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A Systematic Review of the Literature

Arthur Elster, MD; Julie Jarosik, MPH; Jonathan VanGeest, PhD; Missy Fleming, PhD

Arch Pediatr Adolesc Med. 2003;157:867-874.

Objective  To identify the extent of racial and ethnic disparities in primary care, mental health care, reproductive health care, and asthma care for adolescents independent of socioeconomic status (SES).

Data Sources  Systematic review of the scientific literature using standard bibliographic databases.

Study Selection  Inclusion criteria were (1) studies published in the past 12 years, (2) analyses included children and adolescents aged 17 years and younger, and (3) data analyzed by racial/ethnic groups while accounting for SES. A total of 203 studies were reviewed, of which 31 met the criteria for inclusion: 14 of 65 studies on primary care, 11 of 61 studies on mental health care, 2 of 50 studies on reproductive health, and 4 of 27 studies on asthma services.

Data Extraction  Data from tables in the selected studies were used to determine whether minority children and adolescents received fewer, greater, or the same health care services as white children and youth after taking into account SES.

Data Synthesis  Black youth received fewer primary care services in 8 studies, whereas in 4 studies no disparity was noted. Hispanic youth received fewer primary care services in 6 studies, whereas no disparity was noted in 5. One study did not include Hispanic subjects. In 2 studies minority youth, combined into a single category, received fewer services than did white youth. In a total of 6 studies black youth received fewer mental health services, whereas in 3 studies no disparity was noted and in 1 study black youth received a greater number of services. In 3 studies Hispanic youth received fewer mental health services, and in 3 studies there were no group differences. In 1 study, with racial and ethnic groups combined in a single category, minority children and youth received fewer mental health services than white subjects. Three studies did not include Hispanic subjects. Too few studies of reproductive and asthma care were available to draw conclusions.

Conclusions  These results suggest that racial and ethnic disparities, independent of SES, exist in selected areas of adolescent health care. More studies are needed to better understand the extent and causes of these findings.

From the American Medical Association, Chicago, Ill.

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