TABLE 4

Disparities in the Health and Health Care of AI/AN Children

Disparity (vs White Children)Study DesignSample Size(s)NotesRef No.
Adolescents
    Female adolescents: higher risks of needing but not getting medical care and perpetrating violenceAnalysis of Add Health (waves 1 and 2), a nationally representative school-based study of youths in grades 7–12, with follow-up into adulthoodAI/AN: n = 136; AA: n = 3038; API: n = 1021; Latino: n = 2340; white: n = 7728Prevalence in published tables not adjusted, but 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 provided35
    Male adolescents: higher risk of skipping breakfast, poor/fair health status, and perpetrating violence
    Live birth rate for adolescent girls 15–17 y of age >2 times higher1990–1998 natality files from the National Vital Statistics SystemNot providedExpressed as rates per 1000; not adjusted for covariates36
    Birth rate for 15–19 y-old girls almost 3 times as highBirth certificate data reported to the CDC National Center for Health StatisticsNot providedNot adjusted for covariates; no P values or 95% CIs38
Injuries
    Firearm injury rate >7 times higherAnalysis of data from Minnesota Department of Health's Minnesota Trauma Data Bank on fatal and nonfatal firearm injuries in children 0–19 y of ageTotal sample: N = 175aNot adjusted for covariates65
Mental health and behavioral/developmental issuesAnalysis 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 813aAdjusted for 17 covariates126
    Lower adjusted likelihood of mental health services use among Medicaid-eligible and non–Medicaid-eligible adolescents in substance abuse treatment
    Within 6 mo of a new episode of depressionAnalysis of Washington State Medicaid claims for children 5–18 y of ageAI/AN: n = 154; Latino: n = 90; white: n = 1048Adjusted for 5 covariates128
        Lower adjusted odds of filling an antidepressant prescription
        Lower adjusted odds of any mental health visit or antidepressant prescription filled
Mortality
    Significantly higher age-specific mortality rate among 1- to 14-y-old urban children (vs urban white children)Vital statistics data for 10 y from King County, WashingtonNot stated for this outcomeNot adjusted for covariates134
    Approximately 50% higher mortality rate for 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 FileAI/AN: n = 1336; white: n = 67 200Not adjusted for covariates; presented only as population rates; no statistical comparisons or 95% CIs79
    Higher mortality rate for children 5–14 y of age
    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 programAI/AN: n = 61; AA: n = 356; API: n = 410; Latino: n = 504; white: n = 3621Adjusted for 3 covariates; not adjusted for SES or insurance coverage81
Obesity physical activity and nutrition
    Higher 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 630aAdjusted for 4 covariates88
    Higher prevalence of overweight and obesity (highest prevalence of any racial/ethnic group for boys)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 = 4746aNot adjusted for covariates, but 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
    Lower calcium intake among boys
    Higher adjusted odds of overweightCross-sectional sample of California public school 5th-, 7th-, and 9th-graders (10–15 y old)AI/AN: n = 7977; AA: n = 58 491; Asian: n = 63 292; Filipino: n = 22 598; Latino: n = 330 758; Pacific Islander: n = 7977; white: 275 722Adjusted for 2 covariates and stratified according to age; run/walk times not significantly different for 2 older strata for both genders94
    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 = 2813aAdjusted for 13 covariates; the authors concluded that disparities indicated possible underdiagnosis, undertreatment, or both; no disparities in being diagnosed with an eye or vision condition other than conjunctivitis95
Quality
    Lower adjusted scores for timeliness of careAnalysis of parental survey data on children 0–17 y of age from the CAHPS Benchmarking Database 1.0 administered by Medicaid sponsors comprising 33 health maintenance organizations from Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and WashingtonAI/AN: n = 330; AA: n = 1344; API: n = 291; Latino: n = 842; white: n = 6328Adjusted for 4 covariates101
    Lower adjusted scores for provider communication
    Lower adjusted scores for health insurance plan service
    Lower adjusted ratings of child's personal doctor
    Lower adjusted ratings of health plan
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 ageAI/AN: n = 1067; API: n = 2516; AA: n = 17 324; Latino: n = 12 765; white: n = 62 572Adjusted for 4 covariates112
    More than double the adjusted odds of suboptimal health status and highest prevalence of any racial/ethnic group
  • MEPS indicates Medical Expenditure Panel Survey; Add Health, National Longitudinal Study of Adolescent Health; NHIS, National Health Interview Survey; CAHPS, Consumer Assessment of Health Plans.

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