Child Health Disparities Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington...

Child Health Disparities

Denice Cora-Bramble, MD, MBAProfessor of Pediatrics, George Washington University

Executive DirectorGoldberg Center for Community Pediatric Health

Children’s National Medical Center

Washington, D.C.

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

Washington, D.C.

Healthcare Disparities

• Access to health care services• Health outcomes• Quality of care

Washington, D.C.

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

Washington, D.C.

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

Washington, D.C.

Pediatric Disparities

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

Washington, D.C.

Childhood Obesity: 400% increase since 1970

Washington, D.C.

Washington, D.C.

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

Washington, D.C.

DC Partnership to Improve Children’s Healthcare Quality

0

10

20

30

40

50

60

70

2-5 years

6-10 years

11-21 years

<5th%ile 5th-85th 85th-95th >95th%ile

Overweight or obese:

33% of preschoolers

43% of 6-10 years old

47% of 11-21 years old

Washington, D.C.

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

Washington, D.C.

Psychosocial Outcomes

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

Washington, D.C.

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

Washington, D.C.

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

Washington, D.C.

Pediatric ED Visit Rates for Asthma0-4y, inclusive (IMPACT DC Project, S.Teach)

159.6

380.1

745.7

0100

200

300400

500

600700

800

*NationalRate 2000

*AfricanAmerican

2000

**District2003

Rate per 10,000

Healthy People 2010 Target:

80 per 10,000

Washington, D.C.

ED Asthma Visits by Zip Code, 2002ED Asthma Visits by Zip Code, 2002

IMPACT DC Project, S. TeachIMPACT DC Project, S. Teach

Lowest Rate = 3.9/1000

Highest Rate = 45.2/1000

11.6-fold Difference in Rate

Washington, D.C.

Understanding Health Disparities

• Contributing risk factors– Race– Income– Insurance status– Language & culture– Unknown factors?

Washington, D.C.

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

Washington, D.C.

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