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Health inequity in children and youth with chronic health conditions
Jay G Berry1, Sheila Bloom, Susan Foley
1Complex Care Service, Program for Patient Safety and Quality, Children's Hospital Boston, Fegan 10, 300 Longwood Ave, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
Insights
Racial and ethnic disparities persist in pediatric chronic health conditions. Black and Hispanic children face worse outcomes and less diagnosis for conditions like asthma and ADHD compared to white children.
Area of Science:
- Pediatric Health Outcomes
- Health Disparities Research
- Chronic Condition Management
Background:
- Significant advancements in pediatric chronic healthcare have not benefited all children equally.
- Existing research highlights persistent inequities in health and healthcare access for children with chronic conditions.
Purpose of the Study:
- To comprehensively describe the health inequities experienced by children with chronic health conditions.
- To identify specific disparities in incidence, prevalence, survival, and mortality rates among diverse pediatric populations.
Main Methods:
- Conducted a literature review of English-language studies from 1985-2009.
- Searched major databases (Medline, CDC, NCI, CFF) for keywords including "incidence," "prevalence," "survival," "mortality," and "disparity."
- Focused on a range of chronic conditions in children aged 0-18 years, including leukemia, asthma, ADHD, autism, cerebral palsy, cystic fibrosis, diabetes, Down syndrome, HIV/AIDS, congenital heart defects, depression, sickle cell anemia, spina bifida, and TBI.
Main Results:
- Black children exhibited higher rates of cerebral palsy and HIV/AIDS, lower ADHD diagnosis, increased healthcare utilization, and higher asthma mortality.
- Hispanic children showed higher rates of spina bifida, HIV/AIDS, and depression, with lower ADHD diagnosis and poorer diabetes control.
- Both Black and Hispanic children experienced reduced survival rates for conditions like Down syndrome, type 1 diabetes, traumatic brain injury, and acute leukemia compared to white children.
Conclusions:
- Persistent and serious racial and ethnic health inequities exist for children with chronic health conditions.
- Healthcare disparities continue to impact diagnosis, treatment, and survival outcomes in vulnerable pediatric populations.
Background:
Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them.
Objectives:
To describe health inequities experienced by children with chronic health conditions.
Methods:
We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words "incidence," "prevalence," "survival," "mortality," or "disparity" in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury.
Results:
Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children.
Conclusions:
Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.
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