New York: API, n = 80; AA, n = 342; Latino, n = 444; white, n = 2379Adjusted for 7 covariates; nonsignificant trend observed in New York29
    Higher adjusted proportion in fair or poor health among new SCHIP enrollees in Florida and New YorkAnalysis 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 of age in Florida)Total sample: N = 8975bAdjusted for 10 covariates30
    Lower adjusted proportion had preventive care visits before SCHIP among new SCHIP enrollees in Florida and New York
    Lower adjusted proportion had usual source of care before SCHIP among new SCHIP enrollees in Florida and 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 = 2644 (baseline) and N = 2290 (1-y follow-up)bAdjusted for 12 covariates; 1 unadjusted quality-of-care disparity noted31
        Lower adjusted rate of having usual source of care
        Higher adjusted rate of having unmet needs for health care
    Lower adjusted odds of always getting timely medical care without waitsAnalysis of CAHPS data on cross-sectional cohort from the MEPSLatino: n = 1236; AA: n = 700; white: n = 2184Adjusted for 6 covariates122
    Lower adjusted odds of always getting timely telephone help for medical care
    Lower adjusted odds of brief wait times for medical appointments
    Higher adjusted odds of never/only sometimes getting medical care without long waits
    Higher adjusted odds of never/only sometimes getting timely routine care
    Higher adjusted odds of never/only sometimes getting timely telephone help
    Higher adjusted odds of never/only sometimes getting brief wait times for medical appointments
    Greater adjusted odds of being uninsuredAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthLatino: n = 817; AA: n = 477; white: n = 718Adjusted for 9 covariates32
    Greater adjusted odds of not being referred to specialist by health care provider
Adolescents
    Female adolescents: higher risk of no health insurance, 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 adulthoodLatino: n = 2340; AA: n = 3038; API: n = 1021; AI/AN: n = 136; white: n = 7728Prevalence in published tables was not adjusted; the 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 adolescents; no formal statistical evaluation of disparities was provided in article35
    Male adolescents: higher risk of no health insurance, last physical examination >2 y ago, and being a victim of violence
    Lower adjusted odds of bicycle helmet useAnalysis of California Health Interview Survey data on adolescents 12–17 y of ageLatino: n = 1515; API: n = 376; white: n = 3263Adjusted for 5 covariates; interactions noted with generational status for certain outcomes116
    Lower adjusted odds of sunscreen use
    Live birth rate for adolescent girls 15–17 y of age >3 times higher (and highest for any racial/ethnic group)1990–1998 natality files from the National Vital Statistics SystemNot providedExpressed as rates per 1000; rates not adjusted for any covariates36
    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 = 2036bNot adjusted for covariates33
    Less likely to use doctor's offices as their usual source of care among adolescents recently enrolled in SCHIP
    Lower adjusted odds of being treated for sexually transmitted infections in the EDAnalysis of 7 y of data from the National Hospital Ambulatory Medical Care Survey on children 12–19 y of ageLatino: n = 1710; AA: n = 8170; white: n = 8930Adjusted for 4 covariates123
    Birth rate for 15- to 19-y-old girls almost 3 times 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 male 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 injuryLatino: n = 396; AA: n = 1760; white: n = 5584Adjusted for 7 covariates39
Asthma and allergies
    Puerto Rican children have significantly higher adjusted odds of having current asthma (and are only racial/ethnic minority group with higher odds after adjustment for income and neighborhood factors)Cross-sectional parental survey of 26 randomly selected New York City public elementary schoolsLatino: n = 2058; AA: n = 1171; white: n = 798; Asian: n = 646Adjusted for 4 covariates; Asian children had significantly lower adjusted odds of having current asthma (vs white children)124
    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 adjusted odds of an asthma ED visit or hospitalization among Puerto Ricans, Dominicans, and “other Latinos” but not Mexicans
    Higher diagnosed asthma prevalence among Puerto Rican children (22%)Cross-sectional analysis of parent-report questionnaire data from 14 low- income, diverse Chicago public elementary schoolsLatino: n = 6002 (Puerto Rican: n = 473); AA: n = 2938; white: n = 1560Not adjusted for covariates46
    Higher total potential asthma burden (diagnosed plus possible but undiagnosed asthma) among Puerto Rican children
    Higher asthma prevalenceTrends 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 National Vital Statistics SystemNot providedOnly unadjusted rates were presented; no differences or lower rate of asthma attack prevalence vs white children; no statistical comparisons performed or 95% CIs provided40
    Substantial rise in asthma prevalence over 11-y period (more than doubled)
    Lower adjusted odds of daily anti-inflammatory use for asthmaCross-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 MassachusettsLatino: n = 313; AA: n = 636; white: n = 512Adjusted for SES, health status, age, gender, and other sociodemographic variables48
    Higher adjusted odds of cockroach allergen sensitivity among Mexican American childrenCross-sectional analysis of children 6–16 y of age who participated in allergen testing in the NHANES IIIMexican American: n = 1546; AA: n = 1502; white: n = 1116Adjusted for 8 covariates; Mexican American children were the only Latino children examined49
    Higher adjusted odds of dust mite allergen sensitivity among Mexican American children
    Higher adjusted odds of asthma-associated activity limitationsAnalysis of data from the Los Angeles County Health Survey on children <18 y of ageLatino: n = 3675; AA: n = 566; 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 inhaled steroidsAnalysis 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 residing in Connecticut and MassachusettsLatino: n = 255; AA: n = 139; white: n = 549Adjusted for 9 covariates51
    Lower adjusted odds of use of inhaled steroids among those cared for in private practices
    For Puerto Rican children, higher adjusted odds of physician-diagnosed asthmaAnalysis of NHIS data on 3- to 17-y-olds currently symptomatic with wheezingPuerto Rican: n = 40; Mexican: n = 122; AA: n = 174; white: n = 610Adjusted for 10 covariates125
Breastfeeding
    Lower proportion of children ever breastfed among Mexican American childrenAnalysis of breastfeeding data on children 12–71 mo of age in the NHANES III (1988–1994)Mexican American: n = 2118; AA: n = 1845; white: n = 1869Not adjusted for any covariates53
Health status
    Higher adjusted likelihood of fair or poor healthAnalysis of 3 y of NHIS data on children 0–17 y of ageLatino: n = 12 765; API: n = 2516; AA: n = 17 324; AI/AN: n = 1067; white: n = 62 572Adjusted for 4 covariates112
HIV/AIDS
    Approximately twice the percentage of new HIV/AIDS diagnoses vs white children for those <13 y of age, perinatal transmission, and other pediatric casesDiagnoses 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 yLatino: n = 3249; AA: n = 11 554; white: n = 3707aNo 95% CIs or P values presented for children; not adjusted for covariates59
    Number of new HIV/AIDS diagnoses exceeds that for white children for those <13 y of age, perinatal transmission, and other pediatric cases
    Although Latino children constitute 14% of US children, number of new HIV/AIDS diagnoses among those 0–24 y of agea (n = 3249) almost equal to that of white individuals of same age (n = 3707)
Infectious diseases (other than HIV/AIDS)
    Higher incidence rate of tuberculosisAnalysis of 8 y of data on children <15 y of age from North Carolina Tuberculosis Information Management System databaseLatino: n = 33; AA: n = 114; API: n = 12; white: n = 21Not adjusted for any covariates64
Injuries
    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 HealthLatino: n = 817; AA: n = 477; white: n = 718Adjusted for 9 covariates66
Mental health and behavioral/developmental issues
    Significantly lower adjusted odds of externalizing behavioral disordersSecondary analysis of 2 y of MEPS data on children 2–18 y of ageTotal 1996 MEPS sample size: N = 3955; total 1997 MEPS sample size: N = 5933Adjusted for 7–9 covariates43
    Significantly lower adjusted odds of ambulatory visits
    Lower adjusted likelihood of mental health services use among Medicaid-eligible adolescents in substance abuse treatmentAnalysis of Oregon's substance abuse treatment database (Client Processing Monitoring System) for adolescents 12–17 y of age admitted to publicly funded treatment for a substance use disorder during a 9-y periodTotal sample: N = 25 813bAdjusted for 17 covariates126
    Lower adjusted odds of receiving treatment for any condition 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 covariates67
    Lower adjusted odds of receiving treatment for behavior problems from a mental health specialist
    Lower adjusted odds of receiving treatment for depression from a mental health specialist
    Triple the adjusted odds of unmet need for mental health careCross-sectional analyses of data on children 3–17 y of age from the NHIS, the National Survey of American Families, and the Community Tracking SurveyLatino: n = 695; AA: n = 867; white: n = 3049Adjusted for 8 covariates127
    Within 6 mo of a new episode of depressionAnalysis of Washington state Medicaid claims for children 5–18 y of ageLatino: n = 90; AI/AN: n = 154; white: n = 1048Adjusted for 5 covariates128
        Lower adjusted odds of filling an antidepressant prescription
        Lower adjusted odds of any mental health visit
        Lower adjusted odds of any mental health visit or antidepressant prescription filled (combined)
    Higher rate of unmet need for mental health services (no services among children with identified need)Analysis of data from National Survey of America's Families for children 6–17 y of ageLatino: n = 6022; AA: n = 6371; white: n = 31 240Not adjusted for covariates129
    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
    Substantially lower adjusted odds of receiving an ADHD diagnosis during outpatient primary care provider visitsAnalysis of 6 y of data on children 3–18 y of age from National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care SurveyLatino: n = 4117; AA: n = 5074; white: n = 16 406Adjusted for 3 covariates130
    Substantially lower adjusted odds of receiving a stimulant prescription during outpatient primary care provider visits
    Substantially lower adjusted odds of receiving an ADHD diagnosis or stimulant prescription during outpatient primary care provider visits
    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 ageLatino: n = 487; AA: n = 899; white: n = 1208Adjusted for 11 covariates and 2 interaction terms; no longer significant adjusted odds in 1 of 3 models (when provider supply, linkage variables, and interactions added)73
    Higher adjusted odds of family never eating lunch or dinner togetherAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthLatino: n = 817; AA: n = 477; white: n = 718Adjusted for 9 covariates66
    Higher adjusted odds of reading to child less than every day
    Lower adjusted mean number of children's books in home
Mortality
    Higher swimming pool drowning rates for adolescent boysAnalysis 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 clippingsLatino: n = 81; AA: n = 316; AI/AN: n = 18; white: n = 222Adjusted for income; values expressed as rate ratios and 95% CIs, but no P values were provided75
    Higher rates of drowning in neighborhood pools, including community shared apartment and housing complex pools
    Higher mortality rate for Puerto Rican children 1–4 y of ageAnalysis of 6 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 FilePuerto Rican: n = 265; white: n = 67 200Not adjusted for covariates; presented only as population rates; no statistical comparisons or 95% CIs; small sample sizes in 1979–1981 interval79
    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 programLatino: n = 504; AA: n = 356; AI/AN: 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 2000 KID of the HCUP, limited to 19 states with adequate race/ethnicity dataLatino: n = 1835; AA: n = 860; white: n = 4134Adjusted for 8 covariates; in full model, P value for Latino ethnicity was .0582
Obesity, physical activity, and nutrition
    Significantly 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 compositionLatino: n = 36; AA: n = 19; white: n = 18Adjusted for 3 covariates but not SES87
    Double the adjusted odds of overweightAnalysis of height and weight data collected in 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
    Highest overweight prevalence of any racial/ethnic group
    Higher prevalence of overweight in boys among 8th-graders (35%), 10th-graders (40%), and 12th-graders (30%) (highest prevalence among all racial/ethnic groups studied)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 yearbNot adjusted for covariates90
    Higher prevalence of overweight in girls among 8th-graders (27%), 10th-graders (32%), and 12th-graders (19%) (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 obesityCross-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 stratified analyses adjusting for grade and SES were performed but not reported because generally showed patterns similar to those of unadjusted analyses91
    Boys more likely to consume >10% of calories as saturated fat
    Lower calcium intake
    Among Mexican AmericansAnalysis of NHANES data on children 2–19 y old from 1999–2000 and 2001–2002Latino: n = 1475; AA: n = 1274; white: n = 1094Not adjusted for covariates; Mexican Americans only Latino group analyzed93
        Higher prevalence of overweight
        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 boys (and highest of all racial/ethnic groups analyzed)
        Higher prevalence of overweight among 6- to 11-y-old boys (and highest of all racial/ethnic groups analyzed)
        Higher prevalence of overweight among 12- to 19-y-old boys
        Higher prevalence of overweight among girls
        Higher prevalence of at risk of overweight or overweight (and highest of all racial/ethnic groups analyzed)
        Higher prevalence of at risk of overweight or overweight among 6- to 11-y-olds
        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 boys (and highest of all racial/ethnic groups analyzed)
        Higher prevalence of at risk of overweight or overweight among 6- to 11-y-old boys (and highest of all racial/ethnic groups analyzed)
        Higher prevalence of at risk of overweight or overweight among 12- to 19-y-old boys (and highest of all racial/ethnic groups analyzed)
        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 overweight and highest adjusted odds of any racial/ethnic groupCross-sectional sample of California public school 5th, 7th, and 9th-graders (10–15 y old)Latino: n = 330 758; AA: n = 58 491; Asian: n = 63 292; Pacific Islander: n = 7977; Filipino: n = 22 598; AI/AN: n = 7977; white: n = 275 722Adjusted for 2 covariates and stratified according to age94
    Slower adjusted 1-mile run/walk time
Orthopedics
    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 HCUPLatino: n = 659; AA: n = 207; white: n = 1478Not adjusted for covariates; no disparities seen 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 = 2892bNo multivariable adjustments performed for visit duration; counseling findings were adjusted for 7 covariates97
    Shorter well-child visit duration
    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, CaliforniaLatino: n = 84; AA: n = 100; API: n = 91; white: n = 102Adjusted for 11 covariates100
    Lower primary care provider interpersonal relationship scores (unadjusted and adjusted [if required by managed care organization to seek referral and to stay in network])
    Among those in which the primary language spoken at home is a language other than EnglishAnalysis 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 WashingtonLatino: n = 842; AA: n = 1344; API: n = 291; AI/AN: n = 330; white: n = 6328Adjusted for 4 covariates; no disparities noted for Latino children in households in which English is primary language101
        Lower adjusted scores for timeliness of care
        Lower adjusted scores for provider communication
        Lower adjusted scores for staff helpfulness
        Lower adjusted scores for health insurance plan service
        Lower adjusted ratings of child's personal doctor
        Lower adjusted ratings of specialist
        Lower adjusted ratings of health plan
    Among those seen in the ED for acute gastroenteritisAll patients seen in the ED over a 6-mo period with a discharge diagnosis of acute gastroenteritis as identified through a computerized patient logLatino: n = 143; AA: n = 122; white: n = 132Adjusted for 7 covariates131
        Lower adjusted likelihood to undergo >2 diagnostic tests
        Lower adjusted likelihood of having undergone radiography
        Lower mean participatory decision-making score for child's physicianCross-sectional, population-based, random-digit-dialing survey of parents/guardians of children 3–18 y of age residing in 111 counties in west TexasLatino: n = 1720; white: n = 2156Adjusted for 11 covariates132
    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 CaliforniaLatino: n = 1292; API: n = 1158; AA: n = 458; white: n = 479Adjusted for 5 covariates102
    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 HCUPLatino: n = 15 152; API: n = 2050; AA: n = 17 095; 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
        Longer adjusted length of stay
        Higher adjusted charges
    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 HealthLatino: n = 817; AA: n = 477; white: n = 718Adjusted for 9 covariates32
    Greater adjusted odds of parent being not very likely to recommend child's well-child care provider
    Greater adjusted odds of health care provider never/only sometimes understanding how parent prefers to rear child
    Greater adjusted odds of health care provider never/only sometimes understanding child's specific needs
    Greater adjusted odds of discussing violence in the community, and use of alcohol or drugs in household
Special health care needs
    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 disabilityLatino: n = 1777; AA: n = 1762; white: n = 6365Adjusted for 9–10 covariates104
        Higher adjusted odds of being uninsured
        Higher adjusted odds of having no usual source of care
        Higher adjusted odds of not identifying a regular clinician
        Higher adjusted odds of not being satisfied with care
        Higher adjusted odds of being unable to get needed medical care
        Lower adjusted odds of usual source of care being doctor's private office or health maintenance organization
        Higher adjusted odds of not having seen doctor in previous 12 mo
        Average 2 fewer doctor visits per year
    Lower adjusted odds of receiving adequate time and information from child's health care providerAnalysis 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 from the National Survey of Children With Special Health Care NeedsNot indicatedAdjusted for 6 covariates105
        Higher adjusted odds of having no usual source of care
        Higher adjusted odds of having difficulty receiving referrals for specialty care
        Higher adjusted odds of dissatisfaction with care
        Higher adjusted odds of family members having to reduce or stop employment because of child's condition
    Among children with special health care needsAnalysis of data on children 0–17 y of age from the National Survey of Children With Special Health Care NeedsLatino: n = 3424; API: n = 197; AA: n = 3833; white: n = 28 967Adjusted for 6 covariates133
        Higher adjusted odds of not receiving family-centered care
        Higher adjusted odds of parents experiencing employment consequences as a result of child's condition
    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 NeedsLatino: n = 3210; AA: n = 3820; 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 appendicitis rate
        Higher adjusted odds of perforation or other complicating factors
Use of health services
    Greater adjusted odds of ≥1 y since last physician visitAnalysis of 3 y of NHIS data on children 0–17 y of ageLatino: n = 12 765; AA: n = 17 324; API: n = 2516; AI/AN: n = 1067; white: n = 62 572Adjusted for 4 covariates112
    Lower adjusted number of physician visits in previous 12 mo
    Greater adjusted odds of suboptimal health status
    Greater adjusted odds among Puerto Rican children of suboptimal health status
    Mexican American children had greater adjusted odds of suboptimal health status and ≥1 y since last physician visit and made a lower adjusted number of physician visits in the previous year
    Lower adjusted mean number of calls to doctor's office in previous yearAnalysis of data on children 4–35 mo of age from the National Survey of Early Childhood HealthLatino: n = 817; AA: n = 477; white: n = 718Adjusted for 9 covariates32
  • 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; KID, Kid's Inpatient Database; HCUP, Healthcare Cost and Utilization Project; CAHPS, Consumer Assessment of Health Plans Study; V̇o2, oxygen consumption per unit time.

  • a Sample sizes includes those 0 to 24 years of age, because the CDC grouped those 15 to 24 years of age together.

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