Measuring health status and quality of life for US children: relationship to race, ethnicity, and income status.

OBJECTIVE: Accurately measuring the health of the increasingly diverse population of US children requires instruments that are comparable and valid across cultures, economic background, and language. This paper asks: Has the field of pediatric health status measures reached this level of comprehensiveness?
METHODS: Children's health status and quality of life measures commonly used in the United States were reviewed to assess how they have included racial/ethnic minority and low-income groups. Four generic and 2 condition-specific instruments (asthma) were examined for total sample size, percent of sample from racial/ethnic and low-income groups, language availability, translation methods for US-Spanish, reading level, and separately reported psychometric findings and outcomes/scores.
RESULTS: Most measures have included minority groups, usually African American or Hispanic children, although with little information by Hispanic subgroup. Children's measures have generally been tested on relatively small samples, without separate analyses by subgroups. When done, tests of reliability and validity find few differences from 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 outcome are reported by income, lower income children usually have poorer health.
CONCLUSIONS: Much has been accomplished in advancing health status measures for children. Next-generation issues include the influence of race, ethnicity, and income on health and health reports.