Disparities in Pediatric Preventive Care in the United States, 1993-2002

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Abstract
Objectives To quantify physician-reported preventive counseling and screening during well-child visits (WCVs) and to examine racial and ethnic disparities in these activities. Design Cross-sectional study using the National Ambulatory Medical Care Survey, January 1993 through December 2002. Setting Office-based physician practices. Participants Children from birth to 18 years old who were seen by a physician for a WCV. Main Outcome Measure 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.