Division of Epidemiology/Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA.
Matern Child Health J. 2012 Dec;16 Suppl 2:330-8. doi: 10.1007/s10995-012-1131-7.
This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.
本研究扩展了中介分析技术，以探讨医疗之家的不同可及性是否以及在何种程度上解释了有特殊医疗需求的儿童（CSHCN）中未满足的医疗需求的黑/白差距。数据来自 2007 年全国儿童健康调查，分析仅限于非西班牙裔白人和黑人 CSHCN（n=14677）。中介分析的反事实方法用于估计种族对未满足的医疗需求的自然直接和间接影响的优势比。总体而言，43.0%的白人 CSHCN 和 60.4%的黑人 CSHCN 没有医疗之家。此外，8.8%的白人 CSHCN 和 15.3%的黑人 CSHCN 有未满足的医疗需求。自然间接效应表明，由于当前获得医疗之家的水平，黑人 CSHCN 未满足需求的可能性增加了约 20%，而不是获得与白人 CSHCN 相等的水平（OR（NIE）=1.2，95%CI=1.1，1.3）。自然直接效应表明，即使黑人 CSHCN 获得医疗之家的机会与白人 CSHCN 相同，黑人未满足医疗需求的可能性仍比白人高 60%（OR（NDE）=1.6，95%CI=1.1，2.4）。CSHCN 中未满足的医疗需求的种族差距仅部分由拥有医疗之家的差距来解释。确保所有 CSHCN 平等获得医疗之家可能会减少未满足需求的种族差距，但不会完全消除这种差距。
