Disparities in Health

Disparities in health exist in the United States. One in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet, in any given year, it is estimated that less than 1 in 5 of these children receives needed treatment. The long-term consequences of untreated childhood disorders are costly, in both human and financial terms.

Disparities in Health: African Americans

African Americans of all ages are under represented in outpatient treatment but overrepresented in inpatient treatment. Few African American children receive treatment in privately funded psychiatric hospitals, but many receive treatment in publically funded residential treatment centers for emotionally disturbed youth.

While few clinical trials have evaluated the response of African Americans to evidence-based treatment, the limited data available suggest that, for the most part, African Americans respond favorably to treatment. However, there is cause for concern about the appropriateness of some diagnostic and treatment procedures. For example, when compared to whites who show the same symptoms, African Americans tend to be diagnosed more frequently with schizophrenia and less frequently with affective disorders.

In addition, one study found that 27% of blacks compared to 44% of whites received antidepressant medication. Moreover, the newer SSRI medications that have fewer side effects are prescribed less often to African Americans than to whites.

Finally, even though data suggest that blacks may metabolize psychiatric medications more slowly than whites, blacks often receive higher dosages than do whites, leading to more severe side effects. As a result, they may stop taking medications at a greater rate than whites with similar diagnoses.

"We must educate all persons who are involved in the care of children on how to identify early indicators for potential mental health problems. This begins with families. We need to help families understand that these problems are real, that they often can be prevented, and that effective treatments are available. We also need to better educate frontline providers—teachers, health care workers, school counselors and coaches, faith-based workers, and clinicians of all disciplines—to recognize mental health issues. Finally, we need to train health care providers in scientifically-proven, state-of-the-art approaches of assessment, treatment, and prevention."
David Satcher, MD, PhD,
Former Assistant Secretary for Health and Surgeon General

Undetected Vision Problems In African American Children

There is a disproportionate rate of vision problems in African American children. Nearly one-third (30 percent) of African-American parents report that their child has never seen an eye care professional. Early detection and treatment of vision problems are key to preventing permanent vision loss in children. This site desires to help motivate at-risk populations to have regular eye exams. Click here for more information.

Disparities in Health: Autism

In 2004 David S. Mandell, Sc.D. reported at an international conference sponsored by the National Institute of Mental Health that studies show black or African American children with autism are diagnosed nearly two years after children of all other ethnic groups.

Research on disparities in health has shown no differences based on race, ethnicity, or socioeconomic status in either the prevalence or incidence of autism in children. A recent study by autism epidemiologist Dr. Eric Fombonne, is the first to derive a strong population-based estimate for the rate of autism in black children, which is comparable to other racial groups.

Studies have consistently reported negative biases toward minorities in the areas of diagnosis and treatment.

There is a general delay in diagnosing all children with autism (ASD can often be diagnosed in children as young as 18 months).

A recent study found a glaring racial disparity in age at diagnosis (average age at diagnosis was 5.5 years for white children and 7.5 years for black children). They had many more visits than white children yet still were not diagnosed.

This lag time could have important implications for a child's health. All children with autism are eligible for state services, behavior treatments and enrollment in a classroom geared toward their condition.

Although many parents of black children suspect a problem by age 2, their physicians do not take their concerns seriously. Black parents are often reassured that their children fall within the range of normal development and will eventually "catch up."

Pediatricians may hesitate to tell parents their child has a condition for which there is no obvious treatment, relying on "watchful waiting" to see if something changes.

Black autistic children received more misdiagnoses than whites. They were more likely to be misdiagnosed as having organic psychoses, mental retardation, or selective mutism. White autistic children were more likely to have been misdiagnosed as having ADHD.

Black parents may be more concerned than white parents about the consequences of reporting their child's behavioral problems. The literature suggests that under identical conditions in the home, black children are more likely than white children to be taken away from their parents.

Previous research has found that black families have a lot less trust of the medical system than white families do, and that black patients find their office visits to be less satisfactory than white patients do.

African Americans are less likely than whites to see the same doctor over time. A pediatrician who watches a child for many years may spot autism sooner than others.

Clinicians may interpret autism symptoms differently in children of different races.

Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children with Autism
David S. Mandell, Sc.D., John Listerud, M.D., Ph.D.,
Susan E. Levy, M.D., Jennifer A. Pinto-Martin, Ph.D.,
J. Am. Acad. Child Adolesc. Psychiatry 41:12, pp. 1447-1453
December 2002.

Practical ways to improve disparities in health and autism

How can we help ensure minority children get accurate, early diagnosis and treatment? Families can see to it that their children receive regular pediatric care.

Experts must educate parents and clinicians about the symptoms of autism, provide parents with the right language to explain their child's behavior, and help physicians and mental health professionals recognize and seek out their own biases in how they treat patients.

Health care professionals must seek continuing training concerning the diagnosis and treatment of Autism Spectrum Disorder.

Physicians must develop good relationships with parents. They have to work particularly hard to put black families at ease and to obtain relevant information about their children's developmental delays.

Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children with Autism
David S. Mandell, Sc.D., John Listerud, M.D., Ph.D.,
Susan E. Levy, M.D., Jennifer A. Pinto-Martin, Ph.D.,
J. Am. Acad. Child Adolesc. Psychiatry 41:12, pp. 1447-1453
December 2002.

For information on Disparities in Special Education click here.

Books: Disparities in Health

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received.

In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients and providers attitudes, expectations, and behavior are analyzed.

How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color. This book can be read online free of charge.

Disparities in Health:
Down Syndrome

African Americans with Down Syndrome

Racial Disparities in Median Age at Death of Persons With Down Syndrome

Down syndrome occurs in approximately 1 in 800 births. Down Syndrome is the most common identified cause of mental retardation. Epidemiological studies have found there are individuals with both Down Syndrome and autism. These cases are said to be rare. The affects of Down Syndrome and autism in children are severe, making autism the primary condition.

According to the Center for Disease Control and Prevention (CDC), people with Down syndrome in the United States live much longer now than 30 years ago, but this improvement is much greater for whites than for blacks or other races. The causes for this racial disparity are unknown. Death at an early age is more common among people with Down syndrome who are black or of other races than among those who are white. In 1997, on average, whites with Down syndrome lived 50 years, blacks lived 25 years, and other racial groups lived 11 years. Further study is needed to determine why the age at death for people with Down syndrome varies so greatly among racial groups.

Racial Disparities in Median Age at Death of Persons With Down Syndrome

Read the CDC study, Racial Disparities in Median Age at Death of Persons With Down Syndrome, MMWR Weekly June 08, 2001 / 50(22);463-5

National Down Syndrome Society Position Statement on Racial Disparity

Disparities in Health
Related Research

Prevalence of autism in a US metropolitan area.

JAMA. 2003 Jan 1;289(1):49-55.
Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C.

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (F-15), 4770 Buford Hwy NE, Atlanta, GA 30341, USA. mxy1@cdc.gov

Context: Concern has been raised about possible increases in the prevalence of autism. However, few population-based studies have been conducted in the United States.

Objectives: To determine the prevalence of autism among children in a major US metropolitan area and to describe characteristics of the study population.

Design, Setting, And Population: Study of the prevalence of autism among children aged 3 to 10 years in the 5 counties of metropolitan Atlanta, Ga, in 1996. Cases were identified through screening and abstracting records at multiple medical and educational sources, with case status determined by expert review.

Main Outcome Measures: Autism prevalence by demographic factors, levels of cognitive functioning, previous autism diagnoses, special education eligibility categories, and sources of identification.

Results: A total of 987 children displayed behaviors consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for autistic disorder, pervasive developmental disorder-not otherwise specified, or Asperger disorder. The prevalence for autism was 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6) (male-female ratio, 4:1). Overall, the prevalence was comparable for black and white children (black, 3.4 per 1000 [95% CI, 3.0-3.7] and white, 3.4 per 1000 [95% CI, 3.2-3.7]). Sixty-eight percent of children with IQ or developmental test results (N = 880) had cognitive impairment. As severity of cognitive impairment increased from mild to profound, the male-female ratio decreased from 4.4 to 1.3. Forty percent of children with autism were identified only at educational sources. Schools were the most important source for information on black children, children of younger mothers, and children of mothers with less than 12 years of education.

Conclusion: The rate of autism found in this study was higher than the rates from studies conducted in the United States during the 1980s and early 1990s, but it was consistent with those of more recent studies.

PMID: 12503976 [PubMed]

About 3 in every 1000 US children in large metropolitan areas may have autism or related developmental disorders.

Evid Based Ment Health. 2003 Aug;6(3):73.
Comment on:
"JAMA. 2003 Jan 1;289(1):49-55.
Bryson SE.
Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Publication Types:

PMID: 12893784 [PubMed]

Disparities in Health
Related Articles

For more information on disparities in health, view the article Disparities Among African Americans With Autism.

Autism Dx Delayed 2 Years in African Americans Study of 406 Medicaid claimsby Mary Ann Moon

Autism Diagnosis Comes Later for Blacks Than Whites
by Alison McCook

Minorities Get Inferior Care, Even if Insured, Study Finds
Please Note: Disparities in health related news articles online may only be available for a short period of time. Use SiteSearch located on the navigation bar on the left side of this page to search the title to help find an article on the Web.

Data Updates on Health Status and Health Insurance

Statehealthfacts.org provides free, up-to-date, and easy-to-use health data on all 50 states, covering more than 500 health topics, including:

Rate of Nonelderly Uninsured by Race/Ethnicity, state data 2002-2003, U.S. 2003

Percent of Adults with Poor Mental Health by Race Ethnicity, 2004

Percent of Persons with a Disability, 2003

For information on Disparities in Special Education click here.

Return to African Americans and Autism page

Return to Autism Articles page

Return to Home page