From neonatal and primary care to emergency medicine and surgery, minority children in the United States receive almost universally poorer quality health care than their white peers, according to new findings from Northwestern University scientists Ann and Robert H. Lurie Children’s Hospital of Chicago and several other institutions.
The findings reveal widespread inequalities in care across pediatric specialties, including neonatal care, emergency medicine and palliative care.Overcoming these pervasive health care inequalities caused by structural racism requires Policy changes in multiple sectors of broader society, including housing, health insurance and the criminal justice system, the study authors said.
The results of the investigation have been published Published in The Lancet Child and Adolescent Health on January 17 In a two-paper series.
“We now have more evidence than ever that pediatric care in the United States is not only disparate but also inequitable for a large group of children,” said the senior author of two papers in the series. Dr. Nia Hurd-Garrisis a senior assistant professor of general pediatrics and primary care at Northwestern University Feinberg School of Medicine and a physician at Lurie Children’s Hospital. “Policies that advance health justice and reach across institutions, communities and populations are urgently needed.”
White patients received more painkillers, antibiotics, intravenous fluids, and diagnostic imaging, even when there was no medical justification.
The authors outline several implications of their findings for health care practice and policy, including that hospitals and other health care systems should investigate and address the sources of structural racism in their existing policies and guidelines, health care systems, and providers Senior managers must take steps to eliminate race-based pediatric care. They also emphasized the need for policy changes to end racial segregation in pediatric care and increase diversity in the medical workforce.
Widespread inequalities in pediatric care across specialties
“Racial disparities exist in every area of American society and span generations,” said policy series author Monique Jindal, Ph.D., of the University of Illinois at Chicago School of Medicine. “Among other shortcomings, this has resulted in racial minorities There are glaring inequalities in health care for children of all ethnic and racial groups. It is clear that to ensure that every child in the United States has access to the best possible health care, far-reaching policy changes are urgently needed that directly address the deep-rooted of structural racism.”
By limiting the review to studies that controlled for health insurance status, the authors found that differences in quality of care were not due to a lack of access to care.
Evidence from the past five years shows that infants from racial and ethnic minority groups, particularly black and Hispanic children, consistently receive lower quality neonatal care than white infants. Findings show poor quality communication between health care providers and children, youth and families from racial and ethnic minority groups in primary care, contributing to persistent inequities.
There are also disparities in end-of-life care, the study found. Black, Hispanic and Asian American children receiving palliative care are more likely to die in the hospital than white children. Hispanic children are also more likely to receive intensive medical care in their final days of life.
The strongest evidence of difference is in pain management
Emergency medicine has also found disparities in wait times, triage evaluations, and evaluations for suspected child abuse among children from racial and ethnic minority groups. The strongest evidence of disparities is in pain management, with children from racial and ethnic minority groups less likely than their white peers to receive pain medication for broken arms or legs, appendicitis or migraines. Overall trends show that white patients receive more care—such as more painkillers, antibiotics, intravenous fluids, and diagnostic imaging—even if it doesn’t make sense from a medical perspective.
There are disparities in the diagnosis of developmental disabilities, with black and Asian children less likely to be diagnosed in preschool or kindergarten than white children, and Latino children with special health care needs receiving more specialized services than their white peers. few. There are also inequalities in mental health care services; Adequate care rates for major depression and ADHD are lower among black, Hispanic and other children Racial and ethnic minority groups compared to white children.
“From the earliest moments of life, there are widespread inequalities in the quality of health care that children in the United States receive,” said Dr. Natalie Slopen of Harvard University, who led the review of the study. “Racism profoundly impacts not only children’s health, but also people’s health as adults, underscoring the critical importance of addressing disparities in the care children receive.”