Disparities in pediatric preventive care in the United States, 1993-2002.
OBJECTIVE
To quantify physician-reported preventive counseling and screening during well-child visits (WCVs) and to examine racial and ethnic disparities in these activities.


METHODS
Cross-sectional study using the National Ambulatory Medical Care Survey, January 1993 through December 2002.


METHODS
Office-based physician practices.


METHODS
Children from birth to 18 years old who were seen by a physician for a WCV.


METHODS
Preventive counseling and screening.


RESULTS
Well-child visits were shorter for Latino children than for white or black children. At WCVs, white children were more likely to receive preventive counseling than were black or Latino children (72% vs 61% vs 61%, respectively; P = .01) but not more likely to receive screening for elevated blood pressure, anemia, vision and hearing acuity, or lead toxicity. There were no differences in secondary diagnoses made at WCVs for white, black, or Latino children (15% vs 17% vs 14%, respectively; P = .65). The children who received the least counseling were Latino children in the public sector non-health maintenance organization setting (counseled at 39% of visits) and Latino children who self-paid for the visits (counseled at 26% of visits). After adjusting for possible confounders, including medications prescribed at the visit, black and Latino children were less likely to receive counseling than were white children (odds ratios, 0.68 and 0.63; 95% confidence interval, 0.48-0.97 and 0.44-0.90, respectively), and black children were less likely to receive preventive screening services (odds ratios, 0.65; 95% confidence interval, 0.45-0.93).


CONCLUSIONS
By physician report in a nationally representative sample, black and Latino children received less counseling at WCVs than did white children. These disparities were unexplained by the competing demands of other secondary diagnoses or medications prescribed or dispensed.
Hambidge
Simon J
SJ
Denver Health Medical Center, Denver Community Health Services, 777 Bannock Street, Denver, CO 80204, USA. simon.hambidge@uchsc.edu
Emsermann
Caroline Bublitz
CB
Federico
Steven
S
Steiner
John F
JF
D000293:Adolescent; D002648:Child; D002654:Child Care / Q000639:trends*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000639:trends*; D012189:Retrospective Studies; D014481:United States