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Health inequity in children and youth with chronic health conditions.

Posted Dec 09 2010 6:53pm

A recent paper in the Journal Pediatrics looks at differences in prevalence, incidence, survival and other disparities for children with chronic health conditions. These conditions include autism along with acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), 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.

Health inequity in children and youth with chronic health conditions .

Berry JG, Bloom S, Foley S, Palfrey JS.

Complex 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
Abstract

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.

Autism is not unique in that there are racial and ethnic disparities involved. It is clear that many of the disparities involving autism are artificial. For example, there almost certainly aren’t large differences between races and ethnic groups in terms of the fraction of autistic people. And, yet, there are big differences in the number of people identified as autistic.

One focus of the IACC is to direct more research into better identification within the diverse groups in the US, as well as seeing what differences may really exist withing these groups. Here is one short term goal in the Plan:

Enhance existing case-control studies to enroll racially and ethnically diverse populations affected by ASD by 2011. IACC Recommended Budget: $3,300,000 over 5 years.

I am of the opinion that we could use a lot more money applied to exploring autism in diverse populations.

  1. Tweets that mention Autism Blog - Health inequity in children and youth with chronic health conditions. « Left Brain/Right Brain -- Topsy.com:
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  2. williamdawson:
    You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check http://ow.ly/3akSX .If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!
  3. Agustin Legido:
    Excellent information, without doubt one of the best that i have read in the last time, a few days i read a similar report in findrxonline but this is better. Thanks to provide reports on the chronic diseases because a lot of people really help.
  4. vmgillen:
    You're right: this is another "duh!" report: inequities specific to hispanic/black populations, with or with ANY other factor, is not news. And, frankly, it is misleading for the study not to lay that out from the beginning (objective, background) and so save some of us the time spent reading further. The tendency of health care professionals to under-attend to cases involving people with disabilities - including expired warranty syndrome (the elderly) has been repeatedly documented as well, but I'm not aware of any recent studies which include the ASD population... THAT would be news.
  5. Ken:
    It's a shame that even in today's time as evolved as we are that we still have racist issues. I guess it's always going to be an issue we have to deal with until the end of time. Thanks for this post. It is a real eye opener.

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