Abstract
Research Objective: Previous research has identified neighborhood social capital and safety as important determinants of child health. The inequitable distribution of these resources across neighborhoods has been found to play a role in disparities observed in the health of individuals from minoritized groups. Little is known about the relationship between neighborhood social conditions and health among children with special health care needs (CSHCNs). The objective of this study was to analyze the extent to which neighborhood social capital and safety impact racial/ethnic disparities in health and healthcare access among CSHCNs in Boston.
Study Design: An analysis of the 2012 Boston Survey of Children’s Health. CSHCNs were identified using a 5-item screener. Independent variables included caregiver-reported neighborhood social capital; neighborhood safety; child race/ethnicity; and sociodemographic and health services-related controls. Social capital was measured as a 3-item index (α= .82). Two dichotomous outcomes were: whether the child was in very good/excellent health; and whether the child experienced any barriers to needed medical care. Logistic regression was used to assess the impact of social capital/safety on health and healthcare access. Racial/ethnic differences in the effects of social capital/safety were examined by calculating second differences in marginal effects. The relative contributions of social capital/safety to racial/ethnic disparities in health and access were analyzed using Oaxaca-Blinder-style decomposition techniques. Two-fold decompositions were estimated using coefficients from pooled models.
Population Studied: CSHCNs in Boston.
Principal Findings: Descriptive statistics indicated an unequal distribution of social capital between black and white CSHCNs (F = 13.3, p<.01). Neighborhood safety was also lower for black (χ2 =194.23, p<.05) and Latino CSHCNs (χ2 =218.71, p<.05) compared to whites. Increased neighborhood social capital was associated with improved health among black (AME=0.16, p<.01) but not white CSHCNs (AME=-0.02, p=.85; second difference = 0.18, p<.05). Neighborhood safety was negatively associated with experiencing barriers to care among Latino (AME = -.47, p<.01) but not white CSHCNs (AME = 0.13, p=.19; second difference = -.60, p<.01). The decomposition analysis contextualized these results. The log-odds of being in very good/excellent health were about .34 lower for black compared to white CSHCNs (p<.001); intergroup differences in social capital accounted for 15% of this disparity (b=0.05, p<.05). The log-odds of experiencing barriers to care were about .14 higher among Latino compared to white CSHCNs (p<.05); intergroup differences in neighborhood safety accounted for 54% of this disparity (b=-0.08, p<.05).
Conclusions: For CSHCNs in Boston, caregiver-reported neighborhood resources explain part of the observed black-white disparity in health and Latino-white disparity in healthcare access. Accordingly, increases in neighborhood resources have differentially positive effects on health and healthcare access for black and Latino CSHCNs relative to white children.
Implications for Policy or Practice: Racial/ethnic health disparities among children with special health care needs in Boston persist despite the city’s reputation as a “medical mecca” and near-universal insurance coverage of the pediatric population. This study underscores the need for child health services researchers to consider neighborhood contexts in analyses of social determinants of health. The findings emphasize the potential to improve health equity among CSHCNs by addressing local social-structural conditions.