title: Racial disparities in orthodontic service use for Medicaid-enrolled children: An evaluation of the Washington Medicaid program.
abstract: BACKGROUND
  We assessed the relationship between race and orthodontic service use for Medicaid-enrolled children.
  
  
  METHODS
  This cross-sectional study focused on 570,364 Medicaid-enrolled children in Washington state, ages 6 to 19 years. The main predictor variable was self-reported race (white vs nonwhite). The outcome variable was orthodontic service use, defined as children who were preauthorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that nonwhites are less likely to use orthodontic care than are whites.
  
  
  RESULTS
  A total of 8223 children were approved by Medicaid for orthodontic treatment, and 7313 received records and began treatment. Nonwhites were significantly more likely to use orthodontic care than were whites (odds ratio [OR] = 1.18; 95% confidence interval [CI] = 1.02, 1.36; P = 0.031). Hispanic nonwhite children were more likely to use orthodontic care than were non-Hispanic white children (OR = 1.42; 95% CI = 1.18, 1.70; P <0.001).
  
  
  CONCLUSIONS
  In 2012, nonwhite children in the Washington Medicaid program were significantly more likely to use orthodontic care than were white children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service use. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service use for minority children in Medicaid.
authors.affiliation: Resident, Graduate Program in Orthodontics, School of Dentistry, University of Washington, Seattle, Wash.
authors.forename: Jantraveus M
authors.initials: JM
authors.lastname: Merritt
authors.affiliation: Clinical associate professor, Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Greenlee
authors.affiliation: Professor, Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Bollen
authors.affiliation: Acting assistant professor, Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, Wash.
authors.forename: JoAnna M
authors.initials: JM
authors.lastname: Scott
authors.affiliation: Associate professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Wash. Electronic address: dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D003777:Dental Prophylaxis / Q000706:statistics & numerical data; D003792:Dental Records / Q000706:statistics & numerical data; D005260:Female; D005460:Fluorides, Topical / Q000627:therapeutic use; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D061326:Index of Orthodontic Treatment Need; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008913:Minority Groups / Q000706:statistics & numerical data; D009910:Oral Hygiene / Q000193:education; D009971:Orthodontics, Corrective / Q000706:statistics & numerical data*; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D014481:United States; D014861:Washington; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D002327:Cariostatic Agents; D005460:Fluorides, Topical; D010895:Pit and Fissure Sealants