Flores, G., Olson, L., & Tomany-Korman, S. C. (2005).Pediatrics, 115(2), e183-e193.

While racial and ethnic disparities in healthcare have received considerable national attention, minimal data exist regarding such disparities among children. This study from the 2000 National Survey of Early Childhood Health (NSECH) was designed to examine racial/ethnic disparities in early childhood health and healthcare using a nationally representative sample. The NSECH was a telephone survey of a national random-digit-dialed sample of households in all 50 states with children 4 to 35 months of age. The parent or guardian most responsible for the child's healthcare was interviewed. Survey questions addressed health, healthcare, interactions with healthcare providers, and the occurrence of specific child health diagnoses in the previous 12 months. A total of 2,068 interviews were completed with an overall response rate of 65.6%. In addition to descriptive and bivariate analyses, multivariate logistic and linear regressions were used to examine racial/ethnic differences, with adjustment for potential confounding variables (i.e., insurance coverage, survey language). Results indicated that Hispanic and black children were significantly less likely than whites to be in excellent/very good health (72%, 79%, and 90%, respectively) and were more likely to be uninsured (31%, 18%, and 9%, respectively). While 84% of white parents would recommend their child's healthcare provider to others, only 60% of Hispanic and 77% of black parents would do so. Consistent with these findings, minority parents more often reported that providers never or only sometimes understood their child-rearing preferences. Compared with their white counterparts, minority parents were more likely to report that their child's provider discussed community violence, household smoking, and use of alcohol or illicit drugs. Racial/ethnic disparities were also observed for referrals by providers to any specialist in the prior year; 11% of Hispanic children, 17% of black children, and 22% of white children were referred.

The "causes" of the disparities observed in health status, insurance coverage, topics discussed during pediatric visits, parents feeling understood by providers, parental satisfaction with care, and referral to specialists are not clear. Given the increasingly diverse pediatric patient populations, research on the root causes of disparities, additional education for healthcare providers, and ongoing monitoring by health plans, including the State Children's Health Insurance Program, Medicaid, and other health-care systems, are clearly warranted. Child healthcare providers and advocates are central to the success of such multilevel efforts designed to eliminate disparities in health and healthcare for our children.

Comment by Laura L. Hayman