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Racial and ethnic disparities in socio-economic status, access to care, and healthcare utilisation among children with heart conditions, National Survey of Children’s Health 2016–2019

Published online by Cambridge University Press:  31 March 2023

Ashley S. Judge Open the ORCID record for Ashley S. Judge [Opens in a new window] ,
Karrie F. Downing Open the ORCID record for Karrie F. Downing [Opens in a new window] ,
Wendy N. Nembhard ,
Matthew E. Oster Open the ORCID record for Matthew E. Oster [Opens in a new window]  and
Sherry L. Farr
Ashley S. Judge
Affiliation:
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
Karrie F. Downing
Affiliation:
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
Wendy N. Nembhard
Affiliation:
Department of Epidemiology, Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Matthew E. Oster
Affiliation:
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
Sherry L. Farr*
Affiliation:
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
*
Author for correspondence: Sherry L. Farr, PhD, National Center on Birth Defects and Developmental, Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 106-3, Atlanta, GA 30341, USA. Tel: +1 404 274 5638. E-mail: sfarr@cdc.gov
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Abstract

Among children with and without heart conditions of different race/ethnicities, upstream social determinants of health, such as socio-economic status, access to care, and healthcare utilisation, may vary. Using caregiver-reported data from the 2016–19 National Survey of Children’s Health, we calculated the prevalence of caregiver employment and education, child’s health insurance, usual place of medical care in the past 12 months, problems paying for child’s care, ≥2 emergency room visits, and unmet healthcare needs by heart condition status and race/ethnicity (Hispanic, non-Hispanic Black, and non-Hispanic White). For each outcome, we used multivariable logistic regression to generate adjusted prevalence ratios controlling for child’s age and sex. Of 2632 children with heart conditions and 104,841 without, 65.4% and 58.0% were non-Hispanic White and 52.0% and 51.1% were male, respectively. Children with heart conditions, compared to those without, were 1.7–2.6 times more likely to have problems paying for healthcare, have ≥2 emergency room visits, and have unmet healthcare needs. Hispanic and non-Hispanic Black children with heart conditions, compared to non-Hispanic White, were 1.5–3.2 times as likely to have caregivers employed <50 weeks in the past year and caregivers with ≤ high school education, public or no health insurance, no usual place of care, and ≥2 emergency room visits. Children with heart conditions, compared to those without, may have greater healthcare needs that more commonly go unmet. Among children with heart conditions, Hispanic and non-Hispanic Black children may experience lower socio-economic status and greater barriers to healthcare than non-Hispanic White children.

Keywords

Racial/ethnic disparitieshealth care accesshealth care utilisationCHDpaediatricsocial determinants of health
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 12 , December 2023 , pp. 2539 - 2547
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Creative Commons
To the extent this work is subject to copyright outside of the United States, such copyright shall be assigned to the Publisher. Outside of the United States, the US Government retains a paidup, nonexclusive, irrevocable worldwide license to reproduce, prepare derivative works, distribute copies to the public and display publicly the Contribution, and to permit others to do so. This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press & Assessment.
Copyright
© Cambridge University Press & Assessment, 2023

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Footnotes

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This project was supported in part by an appointment to the Research Participation Programme at the Centers for Disease Control and Prevention, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC.

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