Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA.
Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, NY.
J Dev Behav Pediatr. 2020 Jan;41(1):23-30. doi: 10.1097/DBP.0000000000000710.
To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted.
DESIGN/METHODS: This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses.
Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity.
This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.
在学术医疗中心，研究非西班牙裔白人（NHW）和非裔（NW）儿童在发育行为儿科医生（DBP）评估中的转诊问题、评估和诊断是否存在差异，以及社会经济因素在任何差异中的潜在作用。
本观察性研究使用了来自参与 DBPNet 的 12 个地点的 56 名 DBP 的调查数据。儿童的种族和族裔从 DBP 报告中获得。使用混合模型逻辑和线性回归分析，控制地点、提供者和社会经济代理变量（保险类型、父母教育程度和家庭语言），比较两组转诊关注点、评估程序和诊断结果。
在所评估的患者中，349 名是 NHW，406 名是 NW（187 名西班牙裔、135 名黑人、58 名亚洲/太平洋岛民和 26 名其他/混合族裔），29 名患者的种族/族裔数据缺失。控制地点和提供者后，NHW 儿童的平均等待时间为 20.4 周，NW 儿童的平均等待时间为 20.5 周。NHW 儿童的睡眠问题就诊率（9.2%）高于 NW 儿童（3.4%），转诊原因在 NHW 和 NW 两组中相似（p=0.01）。两组患者的评估也相似；唯一的差异是，NHW 儿童比 NW 儿童更倾向于接受基因检测（33.1%比 19.3%，p=0.02）、眼科评估（8.7%比 3.4%，p=0.03）和精神药理学评估（19.1%比 9.7%，p=0.008）。诊断的数量和类型不受种族/族裔的影响。
在考虑社会经济因素的情况下，这项研究表明，在这 12 家学术 DBP 中心，NHW 和 NW 儿童在等待治疗的时间、转诊原因、检查或初次 DBP 评估的最终诊断方面几乎没有不平等现象。然而，由于这些相关因素的差异可能是导致种族/族裔差异的机制，因此在为服务不足的社区规划模式和护理方案时，考虑这些因素将非常重要。
