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Instruments that measure the health status of children need to account for the impact of race, ethnicity, and income on health

Although much has been accomplished in advancing health status measures for children, the next challenge is to include the influence of race, ethnicity, and income on health and health reports. In a study supported in part by the Agency for Healthcare Research and Quality (HS12078 and K08 HS00008), Marielena Lara, M.D., Ph.D., of RAND Health, and her colleagues reviewed commonly used U.S. measures of children's health status and quality of life to assess how they have included low-income and racial/ethnic minority groups. They examined four generic and two condition-specific instruments: the Child Health and Illness Profile-Adolescent Edition, Child Health Questionnaire Parent Form, Functional Status Measure and FSIIR, Pediatric Quality of Life Inventory, Pediatric Asthma Quality of Life Questionnaire, and Children's Health Survey for Asthma.

Most of these measures included some minority groups in the development and testing of the instruments. However, no measure currently has enough information to confirm its comparability across cultures, economic background, and language. Most measures have included minority groups, usually black or Hispanic children, but there is little information by Hispanic subgroups, which can differ in health risks and profile.

Children's measures have generally been tested in relatively small samples and without separate analyses by subgroups. When done, tests of reliability and validity find few differences between these groups and the general population. Some studies report information on health by racial or ethnic group, but the findings are inconclusive. Economic status is usually measured in some way, but rarely are psychometric findings examined separately by income. When differences in health outcomes are reported by income, lower income children usually have poorer health.

See "Measuring health status and quality of life for U.S. children: Relationship to race, ethnicity, and income status," by Lynn M. Olson, Ph.D., Dr. Lara, and Mary Pat Frintner, M.S.P.H., in the July 2004 Ambulatory Pediatrics 4, pp. 377-386.

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