379 Health Disparities in Well Child Visit in a Comprehensive Pediatric Care Center in United States: Does Insurance Matter?

Abstract

Background and Aims The Center for Disease Control and Prevention (CDC) provides guidelines on age-appropriate well child visist. We aimed in this study to examine the health disparities in well child prevalence. Methods We examined data on children born between 2007 and 2009 in 2010/2011. Using the primary level of service (LOS) procedure codes: 99381, 99382, 99391, and 99392 (evaluation and management codes), we obtained 69,447 visit records (11,374 patients). The health disparities by race and insurance status were examined using Chi squared statistic and multivariable logistic regression. Results A significant racial/ethnic disparities was observed: Caucasians (68.1%) relative to African Americans/Blacks (46.1%), Asians (66.3%), Hawaian/PI (53.4%), and some other race (52.4%) were more likely to meet the recommended schedule, χ2 (7) =2,800, p <0.0001. Similarly, higher compliance was associated with commercially insured patients (73.4%), relative to Medicaid (45%) or uninsured/Nemours subsidized (38.3%), χ2 (2) =4,700, p <0.0001. Compared with Caucasians, AA/Blacks were 60% (Prevalence Odds ratio[POR]=0.40, 95%CI, 0.39–0.42), while Asians were 8% (POR= 0.92.95%CI, 0.82–1.12) less likely to comply with the schedule. After controlling for insurance status, racial disparities was lowered, and AA/blacks were 42% less likely to comply compared with Caucasians, adjusted POR = 0.58, 99%CI, 0.55–0.61; and uninsured/Nemours subsidized were 77% less likely to adhere to schedule relative to the commercially insured patients, adjusted POR, 0.23, 99%CI, 0.21–0.26. Conclusions Racial disparities exist in “well infant visit”, and was not completely removed after adjustment for insurance staus which is known to influence access and care utilization.