title: Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?
abstract: This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.
authors.affiliation: Division of Epidemiology/Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA. acaven3@uic.edu
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Bennett
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Rankin
authors.forename: Deborah
authors.initials: D
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D044383:Black People; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D016017:Odds Ratio; D018802:Patient-Centered Care / Q000458:organization & administration*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People; D001741:Black or African American