Health inequity in children and youth with chronic health conditions.
BACKGROUND
Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them.


OBJECTIVE
To describe health inequities experienced by children with chronic health conditions.


METHODS
We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words "incidence," "prevalence," "survival," "mortality," or "disparity" in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury.


RESULTS
Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children.


CONCLUSIONS
Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.
Complex Care Service, Program for Patient Safety and Quality, Children's Hospital Boston, Fegan 10, 300 Longwood Ave, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
Jay G
JG
Berry
Sheila
S
Bloom
Susan
S
Foley
Judith S
JS
Palfrey
D000293:Adolescent; D044383:Black People; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D014481:United States; D044465:White People; D055815:Young Adult; D001741:Black or African American