Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions.
OBJECTIVE
We investigated trends in national childhood mortality, racial disparities in child mortality, and the effect of Medicaid and State Children's Health Insurance Program (SCHIP) eligibility expansions on child mortality.


METHODS
We analyzed child mortality by state, race, and age using the National Center for Health Statistics' multiple cause of death files over 20 years, from 1985 to 2004.


RESULTS
Child mortality continued to decline in the United States, but racial disparities in mortality remained. Declines in child mortality (ages 1-17 years) were substantial for both natural (disease-related) and external (injuries, homicide, and suicide) causes for children of all races/ethnicities, although Black-White mortality ratios remained unchanged during the study period. Expanded Medicaid and SCHIP eligibility was significantly related to the decline in external-cause mortality; the relationship between natural-cause mortality and Medicaid or SCHIP eligibility remains unclear. Eligibility expansions did not affect relative racial disparities in child mortality.


CONCLUSIONS
Although the study provides some evidence that public insurance expansions reduce child mortality, future research is needed on the effect of new health insurance on child health and on factors causing relative racial disparities.
Health Policy Center, Urban Institute, Washington, DC 20037, USA. ehowell@urban.org
Embry
E
Howell
Sandy
S
Decker
Sara
S
Hogan
Alshadye
A
Yemane
Jonay
J
Foster
D000293:Adolescent; D044383:Black People / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000191:economics; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D004608:Eligibility Determination; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D008484:Medicaid; D013221:State Health Plans; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American