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Disparities for Latino Children in the Receipt of
Timely Medical Care
David Brousseau MD, MS, Jennifer Yauck MS,
Raymond Hoffmann PhD, Ann Nattinger MD, MPH,
Glenn Flores MD
Background
• Latino children: population– Largest minority racial/ethnic group = 16%– California: largest racial/ethnic group
• Latino children: health– Sub-optimal health status– Fewer physician visits– Lack health insurance– Less likely to have primary care provider
• Effect on quality of care ?
Latino quality of care
• Adherence to accepted standards– Lower likelihood of vision screening– Decreased use of inhaled steroids
• Self/Parent reported quality of care– No studies specifically looking at children– No studies controlling for confounders
Objective
• To compare the parent-reported ability of children to get timely medical care among Latino, White and African-American children
Methods
• Population: – 2000 Medical Expenditure Panel Survey
(MEPS)– Children < 18 years of age with a usual
source of care
• All analyses weighted to represent national averages
Methods
• Timely medical care– 1) Timely routine care from a provider– 2) Timely illness or injury care from an office, clinic
or ED– 3) Phone help from a provider– 4) Brief wait time with an appointment
• Scoring– 4 point Likert scale, except Brief wait time
Methods: Analysis
• Primary outcome measure: – Not receiving the highest quality
primary care• Always receiving timely medical care• Shortest waits for Brief wait time
• Univariate analysis by race/ethnicity– Analyzed using Chi-square
Methods: Multiple regression
• Latinos as the referent group
• Adjusted for:– Age, sex, health status, special health care
needs– Insurance type, highest education
• With and without language in model
• Odds ratios
Results
• 4,120 children– Weighted to represent 47 million children – Average age: 8 years– 51% male
Results: Unweighted
30%17%
53%
LatinoWhiteAfrican American
24%11%
65%
PublicPrivateUninsured
Race/ethnicity Insurance
Results: Univariate analysis
Latino White African-
American
Routine care * 56% 46% 46%
Illness/injury care 39% 34% 36%
Phone help * 60% 51% 53%
Brief wait time * 64% 45% 56%
* P < 0.005
Results: OR for Latinos compared to Whites
Without language
95% CI With language
95% CI
Routine care
1.28 1.04-1.56 1.19 0.95-1.50
Illness care 1.04 0.79-1.39 0.88 0.64-1.20
Phone help 1.37 1.16-1.62 1.28 1.07-1.54
Brief wait time
1.96 1.66-2.32 1.65 1.38-1.99
Results: OR for Latinos compared to African-Americans
Without language
95% CI With language
95% CI
Routine care
1.48 1.15-1.98 1.38 1.04-1.82
Illness care
1.09 0.75-1.61 0.90 0.60-1.36
Phone help
1.29 1.05-1.58 1.20 0.96-1.50
Brief wait time
1.43 1.16-1.76 1.19 0.95-1.49
Conclusion
• Latino children experience marked disparities in obtaining timely medical care
• The disparities are only partially explained by language differences
• Improvements are needed in the delivery and efficiency of medical care for Latino children