Racial disparities in orthodontic service use for Medicaid-enrolled children: An evaluation of the Washington Medicaid program

Introduction: We assessed the relationship between race and orthodontic service use for Medicaid-enrolled children. Methods: This cross-sectional study focused on 570,364 Medicaid-enrolled children in Washington state, ages 6 to 19 years. The main predictor variable was self-reported race (white vs nonwhite). The outcome variable was orthodontic service use, defined as children who were preauthorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that nonwhites are less likely to use orthodontic care than are whites. Results: A total of 8223 children were approved by Medicaid for orthodontic treatment, and 7313 received records and began treatment. Nonwhites were significantly more likely to use orthodontic care than were whites (odds ratio [OR] 5 1.18; 95% confidence interval [CI] 5 1.02, 1.36; P 5 0.031). Hispanic nonwhite children were more likely to use orthodontic care than were non-Hispanic white children (OR 5 1.42; 95% CI 5 1.18, 1.70; P\0.001). Conclusions: In 2012, nonwhite children in the Washington Medicaid program were significantly more likely to use orthodontic care than were white children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service use. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service use for minority children in Medicaid. (Am J Orthod Dentofacial Orthop 2016;149:516-22)

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