Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood

Gallegos, Abraham; Dudovitz, Rebecca; Biely, Christopher; Coker, Tumaini R.; Barnert, Elizabeth S.; Guerrero, Alma D.; Szilâgyi, Peter G.; Nelson, Bergen B.

doi:10.1016/j.acap.2021.05.008

Cited by 33 publications

(8 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, prior investigations have shown that factors such as a history of substance use are more likely to cause Black kidney transplant candidates to be denied waitlisting compared with White candidates. The disparate application of these subjective criteria to the detriment of the candidacy of racially minoritized patients is an example of structural racism and is consistent with data from a broad range of health care scenarios demonstrating that implicit practitioner bias has detrimental impacts on the management and outcomes of minoritized patients …”

Section: Discussionmentioning

confidence: 99%

Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

Husain,

Yu,

King

et al. 2023

JAMA Intern Med

View full text Add to dashboard Cite

ImportanceDisparities in kidney transplant referral and waitlisting contribute to disparities in kidney disease outcomes. Whether these differences are rooted in population differences in comorbidity burden is unclear.ObjectiveTo examine whether disparities in kidney transplant waitlisting were present among a young, relatively healthy cohort of patients unlikely to have medical contraindications to kidney transplant.Design, Setting, and ParticipantsThis retrospective cohort study used the US Renal Data System Registry to identify patients with end-stage kidney disease who initiated dialysis between January 1, 2005, and December 31, 2019. Patients who were older than 40 years, received a preemptive transplant, were preemptively waitlisted, or had documented medical comorbidities other than hypertension or smoking were excluded, yielding an analytic cohort of 52 902 patients. Data were analyzed between March 1, 2022, and February 1, 2023.Main Outcome(s) and Measure(s)Kidney transplant waitlisting after dialysis initiation.ResultsOf 52 902 patients (mean [SD] age, 31 [5] years; 31 132 [59%] male; 3547 [7%] Asian/Pacific Islander, 20 782 [39%] Black/African American, and 28 006 [53%] White) included in the analysis, 15 840 (30%) were waitlisted for a kidney transplant within 1 year of dialysis initiation, 11 122 (21%) were waitlisted between 1 and 5 years after dialysis initiation, and 25 940 (49%) were not waitlisted by 5 years. Patients waitlisted within 1 year of dialysis initiation were more likely to be male, to be White, to be employed full time, and to have had predialysis nephrology care. There were large state-level differences in the proportion of patients waitlisted within 1 year (median, 33%; range, 15%-58%). In competing risk regression, female sex (adjusted subhazard ratio [SHR], 0.92; 95% CI, 0.90-0.94), Hispanic ethnicity (SHR, 0.77; 95% CI, 0.75-0.80), and Black race (SHR, 0.66; 95% CI, 0.64-0.68) were all associated with lower waitlisting after dialysis initiation. Unemployment (SHR, 0.47; 95% CI, 0.45-0.48) and part-time employment (SHR, 0.74; 95% CI, 0.70-0.77) were associated with lower waitlisting compared with full-time employment, and more than 1 year of predialysis nephrology care, compared with none, was associated with greater waitlisting (SHR, 1.51; 95% CI, 1.46-1.56).Conclusions and RelevanceThis retrospective cohort study found that fewer than one-third of patients without major medical comorbidities were waitlisted for a kidney transplant within 1 year of dialysis initiation, with sociodemographic disparities in waitlisting even in this cohort of young, relatively healthy patients unlikely to have a medical contraindication to transplantation. Transplant policy changes are needed to increase transparency and address structural barriers to waitlist access.

show abstract

Section: Discussionmentioning

confidence: 99%

Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

Husain,

Yu,

King

et al. 2023

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

“…A limitation of our study is that the results of our survey may only be generalized to children who receive tertiary care in the United States, given the highly unique circumstances in the country at the time when our families were queried. Because access to developmental services can vary based on sociodemographic inequities 21 , 22 , access to tertiary care centers may differ based on patient demographics and may have biased the sample that we accessed through the Neonatal Seizure Registry. Unfortunately, we did not have baseline data about children’s access to developmental services prior to the pandemic because the children in our study were enrolled between June of 2020 and April of 2021, reflecting a period of time in which the COVID-19 vaccine was not yet widely available, and restrictions were variable based on geographic region.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Pandemic on Developmental Service Delivery in Children With a History of Neonatal Seizures

Peyton

Girvan

Shellhaas

et al. 2022

Pediatric Neurology

View full text Add to dashboard Cite

Background and Objective Children with a history of acute provoked neonatal seizures are at high risk for disability, often requiring developmental services. The COVID-19 pandemic has led to widespread changes in how healthcare is delivered. Our objective was to determine the magnitude of service interruption of services among children born between 10/2014-12/2017 and enrolled in the Neonatal Seizure Registry (NSR) , a nine-center collaborative of pediatric centers in the US. Design /Methods Prospective cohort study of children with acute provoked seizures with onset 44 weeks gestation and evaluated at age 3-6 years. Parents of children enrolled in the NSR completed a survey about their child’s access to developmental services between June 2020 and April 2021. Results Among 144 children enrolled, 72 children (50%) were receiving developmental services at the time of assessment. Children receiving services were more likely to be male, born preterm, and have seizure etiology of infection or ischemic stroke. Of these children, 64 (89%) experienced a disruption in developmental services due to the pandemic, with the majority of families (n=47, 73%) reporting that in-person services were no longer available. Conclusion Half of children with acute provoked neonatal seizures were receiving developmental services at ages 3-6 years. The COVID-19 pandemic has led to widespread changes in delivery of developmental services. Disruptions in services have the potential to impact long term outcomes for children who rely on specialized care programs to optimize mobility and learning.

show abstract

“… 22 , 23 , 24 , 25 With regard to racial and ethnic differences in the implementation of autism treatment, studies have highlighted disparities that exist for minoritized racial and ethnic groups in the early identification of autism as well as the differential use patterns of ASD resources through school systems, academic hospitals, and insurance billing codes. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 However, the research community has yet to characterize the extent to which geographic proximity to autism resources varies between racial and ethnic groups on a national scale. The Autism and Developmental Disabilities Monitoring (ADDM) Network of the Centers for Disease Control and Prevention reports diagnostic differences by racial and ethnic group annually to track inequity in 11 states in the US.…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US

et al. 2023

View full text Add to dashboard Cite

ImportanceWhile research has identified racial and ethnic disparities in access to autism services, the size, extent, and specific locations of these access gaps have not yet been characterized on a national scale. Mapping comprehensive national listings of autism health care services together with the prevalence of autistic children of various races and ethnicities and evaluating geographic regions defined by localized commuting patterns may help to identify areas within the US where families who belong to minoritized racial and ethnic groups have disproportionally lower access to services.ObjectiveTo evaluate differences in access to autism health care services among autistic children of various races and ethnicities within precisely defined geographic regions encompassing all serviceable areas within the US.Design, Setting, and ParticipantsThis population-based cross-sectional study was conducted from October 5, 2021, to June 3, 2022, and involved 530 965 autistic children in kindergarten through grade 12. Core-based statistical areas (CBSAs; defined as areas containing a city and its surrounding commuter region), the Civil Rights Data Collection (CRDC) data set, and 51 071 autism resources (collected from October 1, 2015, to December 18, 2022) geographically distributed into 912 CBSAs were combined and analyzed to understand variation in access to autism health care services among autistic children of different races and ethnicities. Six racial and ethnic categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White) assigned by the US Department of Education were included in the analysis.Main Outcomes and MeasuresA regularized least-squares regression analysis was used to measure differences in nationwide resource allocation between racial and ethnic groups. The number of autism resources allocated per autistic child was estimated based on the child’s racial and ethnic group. To evaluate how the CBSA population size may have altered the results, the least-squares regression analysis was run on CBSAs divided into metropolitan (&gt;50 000 inhabitants) and micropolitan (10 000-50 000 inhabitants) groups. A Mann-Whitney U test was used to compare the model estimated ratio of autism resources to autistic children among specific racial and ethnic groups comprising the proportions of autistic children in each CBSA.ResultsAmong 530 965 autistic children aged 5 to 18 years, 83.9% were male and 16.1% were female; 0.7% of children were American Indian or Alaska Native, 5.9% were Asian, 14.3% were Black or African American, 22.9% were Hispanic or Latino, 0.2% were Native Hawaiian or other Pacific Islander, 51.7% were White, and 4.2% were of 2 or more races and/or ethnicities. At a national scale, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .01) and Hispanic autistic children (β = 0.02; 95% CI, 0-0.06; P = .02) had significant disparities in access to autism resources in comparison with White autistic children. When evaluating the proportion of autistic children in each racial and ethnic group, areas in which Black autistic children (&gt;50% of the population: β = 0.05; &lt;50% of the population: β = 0.07; P = .002) or Hispanic autistic children (&gt;50% of the population: β = 0.04; &lt;50% of the population: β = 0.07; P &lt; .001) comprised greater than 50% of the total population of autistic children had significantly fewer resources than areas in which Black or Hispanic autistic children comprised less than 50% of the total population. Comparing metropolitan vs micropolitan CBSAs revealed that in micropolitan CBSAs, Black autistic children (β = 0; 95% CI, 0-0; P &lt; .001) and Hispanic autistic children (β = 0; 95% CI, 0-0.02; P &lt; .001) had the greatest disparities in access to autism resources compared with White autistic children. In metropolitan CBSAs, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .005) and Hispanic autistic children (β = 0.01; 95% CI, 0-0.06; P = .02) had the greatest disparities compared with White autistic children.Conclusions and RelevanceIn this study, autistic children from several minoritized racial and ethnic groups, including Black and Hispanic autistic children, had access to significantly fewer autism resources than White autistic children in the US. This study pinpointed the specific geographic regions with the greatest disparities, where increases in the number and types of treatment options are warranted. These findings suggest that a prioritized response strategy to address these racial and ethnic disparities is needed.

show abstract

Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood

Cited by 33 publications

References 35 publications

Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities

Impact of COVID-19 Pandemic on Developmental Service Delivery in Children With a History of Neonatal Seizures

Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US

Contact Info

Product

Resources

About