child health disparities denice cora-bramble, md, mba professor of pediatrics, george washington...
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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