The Association Between Racial Discrimination, Race, and Social Class With Health Among US Children

To assess the association between racial discrimination, race and ethnicity, and social class with child health and unmet health care needs among children in the United States (US).

We used a nationally representative sample of children aged 0 to 17 from the 2018-2019 National Survey of Children's Health. Bivariate and multivariable logistic regression were used to test associations between measures of discrimination, social class (income, employment, and education), and race and ethnicity with overall child health and unmet health care needs controlling for covariates identified a priori.

Overall, 90.3% of children (n = 59,964) had excellent/very good overall health; 3.1% had unmet health care needs. Black, non-Hispanic children had 8.9 times the odds of having experienced racial discrimination compared to White, non-Hispanic children (95% confidence interval [CI], 7.0-11.4). Having special health care needs was significantly associated with greater odds of racial discrimination (OR 2.3; 95% CI, 1.9-2.8). In multivariable models, underrepresented race and ethnicity groups, lower household income level, and lower caregiver education were significantly associated with poorer overall child health. Conversely, experiencing discrimination was not significantly associated with excellent/good overall child health (adjusted odds ratios [aORs], 0.8; 95% CI, 0.6-1.1) Racial discrimination (aOR 2.7; 95% CI, 1.9-4.0) and lower household income (aOR 2.6; 95% CI, 1.8-3.5) were associated with significantly greater odds of unmet health care needs.

Race and ethnicity and low social class were significantly associated with worse overall health while racial discrimination and low-income were associated with more unmet health care needs. These findings underscore the importance of policy and health care system innovations that address the effects of racism and poverty on child health.