Background: Previous studies have documented racial and ethnic disparities in health among children with special health care needs (CSHCNs). Little is known about the relative contributions of social determinants to observed health inequities in this population.

Methods: We analyzed data from the 2012 Boston Survey of Children’s Health. CSHCNs were identified using the 6-item CAHMI screener. The outcome was whether children were in “better-than-average” health, operationalized as “very good or excellent” health. We assessed factors related to Latino-white and black-white health disparities using Oaxaca-Blinder-style decomposition techniques. Two-fold nonlinear decompositions were estimated using coefficients from pooled models.

Results: White CSHCNs were significantly more likely to be in very good/excellent health compared to black (p<.001) and Latino (p<.01) CSHCNs in Boston. Distributional differences on observed variables explained 62.4% of black-white disparity (p<.01) and 76.1% of the Latino-white disparity (p<.01). Specifically, differences in income (p<.01), neighborhood social capital (p<.05), and family structure (p<.05) accounted for most of the black-white disparity. Differences in income (p<.05), exposure to adverse childhood experiences (p<.05), and, to a lesser extent, caregiver health (p=.07) accounted for most of the Latino-white disparity. Notably, racial/ethnic health disparities among CSHCNs were not significantly explained by having unmet health care needs, a usual care provider, adequate insurance, or by sociodemographic differences (age, sex, language).

Conclusion: Large disparities in health among CSHCNs in Boston are explained by relatively few determinants. Several of the contributing factors that emerged from the decomposition analysis are modifiable and could be targeted by public health and policy interventions.