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

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 intersec-tion 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. Diag-nosed ADHD prevalence was significantly higher in less vulner-able non-Hispanic white children compared to more vulnerable.CONCLUSIONS: This study found that even among children who receive Medicaid and are thus economically disadvan-taged, socioeconomic vulnerability applies an additional bur-den 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.

Automated summary

This study found that even among children who receive Medicaid and are economically disadvantaged, socioeconomic vulnerability adds an additional burden within racial and ethnic groups, leading to disparities in health burden. However, the trend of this relationship varied by racial and ethnic group, as well as by specific health conditions.