The Association Between Racial Discrimination,Race, and Social Class With Health Among US Children |
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| Institution: | 1. Icahn School of Medicine at Mount Sinai (MG Wexler), New York, NY;2. Boston University School of Medicine (M McGean), Boston, Mass;3. Boston University School of Public Health (Y Tripodis), Boston, Mass;4. Yale National Clinician Scholars Program, Yale School of Medicine (D Tolliver), New Haven, Conn;5. Department of Pediatrics (E Messmer, A Brochier), Boston Medical Center, Boston, Mass;6. Department of Pediatrics (A Garg), University of Massachusetts Chan Medical School, Worcester, Mass;1. Centre for Community Child Health (S Goldfeld, S Gray, C Pham), Murdoch Children''s Research Institute, Royal Children''s Hospital, Melbourne, Australia;2. Department of Pediatrics (S Goldfeld, S Gray, M O''Connor), University of Melbourne, Melbourne, Australia;3. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (C Pham), University of Melbourne, Melbourne, Australia;4. Melbourne Children''s LifeCourse Initiative (C Pham, M O''Connor), Murdoch Children''s Research Institute, Melbourne, Australia;5. Centre for Urban Research (H Badland), RMIT University, Melbourne, Australia;6. Department of Community Child Health (S Woolfenden), Sydney Children''s Hospital Network, Sydney, Australia;7. Discipline of Pediatrics (S Woolfenden), University of New South Wales, Sydney, Australia;8. Department of Pediatrics (E Schor), School of Medicine, Stanford University, Stanford, Calif;1. Department of Pediatrics, The Children''s Hospital at Montefiore, Albert Einstein College of Medicine (EE Schulte, E Alderman, J Feldman, P Hametz, T Havranek, FJ. Kaskel, A Levy, and D Manwani), Bronx, NY;2. Ferkauf Graduate School of Psychology, Yeshiva University, Department of Pediatrics (Division of Academic General Pediatrics), The Children''s Hospital at Montefiore, Albert Einstein College of Medicine (J Feldman), Bronx, NY;3. Albert Einstein College of Medicine/Children''s Hospital at Montefiore (REK Stein), Bronx NY;1. Department of Pediatrics (R Linderer, N Srinivasan, and A Schwartz), University of Illinois at Chicago, Ill;2. Department of Medical Education (C Park, A Schwartz, and R Yudkowsky), University of Illinois at Chicago, Ill;3. Department of Anesthesiology (C Park), University of Illinois at Chicago, Ill;4. Simulation and Integrative Learning Institute (C Park), University of Illinois at Chicago, Ill;1. Department of Pediatrics, Division of Pediatric Neurology (E Catenaccio), Children''s Hospital of Philadelphia, Philadelphia, PA;2. Department of Emergency Medicine, Division of Pediatric Emergency Medicine (JM Rochlin), Maimonides Medical Center, Brooklyn, NY;3. Departments of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine and Children''s Healthcare of Atlanta, Atlanta, GA;1. Department of Pediatrics (AR Schroeder), Stanford University School of Medicine, Stanford, Calif;2. Department of Pediatrics (LG Solan), Golisano Children''s Hospital at the University of Rochester Medical Center, Rochester, NY;3. Department of Pediatrics (D Williams), Vanderbilt University School of Medicine and the Monroe Carell Junior Children''s Hospital at Vanderbilt, Nashville, TN;4. Pediatric Academic Societies, Inc. (B Thomas, C Smith, and G Minshew);5. Department of Pediatrics (DA Rauch), Tufts University Medical School, Boston, Mass |
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| Abstract: | ObjectivesTo assess the association between racial discrimination, race and ethnicity, and social class with child health and unmet health care needs among children in the United States (US).MethodsWe used a nationally representative sample of children aged 0 to 17 from the 2018–2019 National Survey of Children's Health. Bivariate and multivariable logistic regression were used to test associations between measures of discrimination, social class (income, employment, and education), and race and ethnicity with overall child health and unmet health care needs controlling for covariates identified a priori.ResultsOverall, 90.3% of children (n = 59,964) had excellent/very good overall health; 3.1% had unmet health care needs. Black, non-Hispanic children had 8.9 times the odds of having experienced racial discrimination compared to White, non-Hispanic children (95% confidence interval CI], 7.0–11.4). Having special health care needs was significantly associated with greater odds of racial discrimination (OR 2.3; 95% CI, 1.9–2.8). In multivariable models, underrepresented race and ethnicity groups, lower household income level, and lower caregiver education were significantly associated with poorer overall child health. Conversely, experiencing discrimination was not significantly associated with excellent/good overall child health (adjusted odds ratios aORs], 0.8; 95% CI, 0.6–1.1) Racial discrimination (aOR 2.7; 95% CI, 1.9–4.0) and lower household income (aOR 2.6; 95% CI, 1.8–3.5) were associated with significantly greater odds of unmet health care needs.ConclusionRace and ethnicity and low social class were significantly associated with worse overall health while racial discrimination and low-income were associated with more unmet health care needs. These findings underscore the importance of policy and health care system innovations that address the effects of racism and poverty on child health. |
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