Trends in Racial Disparities in Quality of Care for Children with Autism and Other Developmental Disabilities
Pediatricians who treat children with autism and other developmental disabilities are faced with unique challenges including children with limited communication or intellectual capacity, tactile sensitivities or problem behaviors. Racial and ethnic disparities in quality of provider interaction have been found among this population suggesting that these challenges may intersect with treating children from culturally diverse populations. Policies that advocate for family-centered care have been promoted over the past decade and could lead to a reduction in these disparities. The goal of this study is to determine to what extent racial and ethnic disparities in quality of provider interaction changed between 2006 and 2010 for this vulnerable population of children who typically require much greater service intensity and frequency than other children.
Methods
Data were derived from two cross-sectional waves of the National Survey of Children with Special Health Care Needs (NS-CSHCN), 2005/06 and 2009/10. Descriptive and multivariate logistic regression analyses were performed using each year’ survey and a pooled baseline (2005/06) and follow up (2009/10) NS-CSHCN dataset. The sample included 9,139 White, 1,433 Black and 1,600 Latino children with autism and other developmental disabilities. Six dependent measures of health care quality were analyzed. Regression models included the following covariates: child’s age, sex, insurance, and severity of impairment; and parental education, income, marital status, and urban/rural living situation. Interactions between year and race were used to examine if there were changes in the extent of disparities over time. All statistical analyses were conducted using Stata 12.0 to account for the complex sampling design and appropriately adjust the variance estimates.
Results
Racial and ethnic disparities in quality of provider interaction were substantial in both 2005/2006 and 2009/2010 years. Black and Latino parents were significantly less likely than White parents to report that their provider spent enough time with child and was sensitive to family’s values and customs. However, the insignificant interaction effects indicated disparities did not diminish or increase across years.
Conclusions & Implications
The results show clear evidence that racial and ethnic disparities in health care quality for Black and Latino children with autism and other developmental disabilities were unchanged between 2005 and 2010. Despite ongoing public policy discussions about the need to reduce racial and ethnic disparities in health care, this study provides evidence that disparities are not being reduced over time for the vulnerable population of children with autism and other developmental disabilities. More assertive policy measures are warranted.