Racial Disparities in Orthodontic Care for Medicaid-Enrolled Children in Washington

Abstract

Introduction: This study assesses the relationship between race and orthodontic care utilization for children in the Washington State Medicaid Program. Methods: This cross-sectional study focused on 570,364 Medicaid-enrolled children ages 6 to 19 years in 2012. The main predictor variable was race (White versus non-White). The outcome variable was orthodontic care use, defined using claims data as children who were pre-authorized for orthodontic treatment by Medicaid, received orthodontic records, and subsequently initiated orthodontic treatment. Logistic regression models were used to test our study hypothesis that non-Whites would be less likely to utilize orthodontic care than Whites. We also explored potential mediators of the relationship between race and orthodontic care use. Results: Of the Medicaid-enrolled children, 8,223 were approved by Medicaid for orthodontic treatment and 7,313 initiated orthodontic treatment. Non-Whites were significantly more likely to utilize orthodontic care than Whites (OR: 1.18; 95% CI 1.02, 1.36; p =.031). Ethnicity mediated the relationship between race and orthodontic care utilization, whereby Hispanic non-White children were more likely to utilize orthodontic care than non-Hispanic White children (OR: 1.42; 95% CI: 1.18,1.70; p < .001). Conclusion: Contrary to our original hypothesis, our data suggest that non-White children in the Washington Medicaid program were significantly more likely to utilize orthodontic care than non-Whites. Based on the characteristics of the Washington State Medicaid Program in 2012, Washington state policy may demonstrate a model for eliminating racial disparities in orthodontic care utilization for Medicaid-enrolled children. Future research should continue to monitor use of orthodontic care for racial and ethnic minorities in Medicaid.