Abstract
Lower health care utilization and less favorable health outcomes have been demonstrated in children from Non-English Primary Language households (NEPL) in previous studies. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN) and their association with household language use. We used data from the 2009-2010 National Survey of Children with Special Health Care Needs, restricted to an analytic sample of 40,242 children. Logistic regression models were used to examine the effects of primary household language on the attainment of the 6 health care quality indicators for CSHCN. Compared to CSHCN from English primary language households (EPL), CSHCN from NEPL households had 31% higher odds of not feeling like partners in health care decision-making. They had 67% higher odds of lacking care through a medical home and 42% higher odds of reporting inadequate health insurance. NEPL children had 32% higher odds of not receiving early and continuous screening for special health care needs. NEPL youths had 69% higher odds of not receiving services for transition to adulthood. Minority race/ethnicity, lower income and families other than two biological parents all conferred additional risks to not attaining quality indicators. Publicly insured or uninsured CSHCN were also at higher risk. Our study provides compelling evidence that significant disparities exist for CSHCN by primary household language status across all health care quality indicators. Establishment of effective surveillance systems and targeting of outreach programs in both developed and developing countries may lead to improved understanding of health care needs and quality of services and reduction of health disparities for this underserved population.
Highlights
Children with Special Health Care Needs (CSHCN) are defined as those “who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services of a type or amount beyond that required by children generally.”[1]. The estimated prevalence of children with special health care needs (CSHCN) in the United States (US) has increased from 12.8% in 2001 to 13.9% in 2005 and 15.1% (11.2 million children) in 2010.[2]. As the needs of CSHCN in the US evolved, the federal Maternal and Child Health Bureau (MCHB) worked with state Title V agencies, families, and other stakeholders to develop 6 key system building blocks, referred to as core outcomes or quality indicators, representing the essential elements needed for high-quality systems of health and medical services.[3]
Using data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), our study aims to describe the demographic characteristics of CSHCN and the prevalence of CSHCN meeting six quality indicators by the parent-reported primary household language, and to examine the independent effects of primary household language on the six quality indicators while controlling for confounding variables
The 2009-2010 NS-CSHCN is the third administration of the NS-CSHCN as the previous surveys took place in 2000-2001 and 2005-2006.The final sample was comprised of 40,242 children.The available survey languages included the www.mchandaids.org |
Summary
Children with Special Health Care Needs (CSHCN) are defined as those “who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services of a type or amount beyond that required by children generally.”[1]. For parents with LEP, caring for CSHCN is challenging. Parental LEP has been associated with risks of adverse outcomes in children’s health and disparities in medical and oral health, access to care, and use of services.[6,7,8] parents with LEP may be unable to read and comprehend important clinical evaluations, prescription instructions, followup appointments, referral to specialists and therapyrelated documents. Some parents with LEP may be unable to understand routinely dispensed written medication instructions.[9] The challenge faced by clinicians treating LEP populations remains high. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN) and their association with household language use
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