Abstract
Research Objective: Eliminating racial and ethnic disparities in health care access, service utilization, and quality is one of the most critical public health challenges of our times. Decades of research have generated compelling, consistent evidence: across many indicators, racial and ethnic minorities receive worse health care and experience adverse health outcomes compared to non-Hispanic Whites. We aimed to examine the potential compounding effect of race/ethnicity and disability on children’s health status.
Study Design: We used the 2016-19 National Survey of Children’s Health (NSCH) for our compounded disparity analysis. We used VanderWheel and Knol’s method to predict combined risk ratios of race/ethnicity and disability and then compared them with the observed combined risk ratios.
Population Studied: The analytical sample included 131,774 children under 0-17 years old.
Principal Findings: We demonstrated that racial/ethnic minority children with disabilities experience additional disparities in health status that are greater than the sum of the effects of either characteristic alone. Further, we demonstrate that compounded disparities in having lower health status persisted even after adjusting for sociodemographic characteristics. The adjusted odds ratio was 52.25(95%CI:31.52-87.79) for Black CSHCN, which was more than the sum of the odds ratios for CSHCN alone (OR=21.33;95% CI:13.85-32.84) and Black children alone (OR=3.25;95%CI:1.69-6.23). The adjusted odds ratio was 39.36 (95%CI:1.74-3.37) for Hispanic CSHCN, which was more than the sum of the odds ratios for CSHCN alone (OR=21.33; 95% CI:13.85-32.84) and Hispanic children alone (RR=5.59;95% CI:3.09-10.09). Finally, the adjusted risk ratio was 30.48 (95%CI:10.03-51.52) for CSHCN from other races, which was more than the sum of the odds ratios for CSHCN alone (OR=21.33;95% CI:13.85-32.84) and children from other races alone (RR=1.10; 95% CI: 0.55-2.22).
Conclusions: Despite reform efforts, our study demonstrates that racial/ethnic minority children with disabilities experience double jeopardy. Given the harmful compounded disparities, public health and social service programs should prioritize identifying children with disabilities from minority racial and ethnic groups and ensure that they access quality pediatric preventive and specialty health care services.
Implications for Policy or Practice: These findings can inform and implement policies that address structural inequities in social determinants of health and structural racism, including implicit and explicit biases within the health care system, which drive racial and ethnic disparities in health outcomes.