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

Jaclyn M Hall; Choeeta Chakrabarti; Rahma Mkuu; Lindsay A Thompson; Elizabeth A Shenkman; Ryan P Theis

doi:10.1016/j.acap.2022.09.011

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

Acad Pediatr. 2023 Mar;23(2):372-380. doi: 10.1016/j.acap.2022.09.011. Epub 2022 Sep 16.

Authors

Jaclyn M Hall¹, Choeeta Chakrabarti², Rahma Mkuu³, Lindsay A Thompson⁴, Elizabeth A Shenkman⁵, Ryan P Theis³

Affiliations

¹ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla. Electronic address: jaclynha@ufl.edu.
² Department of Anthropology, College of Arts and Sciences, Florida State University (C Chakrabarti), Tallahassee, Fla.
³ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla.
⁴ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla; Department of Pediatrics, College of Medicine, University of Florida (LA Thompson), Gainesville, Fla.
⁵ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla.

PMID: 36122832
DOI: 10.1016/j.acap.2022.09.011

Abstract

Objective: Individuals enrolled in Medicaid have disproportionately worse health outcomes due to challenges related to Social Determinants of Health. We aim to examine the prevalence of 3 childhood conditions (asthma, type 2 diabetes, and attention deficit hyperactivity disorder [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 within this economically challenged population.

Methods: Children ages 0 to 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.

Keywords: asthma; attention deficit hyperactivity disorder; diabetes; health outcomes; intersectionality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Asthma*
Child
Child, Preschool
Cost of Illness
Diabetes Mellitus, Type 2*
Ethnicity
Humans
Infant
Infant, Newborn
Medicaid
Social Class
United States