Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #101848

Emmanuel M. Ngui, DrPH, Center for the Advancement of Underserved Children, Department of Pediatrics and Department of Epidemiology and Health Policy, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, (414) 456-4302, engui@mcw.edu and Glenn Flores, MD, Center for the Advancement of Underserved Children, Medical College of Wisconsin/Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.

OBJECTIVE: To examine racial/ethnic disparities in perceived unmet needs for specialty, dental, mental, and allied health care, and to identify factors associated with unmet needs among racial/ethnic CSHCN.

METHODS: Bivariate and multivariate analyses of data on 38,886 CSHCN <18 years old participating in the National Survey of Children with Special Health Care Needs (CSHCN). For each outcome, unmet need was defined as parental report of the child not receiving all needed health care in the past year. Covariates included child's age, gender, residence, maternal education, insurance coverage, poverty status, availability of a personal doctor or nurse (PDN), language of interview, and the child's condition severity and stability.

RESULTS: The prevalence of perceived unmet needs among CSHCN ranged from 7% for specialty care to 18% for mental health care. Compared to white CSHCN, black CSHCN had significantly more unmet needs for specialty (10% vs. 7%), dental (16% vs. 8.7%), and mental health care (27% vs. 17%), and Hispanic CSHCN had more unmet dental care needs (16% vs. 9%). Except for unmet mental health care needs among Hispanic CSHCN (OR, 0.6; 95% CI, 0.40 - 0.96) all other racial/ethnic disparities in unmet needs disappeared after multivariate adjustment. Black female CSHCN, however, were disproportionately more likely to have unmet mental health care needs than all other groups (41% vs. 13-20%), and had significantly greater adjusted odds of unmet mental health care needs than black male CSHCN (OR, 2.2; CI, 1.2-4.0). For each racial/ethnic group and for CSHCN overall, the most significant determinants of unmet needs included lack of insurance, poverty, lack of a PDN, and having unstable conditions.

CONCLUSIONS: Racial/ethnic disparities exist in perceived unmet specialty, dental, and mental health care needs among CSHCN, but disappear after adjustment, except for unmet mental health care needs among black female CSHCN. Within and across racial/ethnic groups, key factors associated with disparities in unmet needs included lack of insurance coverage, poverty, lack of a PDN, and having unstable conditions. Our findings suggest the need for increased mental health screening of black female CSHCN. In addition, because minority children are disproportionately more likely than white children to live in poverty, be uninsured, and lack a PDN, eliminating disparities in unmet specialty, dental, and mental health care needs for all CSHCN, and especially minority CSHCN, will require greater efforts to reduce the number of poor and uninsured CSHCN, and to ensure that all CSHCN have a medical home.

Learning Objectives: At the conclusion of the session, the participant in this session will

• have an increased awareness of unmet needs among CSHCN 2)be able to identify factors associated with disparities in unmet needs among CSHCN.

Keywords: Ethnic Minorities, Access and Services

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.