Editor’s Note: Dr. Elif Ozdogan (she/her) is a resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research.
Preventive health offers unique benefits. Children with more frequent preventive visits have fewer episodes of asthma exacerbations requiring hospital visits, improved metabolic outcomes, and lower rates of depression. In addition to these benefits, preventive visits allow for the development of meaningful therapeutic relationships. Unfortunately, not all children have equal access to preventive visits and a medical home due to various reasons.
In the article entitled “Disparities in Preventive Care for Children from English and Non-English-speaking Households,” being early released this week in Pediatrics, Prabi Rajbhandari, MD, from Akron Children's Hospital, Matthew Hall, PhD, from Children's Hospital Association, and Jay Berry, MD, from Boston Children's Hospital examined preventive care use, including routine check-ups, dental visits, and access to a medical home among children from English-speaking, Spanish-speaking, and Non-English-Non-Spanish (NENS)-speaking households (10.1542/peds.2024-069651).
The study used data from the 2022 National Survey of Children’s Health (NSCH), which ultimately included 72,678,635 children, of which 85% resided in English-speaking households, 10% in Spanish-speaking households, and 5% in NENS-speaking households.
The authors then compared the rates of access to preventive care in each subgroup. According to this initial analysis, children from English-speaking households had higher rates of preventive visits, dental visits, and medical home use compared to the Spanish-speaking and NENS-speaking groups. For example, while 81% of children living in English-speaking households attended preventive visits, only 67% of Spanish-speaking and 66% of NENS-speaking households did so.
The authors then adjusted for potential confounding factors such as age, insurance status, and chronic medical needs to focus on the language barrier as singularly as possible. Again, English-speaking families had higher rates of preventive visits and medical home utilization compared to Spanish and NENS-speaking families, but there were no differences in dental visits.
These gaps are not surprising or novel. The 2003–2004 NSCH similarly found that children from non-English-speaking households were less likely to have a usual source of care or receive preventive visits. The persistence of these disparities more than two decades later, despite the exponential progresses made in molecular and computer-based technologies, reminds us of the humanistic role we each play in caring for our diverse patient populations.
While working with interpreters is an undeniably important step, we have further to go. We need a pediatric workforce that reflects the diversity of the communities it serves and practices cultural humility through self-reflection, openness, and partnership with families. Only a healthcare system that listens deeply and responds thoughtfully can ensure that every child, in every language, has access to the high quality and equitable care that they deserve.
