Disparities for Latino Children in the Receipt of Timely Medical Care David Brousseau MD, MS, Jennifer Yauck MS, Raymond Hoffmann PhD, Ann Nattinger MD, MPH, Glenn Flores MD

Background Latino children: population –Largest minority racial/ethnic group = 16% –California: largest racial/ethnic group Latino children: health –Sub-optimal health status –Fewer physician visits –Lack health insurance –Less likely to have primary care provider Effect on quality of care ?

Latino quality of care Adherence to accepted standards –Lower likelihood of vision screening –Decreased use of inhaled steroids Self/Parent reported quality of care –No studies specifically looking at children –No studies controlling for confounders

Objective To compare the parent-reported ability of children to get timely medical care among Latino, White and African-American children

Methods Population: –2000 Medical Expenditure Panel Survey (MEPS) –Children < 18 years of age with a usual source of care All analyses weighted to represent national averages

Methods Timely medical care –1) Timely routine care from a provider –2) Timely illness or injury care from an office, clinic or ED –3) Phone help from a provider –4) Brief wait time with an appointment Scoring –4 point Likert scale, except Brief wait time

Methods: Analysis Primary outcome measure: –Not receiving the highest quality primary care Always receiving timely medical care Shortest waits for Brief wait time Univariate analysis by race/ethnicity –Analyzed using Chi-square

Methods: Multiple regression Latinos as the referent group Adjusted for: –Age, sex, health status, special health care needs –Insurance type, highest education With and without language in model Odds ratios

Results 4,120 children –Weighted to represent 47 million children –Average age: 8 years –51% male

Results: Unweighted Race/ethnicity Insurance

Results: Univariate analysis LatinoWhiteAfrican- American Routine care *56%46% Illness/injury care39%34%36% Phone help *60%51%53% Brief wait time *64%45%56% * P < 0.005

Results: OR for Latinos compared to Whites Without language 95% CIWith language 95% CI Routine care Illness care Phone help Brief wait time

Results: OR for Latinos compared to African-Americans Without language 95% CIWith language 95% CI Routine care Illness care Phone help Brief wait time

Conclusion Latino children experience marked disparities in obtaining timely medical care The disparities are only partially explained by language differences Improvements are needed in the delivery and efficiency of medical care for Latino children