Household Income and Children's Unmet Dental Care Need; Blacks' Diminished Return

Background: Minorities' Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities' Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences in the effects of family income on unmet DCN among children. Methods: Data from the National Survey of Children's Health were used. Participants were either White or Black children age 1 to 18. Family income-to-needs ratio was the independent variable. Unmet DCN was the dependent variable. Covariates included age, gender, and parental educational attainment. Race was the focal moderator. We ran logistic regression for data analysis. Results: Higher income-to-needs ratio was associated with lower risk of unmet DCN in the pooled sample. We found an interaction between race and family income-to-needs ratio on unmet DCN, suggesting a stronger protective effect for Whites than Blacks. Conclusion: Minorities' Diminished Return also holds for the effects of family income-to-needs ratio on unmet DCN. The relative disadvantage of Blacks compared to Whites in gaining oral health from their SES may reflect structural racism that systemically hinders Black families. There is a need for additional research on specific societal barriers that bound Blacks' oral health gain from their SES resources such as income. Policies and programs should also help Black families to leverage their SES resources.