Feinberg Emily, Silverstein Michael, Donahue Sara, Bliss Robin
From the *Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA; Departments of †Community Health Sciences and ‡Biostatistics, Boston University School of Public Health, Boston, MA.
J Dev Behav Pediatr. 2011 May;32(4):284-91. doi: 10.1097/DBP.0b013e3182142fbd.
To quantify racial differences in receipt of early intervention (EI) services among children ages birth to 3 years.
Multivariable analyses of a nationally representative sample of children eligible for EI services using data from the Early Child Longitudinal Study, Birth Cohort was conducted. Birth weight <1000 g, genetic and medical conditions associated with developmental delay, or low scores on a standardized measure of developmental performance defined EI eligibility. Receipt of EI services was ascertained from parent self-report. The effect of race on receipt of EI services was examined in main effect models and models stratified by EI qualifying condition, which was defined as either established medical condition or developmental delay in the absence of an underlying medical diagnosis.
At 9 months of age, among the 1000 children eligible for EI services, 9% of children received services; there were no black-white racial differences in receipt of services. At 24 months of age, among the 1000 children eligible for EI services, 12% received services; black children were 5 times less likely to receive services than white children (adjusted odds ratio [aOR] 0.19; 95% confidence interval [CI] 0.09, 0.39). In models stratified by qualifying condition, black children who qualified for services at 24 months based on developmental delay alone were less likely to receive services (aOR 0.09; 95% CI 0.02, 0.39); there were no differences by race among children who qualified based on established medical conditions (aOR 0.56; 95% CI 0.18, 1.72).
Racial disparities in EI service receipt, which were not present during infancy, emerged as children became toddlers. These disparities were found most consistently among children who qualified for services based on developmental delay alone.
量化出生至3岁儿童接受早期干预(EI)服务方面的种族差异。
利用早期儿童纵向研究出生队列的数据,对符合EI服务条件的具有全国代表性的儿童样本进行多变量分析。出生体重<1000克、与发育迟缓相关的遗传和医疗状况,或发育表现标准化测量得分低定义了EI资格。EI服务的接受情况通过家长自我报告确定。在主效应模型以及按EI资格条件分层的模型中检验种族对EI服务接受情况的影响,EI资格条件定义为既定医疗状况或无潜在医疗诊断的发育迟缓。
在9个月大时,在1000名符合EI服务条件的儿童中,9%的儿童接受了服务;在服务接受方面不存在黑白种族差异。在24个月大时,在1000名符合EI服务条件的儿童中,12%接受了服务;黑人儿童接受服务的可能性比白人儿童低5倍(调整后的优势比[aOR]为0.19;95%置信区间[CI]为0.09,0.39)。在按资格条件分层的模型中,仅基于发育迟缓在24个月时符合服务条件的黑人儿童接受服务的可能性较小(aOR为0.09;95%CI为0.02,0.39);基于既定医疗状况符合条件的儿童中不存在种族差异(aOR为0.56;95%CI为0.18,1.72)。
EI服务接受方面的种族差异在婴儿期不存在,在儿童成长为幼儿时出现。这些差异在仅基于发育迟缓符合服务条件的儿童中最为一致。