Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif; UCLA NRSA T32 Primary Care Research Fellowship, University of California, Los Angeles (A Gallegos, PG Szilagyi, PJ Chung), Calif.
Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif.
Acad Pediatr. 2021 Sep-Oct;21(7):1230-1238. doi: 10.1016/j.acap.2021.05.008. Epub 2021 May 19.
Racial disparities in diagnosis and receipt of services for early childhood developmental delay (DD) are well known but studies have had difficulties distinguishing contributing patient, healthcare system, and physician factors from underlying prevalence. We examine rates of physician diagnoses of DD by preschool and kindergarten entry controlling for a child's objective development via scoring on validated developmental assessment along with other child characteristics.
We used data from the preschool and kindergarten entry waves of the Early Childhood Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with DD by a medical provider and receipt of developmental services. Logistic regression models tested whether a child's race was associated with both outcomes during preschool and kindergarten while controlling for the developmental assessments, as well as other contextual factors.
Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed with DD. Of preschool children with DD, 66.5% were receiving developmental services, while 69.1% of kindergarten children with DD were receiving services. Children who were Black, Asian, spoke a primary language other than English and had no health insurance were less likely to be diagnosed with DD despite accounting for cognitive ability. Black and Latinx children were less likely to receive services.
Racial minority children are less likely to be diagnosed by their pediatric provider with DD and less likely to receive services despite accounting for a child's objective developmental assessment. The pediatric primary care system is an important target for interventions to reduce these disparities.
儿童早期发育迟缓（DD）的诊断和服务获得方面存在明显的种族差异，但研究在区分促成差异的患者、医疗体系和医生因素与潜在流行率方面存在困难。我们通过对经过验证的发育评估进行评分，来控制儿童的客观发育，从而检查儿童在幼儿园和学前班入学时医生诊断 DD 的比率，同时还考虑了其他儿童特征。
我们使用了幼儿纵向研究（出生队列）幼儿园和学前班入学波的数据。因变量包括医疗提供者诊断为 DD 和接受发育服务。逻辑回归模型测试了儿童的种族是否与学前和幼儿园期间的这两个结果相关，同时控制了发育评估以及其他背景因素。
在 7950 名儿童中，有 6.6%的学龄前儿童和 7.5%的幼儿园儿童被诊断为 DD。在有 DD 的学龄前儿童中，有 66.5%正在接受发育服务，而有 DD 的幼儿园儿童中有 69.1%正在接受服务。尽管考虑到认知能力，黑人和亚裔儿童、主要语言不是英语且没有医疗保险的儿童被诊断为 DD 的可能性较小。黑人和拉丁裔儿童获得服务的可能性较小。
尽管考虑到儿童的客观发育评估，但少数族裔儿童被儿科医生诊断为 DD 的可能性较小，获得服务的可能性也较小。儿科初级保健系统是减少这些差异的重要干预目标。
