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The Association of Socioeconomic Vulnerability and Race and Ethnicity with Disease Burden among Children in a Statewide Medicaid Population

Published:September 16, 2022DOI:https://doi.org/10.1016/j.acap.2022.09.011

      Abstract

      Objectives

      Individuals enrolled in Medicaid have disproportionately worse health outcomes on account of challenges related to Social Determinants of Health. We aim to examine the prevalence of three childhood conditions (asthma, Type 2 Diabetes, and ADHD) in children within the Texas Medicaid system. In order to recognize the layers of vulnerability we examine prevalence at the intersection of socioeconomic status with race and ethnicity and within this economically challenged population.

      Methods

      Children ages 0-17 were identified from claims and encounter data for all children enrolled in Texas Medicaid in 2017 for at least 6 months. All children were placed into one of 5 quintiles based on their census tract socioeconomic vulnerability. The Rate Ratio statistical test was employed to identify the statistical significance of the disparity in health outcomes related to higher neighborhood vulnerability within each racial or ethnic group.

      Results

      Asthma for each race and ethnicity group was significantly more prevalent in the higher vulnerability census tracts. Increased vulnerability related to significant increase in Type 2 Diabetes for Hispanic children, but not for other groups. Diagnosed ADHD prevalence was significantly higher in less vulnerable non-Hispanic white children compared to more vulnerable.

      Conclusions

      This study found that even among children who receive Medicaid and are thus economically disadvantaged, socioeconomic vulnerability applies an additional burden within racial and ethnic groups to produce disparities in health-related burden. However, the trend of the relationship varied by race and ethnicity group and health condition.

      Key Words

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