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

Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101712925 Publication Model: Print Cited Medium: Internet ISSN: 2352-4650 (Electronic) Linking ISSN: 23524642 NLM ISO Abbreviation: Lancet Child Adolesc Health Subsets: MEDLINE

Original Publication: [Cambridge, UK] : Elsevier Ltd., [2017]-

Ethnicity* ; Racism*; Humans ; Child ; United States ; Delivery of Health Care ; Palliative Care ; Child Health

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.
Competing Interests: Declaration of interests AC has a contract with Organon & Co (previously part of Merck) as a clinical trainer for the Nexplanon contraceptive device. In this role, she provides training and education to resident physicians at her institution in the use of the subdermal implant device. She does not receive payment or any other form of incentive from Organon & Co in this role. NH-G is the co-owner of XNY Genes. All other authors declare no competing interests.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)

P2C HD041023 United States HD NICHD NIH HHS; U54 GM104941 United States GM NIGMS NIH HHS; K01 HL147995 United States HL NHLBI NIH HHS

Date Created: 20240119 Date Completed: 20240122 Latest Revision: 20240904

20240904

10.1016/S2352-4642(23)00251-1

38242597