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

  • Abraham Gallegos
    Correspondence
    Address correspondence to Abraham Gallegos, MD, MSHS, Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
    Affiliations
    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
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  • Rebecca Dudovitz
    Affiliations
    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
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  • Christopher Biely
    Affiliations
    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
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  • Paul J. Chung
    Affiliations
    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

    Kaiser Permanente Bernard J. Tyson School of Medicine (PJ Chung), Pasadena, Calif

    Department of Health Policy and Management, Fielding School of Public Health, University of California (PJ Chung), Los Angeles, Calif
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  • Tumaini R. Coker
    Affiliations
    Department of Pediatrics, University of Washington and Seattle Children's Research Institute (TR Coker), Seattle, Wash
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  • Elizabeth Barnert
    Affiliations
    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
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  • Alma D. Guerrero
    Affiliations
    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
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  • Peter G. Szilagyi
    Affiliations
    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
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  • Bergen B. Nelson
    Affiliations
    Children's Hospital of Richmond at Virginia Commonwealth University (BB Nelson), Richmond, Va
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      Abstract

      Background and Objective

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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