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Racial/ethnic health disparities among children with special health care needs in Boston, Massachusetts
Robert S Dembo1, Jennifer LaFleur2, Ilhom Akobirshoev2
1Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA.
Insights
Racial and ethnic disparities in health for children with special health care needs (CSHCN) are driven by a few key factors. Understanding these determinants, like income and childhood experiences, can inform public health interventions.
Area of Science:
- Pediatric Health Services Research
- Health Disparities Research
- Social Determinants of Health
Background:
- Racial and ethnic disparities persist among children with special health care needs (CSHCN).
- Limited understanding of the specific factors contributing to these disparities.
- Need for quantitative analysis of determinants in diverse CSHCN populations.
Purpose of the Study:
- To quantify the contribution of various factors to racial/ethnic disparities in health and healthcare access among CSHCN.
- To examine disparities in health status, medical care barriers, oral health, and preventive dental care utilization.
- To identify key determinants driving these disparities in a specific urban setting.
Main Methods:
- Utilized Oaxaca-Blinder decomposition techniques on data from the Boston Survey of Children's Health.
- Analyzed a sample of 326 Black, Latino, and white CSHCN.
- Examined child-, family-, and neighborhood-level factors, alongside health resources.
Main Results:
- Significant racial/ethnic disparities were observed in health status, oral health, and access barriers.
- Compositional differences in predictors explained a substantial portion of Black-white and Latino-white disparities (63-98%).
- Key determinants included household income, adverse childhood experiences, family structure, neighborhood support, and household language.
Conclusions:
- A limited number of determinants significantly explain racial/ethnic health disparities among CSHCN.
- Identified factors such as income, childhood adversity, and language are potential targets for public health and policy interventions.
- Findings highlight the importance of addressing social determinants to reduce health inequities in CSHCN.
Background:
Little is known about the factors that contribute to racial/ethnic disparities among children with special health care needs (CSHCN).
Objective:
To quantify the contributions of determinants of racial/ethnic disparities in health and health care among CSHCN in Boston, Massachusetts.
Methods:
A sample of 326 Black, Latino, and white CSHCN was drawn from the Boston Survey of Children's Health, a city-wide representative sample of children. The study implemented Oaxaca-Blinder-style decomposition techniques to examine the relative contributions of health resources and child-, family-, and neighborhood-level factors to disparities in four outcomes: health status, barriers to medical care, oral health status, and utilization of preventive dental care.
Results:
White CSHCN had a greater likelihood of having very good/excellent health and oral health and were less likely to experience barriers to care than Black CSHCN. Compositional differences on predictors explained 63%, 98%, and 80% of these gradients, respectively. Group variation in household income, family structure, neighborhood support, and exposure to adverse childhood experiences accounted for significant portions of the Black-white gaps in health and access. White CSHCN were also more likely to have very good/excellent health and oral health compared to Latino CSHCN. Differences on predictors accounted for about 86% and 80% of these gaps, respectively. Household income, adverse childhood experiences, and household language emerged as significant determinants of Latino-white disparities.
Conclusions:
Racial/ethnic health disparities among CSHCN are explained by relatively few determinants. Several of the contributing factors that emerged from the analysis and could be targeted by public health and policy interventions.
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