HEALTH STATUS OF AMERICAN CHILDREN

HEALTH STATUS OF AMERICAN CHILDREN

In 2002, there were slightly more than 4 million births. About 33.8% of these were to unmarried women. This percentage increased from 2001-2002 in non-Hispanic whites by 22.9%, in Hispanics by 43.4% and decreased in African Americans by 68%.
Of the current 72.2 million children (2002), 9.7 million children (13%) have no health insurance coverage for a full year. At any time, 24%, approximately 17 to 18 million children, go without health insurance. Insurance coverage under Medicaid, the State Child Health Insurance Plan (SCHIP), and private employer-based insurance varies by populations: 17% of white, 22% of African American, and 41% of Hispanic children had no health insurance at some time during a year. There is also variation by income: 10% of children with family incomes of 400% or greater above the poverty level had no health insurance, in contrast to 31% of all children with family incomes of 100% to 199% of poverty.

Access to primary care is a major goal for children. In 2000, 87% of all children were reported to have a primary care clinician, with most of this care provided by pediatricians. Ninety-one percent of whites and 75% of Hispanics reported a primary care provider; 93% of high-income families and 81% of poor families identified a primary care provider. The AAP advocates that all children have a medical home where their pediatrician and medical team provide needed preventive and curative services.
Prenatal care in the first trimester has increased by 11% since 1990, with 83.4% of all women receiving prenatal care. Whites (88.7%), Hispanics (76.8%), and African Americans (60.6%) begin prenatal care in the first trimester. Smoking has declined considerably, with only 12% of pregnant women reporting smoking in 2002. Cesarean sections have increased to 26.1% of all births. The incidence of preterm births has been increasing since the 1980s, with an increased rate in whites and a decreased rate in blacks. There has been an increase in low birth weight infants (<2500g [7.7% of all births]) and a steady rate of very low birth weight infants (<1500 g [1.5% of all births]) since the 1990s.

The national birthrate for adolescents has been steadily dropping since 1990, with more teenagers delaying their first sexual experience or using birth control (or both). There also was a 39% decrease in abortion in adolescents from 1990 to 1999. In 1999, however, there were approximately 487,000 live births to adolescents 19 years old and younger and 556,000 abortions.

There has been an overall decline in infant mortality by 46% since 1980, with equal declines in the rates for white and the nonwhite populations (see Section XI). The disparity between the ethnic groups has not changed. In 2001, the rates per 1000 live births were white, non-Hispanic, 5.7; Hispanic, 5.7; and African American, 14. In 2000, the U.S. ranked 25th in the infant mortality rate, below the Czech Republic, Cuba, Portugal, and Greece. Marked variations in infant mortality also exist by state. New Hampshire and Minnesota had the lowest infant mortality rates in the U.S., whereas West Virginia, Louisiana, and Mississippi had the highest, comparable to developing countries.

The overall causes of death in all children (1-19 years old) in the U.S. in 2001, in order of frequency, were injuries, assaults (homicide), malignant neoplasms, suicide, and congenital malformations (Table 1-1). For 2001, there were 25,757 deaths in children age 1 to 19 years. Of that total, 15,726 (61%) deaths of children were violence related secondary to injuries (11,196), homicide (2640), and suicide (1890). Many deaths are associated with alcohol abuse. Two thirds of child passengers (≤14 years old) die in automobile crashes in association with a drunk driver.

From 2000 to 2001, there were decreases in the rate of injuries in all ages, a decrease in malignant neoplasms, and a decrease in deaths from congenital malformations in the age group 5 to 14 years. There was an increase in the death rate from heart diseases and congenital malformations in the age group 1 to 4 years. Although there was a decrease in the rate of suicide for children (10 to 19 years), there was an increase in deaths caused by assaults and homicide in the age groups 1 to 4 years (35%) and 15 to 19 years (4.4%).