Racial Gaps Narrow in Child Health Measures

Marcia Frellick

July 15, 2016

Racial disparities have narrowed for many child and adolescent health indicators in the United States, but in many cases they still stand in stark contrast, according to the latest edition of a summary report published every 2 years.

The report, "America's Children in Brief: Key National Indicators of Well-Being, 2016," is published by the Federal Interagency Forum on Child and Family Statistics, a group of 23 federal agencies that analyze and report data related to child and family well-being. This summary tracks 41 indicators.

Sheila Franco, MS, a health statistician for the National Center for Health Statistics and a contributor to the report, told Medscape Medical News that amid the positive and negative trends are some opportunities for targeted interventions.

For instance, "We see that the number of black, non-Hispanic children with asthma is 13%, which is significantly higher than the white, non-Hispanic and Hispanic children at 8%," she said.

Another example is in the numbers of children with elevated blood lead levels. While the levels are down remarkably over time, black, non-Hispanic children age 1 to 5 years were twice as likely as white, non-Hispanic children and three times as likely as Mexican American children to have levels above 5 μg/dL.

"For pediatricians, that's perhaps a group to target screening for," Franco said.

"Overall, while only 1.9% of children have high levels of blood lead, that represents 390,000 children, so it's not a small matter considering the severity of effects lead exposure can have," she added.

In infant mortality, the rates for all racial and ethnic groups fell significantly between 1999 and 2013, but the rates for black non-Hispanics were more than twice as high as the rate for white non-Hispanics (11.1 infant deaths per 1000 live births vs 5.1).

Reporting among adolescents for major depressive episodes (MDE) is higher for white non-Hispanic youth, at about 12%, than for black non-Hispanics (9%) or American Indian/Alaska native non-Hispanic youth (7%). The report notes that most young people with MDE do not receive care for depression.

The following are differences among some of the major indicators related to child health.

Adolescent Birth Rate

From 1995 to 2014, the total adolescent birth rate declined by 25 percentage points, from 36 per 1000 to 11 per 1000, a US record low. This long-term drop was found for each racial and Hispanic origin group.

However, imbalances persist: Adolescent birth rates among Hispanic, black non-Hispanic, and American Indian or Alaska Native non-Hispanic adolescents were persistently higher than the rates for white non-Hispanic and Asian or Pacific Islander non-Hispanic adolescents through the entire period.

Health Insurance

From 2000 to 2014, the percentage of children covered by health insurance increased by 7 percentage points to 95%, but the report noted racial gaps.

Hispanic children were the most likely not to be covered by health insurance. The uninsured rate was 4% for white non-Hispanic and black non-Hispanic children and 10% for Hispanic children.

White non-Hispanic children were twice as likely to have private insurance (68%) than Hispanic (31%) and black non-Hispanic children (34%).

Vaccinations

The number of children age 19 to 35 months who received the recommended 7-vaccine series for major childhood diseases increased sharply from 2009 to 2014.

Black non-Hispanic children had lower vaccination coverage than white non-Hispanic children; poverty levels accounted for much of the difference, the authors write.

During that period, vaccination coverage among children age 19 to 35 months who got the combined vaccine series increased for white non-Hispanic children (from 45% to 73%), black non-Hispanic (from 40% to 65%), and Hispanic (from 46% to 74%) children.

Franco notes that the 2009 numbers were affected by a temporary shortage of the Haemophilus influenzae type b vaccine.

Obesity

From 1988–1994 to 2011–2014, the percentage of children age 6 to 17 years who were obese increased by 8 percentage points, from 11% to 19%.

The prevalence was highest among black non-Hispanic children (23%) and Hispanic children (24%) compared with non-Hispanic white children (17%).

Binge Drinking

Percentages of 10th- and 12th-graders who reported binge drinking (five or more alcoholic drinks in a row) were the lowest in 2015 since the survey began in 1980. Among 12th-graders, Hispanic and white non-Hispanic students reported binge drinking at twice the rate of black non-Hispanic students.

Binging numbers dropped steeply among the younger drinkers: 5% of 8th graders reported binge drinking, down from 11% in 1991. Among, 10th-graders, binge drinking dropped from 21% in 1991 to 11% in 2015.

Smoking

The percentage of 8th-, 10th-, and 12th-grade students who reported smoking cigarettes daily in the past month is at a record low and continues a long decline.

Since 2000, the largest drop among 12th-graders was a 76% drop reported by Hispanic students (from 16% to 4%); the next largest was in whites, with a 70% decline in the same time period (from 26% to 7%). Among black non-Hispanics, the rate of use dropped from 8% to 4%.

Illicit Drug Use

Illicit drug use in the past 30 days remained at 8% among 8th-graders and 24% among 12th-graders.

The report notes that during the past several decades, 12th-grade white non-Hispanics and Hispanics had drug use rates consistently above those reported by black non-Hispanics. But in 2015, that gap was gone and there was no significant difference in the rate by white non-Hispanics, Hispanics, or black non-Hispanics.

Franco said this report focuses on race and ethnicity disparities among the indicators because it is the 30th anniversary of the 1985 Heckler report, which was one of the first federal reports to look at disparities in morbidity and mortality experienced by blacks and other minority groups in the United States compared with whites.

The Heckler report set out a plan to reduce disparities by increasing access to healthcare, health education, and promotion activities and increasing the number of minority health providers.

The Forum's website provides additional information on the indicators.

The report authors have disclosed no relevant financial relationships.

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