Halfon Neal, Aguilar Efren, Stanley Lisa, Hotez Emily, Block Eryn, Janus Magdalena
Neal Halfon (
Efren Aguilar is the geographic information systems lead at the Center for Healthier Children, Families, and Communities at UCLA.
Health Aff (Millwood). 2020 Oct;39(10):1702-1709. doi: 10.1377/hlthaff.2020.00920.
Racialized disparities in health and well-being begin early in life and influence lifelong health outcomes. Using the Early Development Instrument-a population-level early childhood health measure-this article examines potential health inequities with regard to neighborhood income and race/ethnicity in a convenience sample of 183,717 kindergartners in ninety-eight US school districts from 2010 to 2017. Our findings demonstrate a distinct income-related outcome gradient. Thirty percent of children in the lowest-income neighborhoods were vulnerable in one or more domains of health development, compared with 17 percent of children in higher-income settings. Significantly higher rates of income-related Early Development Instrument vulnerability-defined as children falling below the tenth-percentile cutoff on any Early Development Instrument domain-were demonstrated for Black/African American and Hispanic/Latinx children. These findings underscore the utility of the Early Development Instrument as a way for communities to measure child health equity gaps and inform the design, implementation, and performance of multisector place-based child health initiatives. More broadly, results indicate that for the US to make significant headway in decreasing lifelong health inequities, it is important to achieve health equity by early childhood.
健康和幸福方面的种族差异在生命早期就已出现，并会影响一生的健康结果。本文使用早期发展工具（一种针对儿童早期健康的人群层面衡量指标），对2010年至2017年美国98个学区的183,717名幼儿园儿童的便利样本，研究了邻里收入和种族/族裔方面潜在的健康不平等问题。我们的研究结果显示出明显的与收入相关的结果梯度。收入最低社区中30%的儿童在一个或多个健康发展领域存在脆弱性，而高收入社区中这一比例为17%。黑人和非裔美国儿童以及西班牙裔/拉丁裔儿童在与收入相关的早期发展工具脆弱性方面的比例显著更高，即儿童在任何早期发展工具领域低于第十百分位临界值。这些研究结果强调了早期发展工具作为一种让社区衡量儿童健康公平差距并为多部门基于地点的儿童健康倡议的设计、实施和绩效提供信息的方式的效用。更广泛地说，结果表明，美国要在减少一生的健康不平等方面取得重大进展，在儿童早期实现健康公平非常重要。
