Child Health Disparities

1. Child Health Disparities Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington University Executive Director Goldberg Center for Community Pediatric Health Children’s National Medical Center

2. Disparities in Healthcare:Definition “…Racial or ethnic differences in the quality of healthcare that are not due to access related factors or clinical needs, preferences and appropriateness of intervention.” IOM Report: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, 2003

3. Healthcare Disparities • Access to health care services • Health outcomes • Quality of care

4. Findings “Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services.” IOM Report: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, 2003

5. Healthcare Disparities and Socioeconomic Factors • Disparities diminish when socioeconomic factors are controlled • Most studies find persistence of racial and ethnic disparities after adjustment for socioeconomic differences

6. Pediatric Disparities Among Latino children, higher incidence of: • Overweight and obesity • Asthma • Injuries - hospitalizations & death • Tuberculosis - 13X • Type 2 Diabetes • Developmental problems • Dental decay

7. Childhood Obesity: 400% increase since 1970

9. District of Columbia: Highest Rate of Overweight (10 – 17)

10. DC Partnership to Improve Children’s Healthcare Quality Overweight or obese: 33% of preschoolers 43% of 6-10 years old 47% of 11-21 years old

11. Health Outcomes • Being overweight as a child is associated with multiple chronic diseases that typically manifest in adulthood, such as type-2 diabetes, cardiovascular disease and certain cancers Must A et al.: “Long-Term Morbidity and Mortality of Overweight Adolescents”. New England Journal of Medicine;1992.327(19):1350-1355 • Many adult complications, such as type-2 diabetes and hypertension are increasingly being seen in overweight adolescents

12. Psychosocial Outcomes • Discrimination/ teasing • Poor self-esteem • Eating disorders • Family problems • Behavioral and learning problems • Lower education/ socioeconomic status

13. Utilization of Health Services • “Obese children tend to use more resources – hospital days, ER visits, outpatient visits and pharmaceuticals” • “Obese children are more than twice as likely to be hospitalized as compared with non-obese children” Pediatric Obesity: Implications for Pediatric Healthcare Providers, Child Health Corporation of America Executive Institute Special Report, Dec 2007

14. Asthma • African American and Latino children enrolled in Medicaid managed care had worse asthma status and were less likely to be using preventive asthma medications than White children. • This disparity persisted after adjusting for socioeconomic status. Lieu T et al.: Ethnic Variation in Asthma Status and Management Practices Among Children in Managed Medicaid; Pediatrics 109(5); 857-865; 2002

15. Pediatric ED Visit Rates for Asthma0-4y, inclusive (IMPACT DC Project, S.Teach) Healthy People 2010 Target: 80 per 10,000

16. ED Asthma Visits by Zip Code, 2002 IMPACT DC Project, S. Teach Lowest Rate = 3.9/1000 Highest Rate = 45.2/1000 11.6-fold Difference in Rate

17. Understanding Health Disparities • Contributing risk factors • Race • Income • Insurance status • Language & culture • Unknown factors?

18. Responses to the Health Disparities Challenge • Access to health care services: accessible, affordable, culturally responsive • Community as empowered consumer • Partnerships between researchers, clinicians, advocates and communities • Targeted clinical interventions

19. Contact Information Denice Cora-Bramble, MD, MBA Executive Director Goldberg Center for Community Pediatric Health Children’s National Medical Center (202) 476-5857 dcorabra@cnmc.org