“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”
-Martin Luther King, Jr
This quote is part of an editorial (Flores G, “Dead Wrong: The Growing List of Racial/Ethnic Disparities in Childhood Mortality” J Pediatr 2015; 166: 790-3). The author discusses the disparities among African-American (AA) and Latino children in comparison to white children.
- AA children and young adults had ~6 times the death rate for drowning in swimming pools, 4 times more likely of dying after liver transplant, and about twice the likelihood of dying due to acute lymphoblastic leukemia.
- Latino children have higher cancer death rates with about twice the likelihood of dying due to acute lymphoblastic leukemia and increased drowning death rate as well.
- One new study (pages 812-8) shows that black children have increased in-hospital mortality (OR 1.66) after complications following congenital heart surgery and that hispanic children have an increased complication rate following surgery (OR 1.13). This was a retrospective study using the Kids’ Inpatient Database with approximately 3 million discharge abstracts for three separate years.
- A second study (pages 819-26) with a data set of 98,833 children shows that birth defects resulted in higher 8-year adjusted hazards of death for black, latino, and Asian/Pacific Islander children.
Recognizing these disparities inevitable leads to the question of why. Dr. Flores postulates several factors.
- Genetic differences. For example, some ethnicities have more difficult to treat cancers, either due to genetic mutations or due to metabolism of medications.
- Delays in diagnosis and treatment. Patients who present at a later stage of diagnosis often have lower cure/response rates. The author notes that black children receive a diagnosis of autism a mean of 1.4 years later than white children.
- Barriers to specialty care. Specialty care can result in improved outcomes.
- Bias in healthcare delivery, both conscious and unintentional.
Bottomline: The problems of racial inequality is not just a matter of relationships between the police and the community. It is clear that more needs to be done to improve outcomes in healthcare as well.
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