Online Program

Prevalence and patterns of special healthcare needs among preschool-aged children in Chile and the US

Tuesday, November 5, 2013

MaryCatherine Arbour, MD MPH, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA
Hirokazu Yoshikawa, PhD, Harvard Graduate School of Education, Cambridge, MA
Clara Barata, EdD, School of Human and Social Sciences, ISCTE - Lisbon University Institute, Lisbon, Portugal
Ernesto Trevino, PhD, Centro de Políticas Comparadas de Educación, Universidad Diego Portales, Santiago, Chile
Megan Murray, PhD, Epidemiology, Harvard School of Public Health, Boston, MA
Judith S. Palfrey, MD, Division of General Pediatrics, Children's Hospital Boston, Boston, MA
Objectives. We estimated the prevalence of children with special health care needs (CSHCN) among poor Chilean preschool children and examined specific health care consequences they experience. We compared these to estimates for US preschool-aged children. We tested for associations between CSHCN status and sociodemographic traits. Methods. We surveyed parents of 1083 Chilean preschool children to gather the CSHCN screener. We re-analyzed data from the 2005-2006 US National Survey of CSHCN for 4- and 5-year-old children by ethnicity and language. We used bivariate methods to describe relationships between CSHCN status and sociodemographics in Chile and to compare prevalence among Chileans and US ethnic and language subgroups. Results. The prevalence of CSHCN among Chilean 4- and 5-year-olds was 27.5%, twice that of all US children this age and 5 times that of children this age from US Spanish-speaking homes. Among Chilean and English-speaking US children, ~4% have functional limitations and 9-10% need prescription medications. Medication needs account for 75% of CSHCN in the US but only 37% of CSHCN in Chile, where 65% of CSHCN have service needs. Conclusions. Prevalence of CSHCN identified in this Chilean sample is much higher than prevalence among US preschool-aged children. Similar rates of functional limitations and medication needs among Chilean and English-speaking US preschool-aged children suggest that low rates among US Spanish-speaking Hispanics may reflect a healthier immigrant population or poor access to medical care. Higher service-related needs among Chileans may reflect greater service availability and lower stigma or legal consequence associated with using “additional services.”

Learning Areas:

Diversity and culture
Program planning
Public health or related research

Learning Objectives:
Compare the prevalence of Children with Special Healthcare Needs among 4- and 5- year-old children in Chile and the US. Describe different frequencies of health care consequences resulting from SHCN among Spanish- and English-speaking in the US and a Spanish-speaking population in Chile. Discuss insights into variable rates of CSHCN among US subgroups.

Keyword(s): Children With Special Needs, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been director of the health component of a cluster-randomized controlled trial of a school-based child development intervention in Chile, and I conducted the analyses to be presented comparing prevalence of children with special healthcare needs in the US and Chile.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.