Linguistic Disparities in Child Health and Presence of a Medical Home Among United States Latino Children |
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| Affiliation: | 1. Department of Pediatrics, Boston Medical Center, Boston University School of Medicine (EG Cordova-Ramos and MG Parker), Boston, Mass;2. Department of Biostatistics, Boston University School of Public Health (Y Tripodis), Boston, Mass;3. Department of Pediatrics, University of Massachusetts Medical School (A Garg), Worcester, Mass;4. Department of Newborn Medicine, Boston Children''s Hospital, Harvard Medical School (NS Kalluri), Boston, Mass;5. Department of Pediatrics, University of Miami Miller School of Medicine, Holtz Children''s Hospital, Jackson Health System (G Flores), Miami, Florida;1. Department of Pediatrics (K O''Hara, SI Ziniel), University of Colorado School of Medicine, Aurora, Colo;2. Department of Pediatrics (A Tseng), Virginia Commonwealth University School of Medicine, Richmond, Va;3. Department of Hospital Medicine (S Moss), Cleveland Clinic Community Care, Cleveland, Ohio;4. Department of Pediatric Hospital Medicine (S Moss), Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio;5. Division of Hospital Medicine, Department of Pediatrics (L Herbst, B Herbst), Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Geriatrics & Palliative Care Division, Department of Family and Community Medicine (L Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;7. Department of Pediatrics (S Marsicek), AdventHealth for Children, Orlando, Fla;8. Department of Pediatrics (K Molas-Torreblanca), Keck School of Medicine of USC, Los Angeles, Calif;9. Division of Hospital Medicine (K Molas-Torreblanca), Children''s Hospital Los Angeles, Los Angeles, Calif;10. Department of Internal Medicine (B Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;11. Department of Pediatrics (J Maniscalo), Johns Hopkins University, Johns Hopkins All Children''s Hospital, Office of Medical Education, St. Petersburg, Fla;1. University of Florida, Department of Pediatrics (M Fitzgerald, LA Thompson, J Otero, NP Black), Gainesville, Fla;2. University of California, Davis, School of Medicine (A Bhatt), Sacramento, Calif;3. University of Illinois Chicago, Department of Pediatrics (A Schwartz), Chicago, Ill;4. University of Florida, Information Technology (AO Thomas), Gainesville, Fla;5. Northwestern University Feinberg School of Medicine (DA Schinasi), Chicago, Ill;6. University of Utah/Primary Children''s Hospital (P Carpenter), Salt Lake City, Utah;7. University of Florida, UF Health Cancer Center, Clinical Research Office (JS Thomas), Gainesville, Fla;1. Department of Pediatrics (JC Gay), Vanderbilt University Medical Center, Nashville, Tenn;2. Department of Pediatrics (RJ Teufel), Medical University of South Carolina, College of Medicine, Charleston, SC;3. Department of Population Medicine (A Peltz), Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Mass;4. Division of Hospital Medicine and James M. Anderson Center for Healthcare Improvement, Cincinnati Children''s Hospital Medical Center; Department of Pediatrics (KA Auger), University of Cincinnati College of Medicine, Cincinnati, Ohio;5. Children''s Hospital Association (JM Harris), Washington, DC;6. Children''s Hospital Association (M Hall), Lenexa, Kans;7. Division of Emergency Medicine, Boston Children''s Hospital, Department of Pediatrics (MI Neuman), Harvard Medical School, Boston, Mass;8. Department of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine; Children''s Healthcare of Atlanta, Atlanta, Ga;9. Nationwide Children''s Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State College of Medicine (R Morse), Columbus, Ohio;10. Washington University in St. Louis (P Eghtesady), St. Louis, Mo;11. Office of the Chief Medical Officer (R McClead), Nationwide Children''s Hospital, Columbus, Ohio;12. Division of Hospital Medicine (SS Shah), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio |
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| Abstract: | ObjectiveThe impact of household language on Latino-White and Latino intragroup disparities in child health and having a medical home in the United States is poorly understood. This study aimed to examine these disparities 1) between Whites and Latinos (overall and stratified by English-primary-language [EPL] and non-English-primary-language [NEPL] households); 2) within Latinos, stratified by household language; and 3) potential moderation of disparities by social determinants.MethodsCross-sectional analysis of nationally representative sample of children 0 to 17 years old from the 2016–2018 National Survey of Children's Health. We evaluated associations of child race/ethnicity and household language with child health and presence of a medical home. Multivariable logistic regression was used to compare groups of interest, adjusting for sociodemographic factors and health needs. Moderation was assessed using interaction terms for household income, parental educational attainment, and child insurance coverage.ResultsAmong 81,514 children, 13.5% were NEPL Latino, and 19.4% were EPL Latino. Compared with EPL Whites, both EPL and NEPL Latinos had reduced odds of excellent/very good health (adjusted odds ratio [aOR]: 0.70; 95% confidence interval [CI]: 0.58–0.84; and aOR: 0.42; 95% CI: 0.33–0.53) and presence of a medical home (aOR: 0.62; 95% CI: 0.56–0.69; and aOR: 0.45; 95% CI: 0.37–0.54), respectively. Among Latinos, NEPL (vs EPL) was also associated with reduced odds of excellent/very good health (aOR: 0.61; 95% CI: 0.46–0.83), and presence of a medical home (aOR: 0.66; 95% CI: 0.48–0.78); these associations were magnified by adverse social determinants.ConclusionsStriking Latino-White and within-Latino medical-home disparities persist in the United States, particularly for NEPL Latino children. Interventions should target social determinants and the rich sociocultural and linguistic diversity of the Latino population. |
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| Keywords: | social determinants of health |
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