1. Child Health Disparities Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington University Executive Director Goldberg Center for Community Pediatric Health Children’s National Medical Center

2. 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

3. Washington, D.C. Healthcare Disparities Access to health care services Health outcomes Quality of care

4. 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

5. 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

6. 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

7. Washington, D.C. Childhood Obesity: 400% increase since 1970

8. Washington, D.C.

9. District of Columbia: Highest Rate of Overweight (10 – 17)

10. Washington, D.C. DC Partnership to Improve Children’s Healthcare Quality Overweight or obese: 33% of preschoolers 43% of 6-10 years old 47% of 11-21 years old

11. 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

12. Washington, D.C. Psychosocial Outcomes Discrimination/ teasing Poor self-esteem Eating disorders Family problems Behavioral and learning problems Lower education/ socioeconomic status

13. 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

14. 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

15. Washington, D.C. Pediatric ED Visit Rates for Asthma 0-4y, inclusive (IMPACT DC Project, S.Teach) Healthy People 2010 Target: 80 per 10,000

16. Washington, D.C. ED Asthma Visits by Zip Code, 2002 IMPACT DC Project, S. Teach IMPACT DC Project, S. Teach Lowest Rate = 3.9/1000 Highest Rate = 45.2/1000 11.6-fold Difference in Rate

17. Washington, D.C. Understanding Health Disparities Contributing risk factors –Race –Income –Insurance status –Language & culture –Unknown factors?

18. 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

19. 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 dcorabra@cnmc.org