Abstract
Objectives
To assess the association between racial discrimination, race/ethnicity, and social
class with child health and unmet healthcare needs among children in the United States
(US).
Methods
We used a nationally representative sample of children aged 0 to 17 from the 2018-2019
National Survey of Children's Health. Bivariate and multivariable logistic regression
were used to test associations between measures of discrimination, social class (income,
employment, and education), and race/ethnicity with overall child health and unmet
healthcare needs controlling for covariates identified a priori.
Results
Overall, 90.3% of children (n=59,964) had excellent/very good overall health; 3.1%
had unmet healthcare needs. Black, non-Hispanic children had 8.9 times the odds of
having experienced racial discrimination compared to White, non-Hispanic children
(95% CI: 7.0-11.4). Having special healthcare needs was significantly associated with
greater odds of racial discrimination (OR 2.3; 95% CI 1.9-2.8). In multivariable models,
underrepresented race/ethnicity groups, lower household income level, and lower caregiver
education were significantly associated with poorer overall child health. Conversely,
experiencing discrimination was not significantly associated with excellent/good overall
child health (aOR: 0.8; 95% CI 0.6-1.1) Racial discrimination (aOR 2.7; 95% CI: 1.9-4.0)
and lower household income (aOR 2.6; 95% CI 1.8-3.5) were associated with significantly
greater odds of unmet healthcare needs.
Conclusion
Race/ethnicity and low social class were significantly associated with worse overall
health while racial discrimination and low-income were associated with more unmet
healthcare needs. These findings underscore the importance of policy and healthcare
system innovations that address the effects of racism and poverty on child health.
Key Words
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Article Info
Publication History
Accepted:
May 20,
2022
Received:
August 3,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Academic Pediatric Association
