Rate For White Children Research Articles

Black-White Disparities in Asthma Hospitalizations and ED Visits Among Medicaid-Enrolled Children.

Asthma is a common, potentially serious childhood chronic condition that disproportionately afflicts Black children. Hospitalizations and emergency department (ED) visits for asthma can often be prevented. Nearly half of children with asthma are covered by Medicaid, which should facilitate access to care to manage and treat symptoms. We provide new evidence on racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children. We used comprehensive Medicaid claims data from the Transformed Medicaid Statistical Information System. Our study population included 279 985 Medicaid-enrolled children with diagnosed asthma. We identified asthma hospitalizations and ED visits occurring in 2019. We estimated differences in the odds of asthma hospitalizations and ED visits for non-Hispanic Black versus non-Hispanic white children, adjusting for sex, age, Medicaid eligibility group, Medicaid plan type, state, and rurality. In 2019, among Black children with asthma, 1.2% had an asthma hospitalization and 8.0% had an asthma ED visit compared with 0.5% and 3.4% of white children with a hospitalization and ED visit, respectively. After adjusting for other characteristics, the rates for Black children were more than twice the rates for white children (hospitalization adjusted odds ratio 2.45, 95% confidence interval 2.23-2.69; ED adjusted odds ratio 2.42; 95% confidence interval 2.33-2.51). There are stark racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children with asthma. To diminish these disparities, it will be important to implement solutions that address poor quality care, discriminatory treatment in health care settings, and the structural factors that disproportionately expose Black children to asthma triggers and access barriers.

Family Policing as Counterinsurgency and the Gathering Abolitionist Force

Family Policing as Counterinsurgency and the Gathering Abolitionist Force Dorothy Roberts (bio) I spent the first year of the pandemic writing a book about abolishing the so-called child welfare system—what I call the family policing system. When I heard Dylan Rodríguez’s remarkable presidential address, I was already proofing the galleys of Torn Apart: How the Child Welfare System Destroys Black Families—and How Abolition Can Build a Safer World.1 Every word Rodríguez spoke resonated with my thinking and activism around the need to dismantle the child welfare system and replace it with a radically reimagined way of caring for families and keeping children safe. The invitation to write a response to his address gave me the opportunity to frame my arguments in terms of his valuable conceptualization of counterinsurgency and the gathering abolitionist force. Conceptualizing family policing—US government surveillance and destruction of politically marginalized families—as state counterinsurgency usefully illustrates and illuminates his key points. A central theme of Rodríguez’s address is that “counterinsurgency not only is directed by the state’s repressive military, policing, and political might but—especially in moments like this—is commonly performed through narratives, aesthetics, rhetorics, and institutional solicitations of a scrambling reformism.” This seemingly contradictory stance of simultaneous repression and reform is essential to US family policing, characterized by inflicting violence on politically marginalized families under the pretense of protecting children from parental maltreatment. The US child welfare system has historically terrorized Black and Indigenous people in the United States by forcibly removing large numbers of children from their homes and placing them in state custody. It regulates even greater numbers of families by subjecting them to intense supervision under the threat of child removal. The legitimacy of family policing depends on maintaining the mirage that its brutal intrusion in families is a benevolent service for needy children. The origins of the US child welfare system lie in the oppression of Black, Indigenous, and impoverished white families by powerful white elites.2 The ideology of violent supervision of Black families by white people can be traced [End Page 221] back to the separation of enslaved family members at the whim of slaveholders, who had absolute legal authority over them. The mass removal of Native children from their tribes and their consignment to boarding schools was literally a weapon of war developed by the US military in the nineteenth century to overpower tribal resistance to its settler colonial project. The establishment and expansion of the formal foster care system were counterinsurgency initiatives against Black liberation struggles. After the Civil War ended, white judges ordered thousands of Black children to be apprenticed to their former enslavers in conjunction with other white supremacist mechanisms, such as convict leasing, designed to return newly emancipated Black people to a subservient status. In the 1950s and 1960s, southern states began dropping Black families from the welfare rolls and placing their children in foster care as part of a white supremacist backlash against gains won by civil rights activists and Black freedom fighters. The terror of family policing continues today. According to a 2014 study, 15.44 percent of Native children and 11.53 percent of Black children were placed in foster care before their eighteenth birthday.3 The rate for white children (4.86 percent) was much lower, reflecting America’s racial hierarchy, but still remarkably high. Almost all the children the state takes by force come from impoverished or working-class families. State child welfare systems engage in tactics akin to what Rodríguez refers to as “the military protocols for neutralizing resistance to US occupation,” which include “‘integrating civilian and military activities.’” Family policing operations—warrantless home investigations, intensive monitoring of families by state agents and civilians deputized to report on parents (“mandatory reporters”), forcible seizure of children followed by placing them in foster care, and permanent severing of family ties for failing to comply with agency dictates—reflect a carceral logic with parallels in the criminal punishment system. State child protection authorities increasingly use modern surveillance technologies and coordinate with law enforcement agencies to manage regulated populations more efficiently. Family policing is part of the prison industrial complex...

The overrepresentation of First Nations children and families involved with child welfare: Findings from the Ontario incidence study of reported child abuse and neglect 2013.

While there are national studies on the overrepresentation of First Nations children in the Canadian child protection system, there is a dearth of provincial/territorial studies. The objectives are to: 1) estimate the rate of overrepresentation of First Nations children and youth involved in child welfare investigations in the Ontario child welfare system and, 2) determine which factors drive the overrepresentation of First Nations children in child welfare at the investigation stage compared to White children. Child welfare workers completed a three-page data collection form at the conclusion of a child protection investigation. A secondary analysis of the Ontario Incidence Study 2013 was conducted. Incidence rates were calculated and bivariate analyses were conducted, comparing investigations involving First Nations children to investigations involving White children. First Nations children represent 2.5% of the child population; however, they represent 7.4% of child maltreatment related investigations in Ontario. The rate of investigations for First Nations children was approximately three times higher than the rate for White children. Overrepresentation was most pronounced for investigations of neglect and exposure to intimate partner violence. Rates of substantiation, ongoing child welfare services, child welfare court, and placement in care were higher for the First Nations child population. The findings provide a foundation for further research and analyses examining the compounding of disparities across the investigation process. Research is needed to disentangle factors that influence decision-making in the child welfare system and how these vary based on a child's race.

Substantiated Reports of Sexual Abuse among Latinx Children: Multilevel Models of National Data

Despite a rapidly growing U.S. Latinx child population and this group’s representation in the child welfare system (CWS), limited research exists on Latinx children reported to the CWS for child sexual abuse (CSA). This study examined how the intersection of race/ethnicity, age, and biological sex impact case substantiation among Latinx, Black, and White children reported for CSA. We analyzed 2012 National Child Abuse and Neglect Data System Child File data using generalized linear mixed models (GLMMs) to examine a sample of children reported to the CWS for CSA (n = 179,199). GLMMs indicated that among children reported for CSA, Black (AOR = 1.12) and White (AOR = 1.17) children had significantly higher odds of case substantiation compared to Latinx children, controlling for other factors. Main effects indicate older children (in mean-centered years; OR = 1.09) and female children (OR = 2.52) had higher odds of substantiation. Out of the states included in the post-hoc analysis, 16 (84%) had female to male substantiation ratios that were higher for Latinx children compared to White children. In these same states, only 9 (56%) had ratios for Black children that were higher than the rate for White children. Results indicate it is critical to continue examining how child sex, race/ethnicity, age, and state differences may affect CSA case substantiation rates. These findings underscore the importance of providing accessible culturally and linguistically appropriate CWS services that are also responsive to sex and developmental stage.

Preventable injury deaths: a population-based proxy of child maltreatment risk in California.

This study used group variations in child injury fatality rates to assess racial bias in the population of children identified as victims of maltreatment. Injury fatality and maltreatment data from California were compiled for the years 1998-2007. Death and maltreatment risk ratios (RRs) and 95% confidence intervals (CIs) were computed by race and age. Rates of excess child injury mortality by race were derived from three different baseline rates of death. Substantiations per excess injury death were calculated. compared with white children, black children faced a risk of substantiated maltreatment that was more than twice as great (black RR: 2.39, 95% CI 2.37, 2.42) and were fatally injured at nearly twice the rate (black RR: 1.89, 95% CI 1.68, 2.12). Per excess death, however, black children had rates of substantiated maltreatment allegations that were equivalent to or lower than the rates for white children. These data support claims that, at least in California, black-white racial disparities observed in maltreatment rates reflect real group differences in risk. These data provide no evidence of systematic racial bias in the child protective services' substantiation process.

American Indian/Alaska Native Uninsurance Disparities: A Comparison of 3 Surveys

We examined whether 3 nationally representative data sources produce consistent estimates of disparities and rates of uninsurance among the American Indian/Alaska Native (AIAN) population and to demonstrate how choice of data source impacts study conclusions. We estimated all-year and point-in-time uninsurance rates for AIANs and non-Hispanic Whites younger than 65 years using 3 surveys: Current Population Survey (CPS), National Health Interview Survey (NHIS), and Medical Expenditure Panel Survey (MEPS). Sociodemographic differences across surveys suggest that national samples produce differing estimates of the AIAN population. AIAN all-year uninsurance rates varied across surveys (3%-23% for children and 18%-35% for adults). Measures of disparity also differed by survey. For all-year uninsurance, the unadjusted rate for AIAN children was 2.9 times higher than the rate for White children with the CPS, but there were no significant disparities with the NHIS or MEPS. Compared with White adults, AIAN adults had unadjusted rate ratios of 2.5 with the CPS and 2.2 with the NHIS or MEPS. Different data sources produce substantially different estimates for the same population. Consequently, conclusions about health care disparities may be influenced by the data source used.

On-Time Immunization Rates Among Children Who Enter Chicago Public Schools

A primary objective of the Healthy People 2010 initiatives is to increase on-time immunization rates during the first 2 years of life and to decrease racial disparities in coverage. The objective of this study was to determine on-time immunization coverage rates among infants and toddlers stratified by race/ethnicity in a large metropolitan center. A retrospective cohort study that was based on immunization records in the Chicago Public Schools computerized database was conducted using all 67376 children who completed kindergarten in 2001 and 2002. On-time immunization rates in Chicago public school children are low (31% at 7 months, 32% at 19 months, 59% at 36 months). At 19 months of age and thereafter, Hispanic children had the highest rate of on-time immunization coverage. Among children <48 months old, black children had the lowest rates of up-to-date immunization status. At 48 months of age, the up-to-date rate for black children improved to a rate similar to white children (58%) and by school entry surpassed the up-to-date rate for white children (71%). Compared with the recommended 2, 4, 6, and 15 to 18 months schedule, black children received 4 doses of diphtheria/tetanus/acellular pertussis at a mean age of 10.0, 14.6, 20.4, and 34.5 months of age. In contrast, Hispanic children received the same doses at a mean of 4.5, 7.4, 11.0, and 25.1 month of age. In addition, approximately 25% of black children received the majority of their vaccinations >12 months later than the recommended time intervals. Striking immunization delay still exists during the infant and toddler years. Targeted efforts are needed to increase on-time immunization rates and to decrease racial disparity in immunization coverage.

Mortality from pneumonia in children in the United States, 1939 through 1996.

Pneumonia remains an important cause of childhood deaths throughout the world, but in developed countries, the mortality rate is decreasing. We reviewed death records for children in the United States from 1939 through 1996. A plot of the annual rates of change in the number of deaths from pneumonia was used to generate hypotheses about the influence of various events and interventions. We used data from the National Hospital Discharge Survey, the Medicaid program, and published reports to test these hypotheses. During the 58-year study period, the number of children who died from pneumonia declined by 97 percent, from 24,637 in 1939 to 800 in 1996. During the same period, the rate of mortality from other causes declined by 82 percent. There were steep declines in the mortality rates for pneumonia from 1944 to 1950, although the rate increased among older children in 1957, and there were sustained declines in all age groups from 1966 to 1982. From 1966 to 1982, the mortality declined by an average of 13.0 percent annually, and these decreases coincided with increases in the proportion of poor children covered by Medicaid, increases in rates of hospitalization for pneumonia, a narrowing of the gap between the mortality rate for black children and the rate for white children, and a convergence between the mortality rate in the South and the rates in the other three census regions. Since 1939, the rate of mortality from pneumonia in children in the United States has declined markedly. We hypothesize that the steep declines in the late 1940s are attributable to the use of penicillin, that the peak in 1957 was due to the influenza A pandemic, and that the sustained decline from 1966 through 1982 may be attributable in part to improved access to medical care for poor children.

Evidence that childhood acute lymphoblastic leukemia is associated with an infectious agent linked to hygiene conditions.

The incidence of acute lymphoblastic leukemia (ALL) in children has shown temporal and geographic variation during the 20th century, with higher rates in developed nations appearing in the first half of the century, but with persisting low rates in developing nations. We sought to assess the relation of childhood ALL with hygiene conditions, an aspect of socioeconomic development affecting rates of exposure to infectious agents. Infection patterns for hepatitis A virus (HAV), an agent with a fecal-oral route of transmission, were used to indicate hygiene conditions in different populations, with emphasis on instructive United States and Japanese data. A catalytic model was fit to these data, estimating the HAV force of infection and age-specific seroprevalence rates over time. These analyses were used to assess the temporal relationship of changes in HAV infection rates to changes in childhood leukemia mortality and incidence rates. We observed an inverse relationship between HAV infection prevalence and rates of childhood leukemia. Further, decreases in the HAV force of infection in the United States and Japan appear to have preceded increases in childhood leukemia rates. We describe a model based on a putative leukemia-inducing agent with a change in infection rate over time correlated with that of HAV that describes well the temporal trends in childhood leukemia rates for White children in the US and for Japanese children. The data suggest that improved public hygiene conditions, as measured by decreased prevalence of HAV infection, are associated with higher childhood ALL incidence rates. The model that we present supports the plausibility of the hypothesis that decreased childhood exposure to a leukemia-inducing agent associated with hygiene conditions leads to higher rates of ALL in children by increasing the frequency of in utero transmission caused by primary infection during pregnancy (or by increasing the number of individuals infected in early infancy because of lack of protective maternal antibodies).

Perinatal, Infant, and Child Death Rates Among the Old Order Amish

The Old Order Amish are a distinct ethnic group with a very high birth rate and patterns of perinatal risk factors quite different from those of the general population. This study reports marital fertility and perinatal, infant, and child death rates for an entire Amish settlement of approximately 10,000 individuals, centered around Geauga County, Ohio. All 6,623 births from 1948 to 1988 listed in a directory of Geauga Settlement Amish households were studied. The childbearing experience of all 475 married women over the age of 44 years was also described. Women aged > 44 years had a median of 8.3 births; 24% of the births were to women aged > 34 years. Despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish have been very similar to the corresponding rates for white children in rural Ohio and the state as a whole. The beneficial aspects of Amish society that may lessen the impact of perinatal risk factors on mortality merit further study.

Tuberculosis in children: a national survey of notifications in England and Wales in 1988. Medical Research Council Cardiothoracic Epidemiology Group.

A survey of all notified cases of tuberculosis in England and Wales in children (less than 15 years old) in 1988 was undertaken to study changes in the frequency and distribution of disease in the population since similar surveys in 1978-9 and 1983. There were 294 children with newly notified previously untreated tuberculosis, an annual rate of 3.1/100,000. Children of Indian, Pakistani, and Bangladeshi (Indian subcontinent) ethnic origin formed the largest group (134 (46%)), but only 29 (22%) of these children were born outside the UK. The rate for children of Indian subcontinent ethnic origin born abroad (53/100,000) was twice that for those born in the UK (26/100,000), but the latter was 17 times higher than the rate for white children (1.5/100,000). These ratios have changed little since the first survey in 1978-9 and highlight the need for improvement in the prevention and control of tuberculosis in children known to be at increased risk.

Perinatal, Infant, and Child Death Rates among the Old Order Amish

The Old Order Amish are a distinct ethnic group with a very high birth rate and patterns of perinatal risk factors quite different from those of the general population. This study reports marital fertility and perinatal, infant, and child death rates for an entire Amish settlement of approximately 10,000 individuals, centered around Geauga County, Ohio. All 6,623 births from 1948 to 1988 listed in a directory of Geauga Settlement Amish households were studied. The childbearing experience of all 475 married women over the age of 44 years was also described. Women aged > 44 years had a median of 8.3 births; 24% of the births were to women aged > 34 years. Despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish have been very similar to the corresponding rates for white children in rural Ohio and the state as a whole. The beneficial aspects of Amish society that may lessen the impact of perinatal risk factors on mortality merit further study.

Prospective Surveillance of Haemophilus influenzae Type b Disease in Dallas County, Texas, and in Minnesota

Among children less than 12 years of age residing in Dallas County, Texas, and in the state of Minnesota we conducted prospective, active surveillance of invasive Haemophilus influenzae disease. During 18 months, 616 cases were identified, of which 600 were caused by type b organisms. The annual incidence of disease was significantly greater in Dallas than in Minnesota (109 v 68/100,000 children younger than 5 years of age, P less than .001) and was greater in Dallas, even when rates for white children in the two regions were compared (P less than .001). Other regional differences were observed. In Dallas, a larger proportion of cases were in children attending day-care centers (27% compared with 12% in Minnesota, P less than .001) and more patients attended day care for greater than 40 h/wk (56% compared with 30% in Minnesota, P less than .001). Outer membrane protein subtyping of isolates revealed that in Dallas 6U isolates were associated significantly with cases in black children who attended day care. In Minnesota, but not in Dallas, isolates with subtype 1H were associated significantly with cases in children in day care. These data indicate that there are regional differences in the epidemiology of type b Haemophilus disease that may relate to differences in strains, day-care practices, or other unknown cultural or environmental factors. Finally, because only 15% of systemic Haemophilus disease in these regions occurred in children in the age groups recommended for vaccination (24 to 59 months), the new Haemophilus type b polysaccharide vaccine is expected to have a limited impact on the overall incidence of disease.