Abstract
The purpose of this study was to determine the prevalence of chronic conditions and functional difficulties of American Indian/Alaska Native (AIAN) children with special health care needs (CSHCN). We conducted bivariate and multivariable analysis of cross-sectional data on 40,202 children from the 2009–2010 National Survey of Children with Special Health Care Needs aged birth through 17 years, including 1,051 AIAN CSHCN. The prevalence of AIAN CSHCN was 15.7 %, not significantly different from the prevalence of US white CSHCN (16.3 %). As qualifiers for special needs status among AIAN children the use of or need for prescription medication was the most frequent (70 %), compared to the lower rates of need for elevated service use (44 %) and emotional, mental, or behavioral treatment/counseling (36 %). Asthma (45 %), conduct disorder (18 %), developmental delay (27 %), and migraine headaches (16 %) were significantly more common chronic conditions among AIAN CSHCN compared to white CSHCN, as were functional difficulties with respiration (52 %), communication (42 %), anxiety/depression (57 %), and behavior (54 %). AIAN CSHCN were also more likely to have 3 or more chronic conditions (39 vs. 28 %, respectively) and 3 or more functional difficulties (70 vs. 55 %, respectively) than white CSHCN. Results indicated a greater impact on the daily activities of AIAN CSHCN compared to white CSHCN (74 vs. 63 %). Significantly greater disease burden among AIAN CSHCN suggests that care must be taken to ensure an appropriate level of coordinated care in a medical home to ameliorate the severity and complexity of their conditions.
Similar content being viewed by others
References
U.S. Department of Health and Human Services. Healthy People 2010 Midcourse Review.7 May 2013. http://www.healthypeople.gov/2010/data/midcourse/html/focusareas/FA16TOC.htm.
Castor, M. L., Smyser, M. S., Taualii, M. M., Park, A. N., Lawson, S. A., & Forquera, R. A. (2006). A nation-wide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. American Journal of Public Health, 96, 1478–1484.
U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, 31st Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2009, Washington, DC, 2012.
Faircloth, S. C. (2006). Early childhood education among American Indian/Alaska Native children with disabilities: Implications for research and practice. Rural Special Education Quarterly, 25(1), 25–31.
Blumberg, S. J., Olson, L., Frankel, M., Osborn, L., Becker, C. J., Srinath, K. P., et al. (2003). Design and Operation of the National Survey of Children with Special Health Care Needs, 2001. Vital Health Stat., 1(41), 1–136.
Blumberg, S. J., Welch, E. M., Chowdhury, S. R., Upchurch, H. L., Parker, E. K., & Skalland, B. J. (2008). Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. Vital and Health Statistics, 1(45), 1–188.
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1 pt 1), 137–140.
Bethell, C. D., Read, D., Stein, R. E., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: Development and evaluation of a short screening tool. Ambulatory Pediatrics, 2(1), 38–48.
U.S. Department of Health and Human Services. Indian Health Service. Indian Health Service Areas. http://www.ihs.gov/?module=AreaOffices. Accessed 22 May 2013.
Morrill, R., Cromartie, J., & Hart, G. (1999). Metropolitan, urban, and rural commuting areas: Toward a better depiction of the United States settlement system. Urban Geography, 20(8), 727–748.
Waldrop, J., & Stern, S. M. (2003). Disability Status 2000, Census 2000 Brief. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.
Hibel, J., Faircloth, S. C., & Farkas, G. (2008). Unpacking the placement of American Indian and Alaska Native students in special education programs and services in the early grades: School readiness as a predictive variable. Harvard Educational Review, 78(3), 498–528.
Brim, S. N., Rudd, R. A., Funk, R. H., & Callahan, D. B. (2008). Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian. Pediatrics, 122, e217–e222.
Lau, M., Lin, H., & Flores, G. (2012). Racial/ethnic disparities in health and healthcare among US adolescents. Health Services Research, 47(5), 2031–2059.
Rutman, S., Park, A., Castor, M., Taualii, M., & Forquera, R. A. (2008). Urban Indian and Alaska Native youth: Youth Risk Behavior Survey, 1997–2003. Maternal and Child Health Journal, 12, S76–S81.
Bloom, B., Cohen, R. A., & Freeman, G. (2010). Summary health statistics for U.S. children: National Health Interview Survey, 2009. National Center for Health Statistics. Vital and Health Statistics, 10(247), 1–82.
Flores, G. (2010). Committee on Pediatric Research. Technical report—Racial and ethnic disparities in health and healthcare of children. Pediatrics, 125(4), e979–e1020.
Barradas, D. T., Kroelinger, C. D., & Kogan, M. D. (2012). Medical home access among American Indian and Alaska Native children in 7 states: National Survey of Children’s Health. Maternal and Child Health Journal, 16, S6–S13.
Bennett, A. C., Rankin, K. M., & Rosenberg, D. (2012). Does a medical home mediate racial disparities in unmet healthcare needs among children with special health care needs? Maternal and Child Health Journal, 16, S330–S338.
U.S. Government Accountability Office. Telecommunications: Challenges to assessing and improving telecommunications for Native Americans on tribal lands. GAO-06-189. January 2006. http://www.gao.gov/new.items/d06189.pdf. Accessed 22 May 2013.
Pengra, L. M., & Godfrey, J. G. (2001). Different boundaries, different barriers: Disabilities studies and Lakota culture. Disability Studies Quarterly, 21(3), 36–51.
Lovern, L. (2008). Native American worldview and the discourse on disability. Essays in Philosophy, 9(1), 1–10.
Conflict of interest
None.
Ethical standard
No IRB approval was required for this study, which is based on the secondary analysis of a public-use federal database.
Author information
Authors and Affiliations
Corresponding author
Additional information
The views expressed are the authors’ and not necessarily those of the Health Resources and Services Administration or the US Department of Health and Human Services.
Rights and permissions
About this article
Cite this article
Kenney, M.K., Thierry, J. Chronic Conditions, Functional Difficulties, and Disease Burden Among American Indian/Alaska Native Children with Special Health Care Needs, 2009–2010. Matern Child Health J 18, 2071–2079 (2014). https://doi.org/10.1007/s10995-014-1454-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-014-1454-7