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Child/Adolescent Health

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Twice as many minority children than white children with special health care needs do not receive needed vision care

Nearly 6 percent of U.S. children with special health care needs (CSHCN) do not receive needed eyeglasses or vision care. However, black, Latino, and multiracial CSHCN are 2 to 3 times more likely to have an unmet need for vision care than whites (8.9, 10, and 14.3 percent vs. 4.1 percent). American Indian or Alaskan Native CSHCN are one-fifth as likely to have an unmet need for vision care than white CSHCN. These racial/ethnic differences in unmet needs remained after controlling for differences in health status and other child and family characteristics such as insurance and income.

Risk of unmet needs among CSHCN was influenced by type of insurance coverage, type of health care provider, and other factors. Compared with privately insured CSHCN, uninsured CSHCN had nearly twice the risk of an unmet need for vision care, whereas Medicaid and State Children's Health Insurance Program recipients had decreased risks. CSHCN in homes with lower household income, in which an adult had stopped working (often to care for the child), and with more children were more likely to have unmet needs. Also, CSHCN with some impaired functioning were more likely to have unmet needs than unimpaired CSHCN.

Special needs children whose usual care provider was a generalist physician, nurse practitioner, or physician assistant were more likely to have an unmet need for vision care than children whose usual care provider was a pediatrician. Also CSHCN were more likely to have an unmet need if their providers were not culturally competent, if their schools (which often screen for vision problems) and providers communicated poorly with one another, and their parents did not know about the quality of school-provider communication. More physician visits were associated with lower risk of an unmet need.

These findings were based on analysis of 2000-2002 data from the National Survey of Children with Special Health Care Needs on a sample of 14,070 CSHCN who needed eyeglasses or vision care in the previous year. The study was supported in part by the Agency for Healthcare Research and Quality (HS14022).

More details are in "Racial and ethnic differences in unmet need for vision care among children with special health care needs," by Kevin C. Heslin, Ph.D., Richard Casey, M.D., Magda A. Shaheen, M.D., Ph.D., and others, in the June 2006 Archives of Ophthalmology 124, pp. 895-902.

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