Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence.

Racial and ethnic inequities in paediatric care have received increased research attention over the past two decades, particularly in the past 5 years, alongside an increased societal focus on racism. In this Series paper, the first in a two-part Series focused on racism and child health in the USA, we summarise evidence on racial and ethnic inequities in the quality of paediatric care. We review studies published between Jan 1, 2017 and July 31, 2022, that are adjusted for or stratified by insurance status to account for group differences in access, and we exclude studies in which differences in access are probably driven by patient preferences or the appropriateness of intervention. Overall, the literature reveals widespread patterns of inequitable treatment across paediatric specialties, including neonatology, primary care, emergency medicine, inpatient and critical care, surgery, developmental disabilities, mental health care, endocrinology, and palliative care. The identified studies indicate that children from minoritised racial and ethnic groups received poorer health-care services relative to non-Hispanic White children, with most studies drawing on data from multiple sites, and accounting for indicators of family socioeconomic position and clinical characteristics (eg, comorbidities or condition severity). The studies discussed a range of potential causes for the observed disparities, including implicit biases and differences in site of care or clinician characteristics. We outline priorities for future research to better understand and address paediatric treatment inequities and implications for practice and policy. Policy changes within and beyond the health-care system, discussed further in the second paper of this Series, are essential to address the root causes of treatment inequities and to promote equitable and excellent health for all children.

The Detrimental Influence of Racial Discrimination on Child Health in the United States.

BACKGROUND: The current literature describing the largely damaging effect of racial discrimination on child health is weakened by several confounding factors. We aimed to: 1) describe the relation between racial discrimination and child health and 2) evaluate the potential mediating role of mental health relating racial discrimination to child health, using methods that mitigate confounding. METHODS: Using the 2011-2012 National Survey of Children's Health (N = 95,677), we performed: 1) propensity score analysis, matching and comparing discrimination-exposed to non-exposed children and 2) structural equation modeling, examining mental health as a mediator of the pathway between discrimination and child health. RESULTS: In the first approach, the proportion of children with excellent health was 5.4% (95% Confidence Interval (CI), 3.6,7.2%) lower with exposure to racial discrimination. Among minority children, those with low income had the greatest decrements in general health associated with racial discrimination. Among white children, those with high income had the greatest decrements. In the structural equation model, minority children had higher odds of experiencing racial discrimination (Odds ratios (ORs) ≥ 5.47, [95% CIs, 4.92,10.6]); meanwhile, children who experienced discrimination were more likely to have anxiety and depression (ORs ≥ 3.58, [95% CIs, 2.87,4.58]), which were linked to lower odds of excellent health (ORs ≤ 0.44, [95% CIs, 0.41.52]). CONCLUSION: The negative health association of racial discrimination may be mediated by mental health and vary by racial, ethnic, or socioeconomic group. This work may stimulate the formation of targeted interventions to address these disparities.

Minority Parents' Perspectives on Racial Socialization and School Readiness in the Early Childhood Period.

OBJECTIVE: To describe how minority parents help their young children navigate issues of race and racism and discuss implications this racial socialization may have for school readiness. METHODS: Sixteen focus groups were conducted among 114 African American, English language-primary Latino, Spanish language-primary Latino, and Korean language-primary Korean parents of children ages 0 to 4 years old. Transcripts were coded for major themes and subsequently compared across the 4 language-ethnicity groups. Parents also shared demographic and parenting data by survey, from which group-specific proportions provide context for identified themes. RESULTS: In this sample, nearly half of surveyed parents had already talked to their young child about unfair treatment due to race. The proportion of such conversations ranged from one-fifth of Korean parents to two-thirds of Spanish language-primary parents. In focus groups, Korean parents reported fewer experiences with racism than African American and Latino parents. Within each language-ethnicity group, fewer fathers than mothers reported addressing race issues with their young children. All focus groups endorsed messages of cultural pride, preparation for bias, and a strong focus on the individual. The majority of parents viewed racial socialization as an important part of school readiness. CONCLUSIONS: Racial socialization was believed to be salient for school readiness, primarily practiced by mothers, and focused at the individual level. The smaller role of fathers and systems-based approaches represent opportunities for intervention. These results may inform the development of culturally tailored parenting interventions designed to decrease the race-based achievement gap and associated health disparities.